RCPA adds voice to concerns over pathology and the PCEHR

The Royal College of Pathologists of Australasia (RCPA) has added its voice to concerns raised by the private pathology sector about the method by which pathology results may be added to the PCEHR, saying it disagreed with what it understood was the government's preferred model.

Last week, Pathology Australia, the industry association that represents many private pathology practices, voiced its concerns over the safety of the government's proposal, which the Minister for Health recently announced would be paid for with an extra $8 million in funding.

Pathology Australia CEO Katherine McGrath told Pulse+IT that she believed some of the options being canvassed “have very serious consequences for patient safety”.

Professor McGrath said the industry strongly disagreed with a method in which results were directly uplifted from clinical software, which she said “runs the risk of not having the most recent results, some results not being there, and patients being misled by incomplete and confused information”.

Yee Khong, president of the RCPA, said the college also had serious concerns about what it understood was the preferred model, in which a GP or medical specialist, in consultation with their patient, would be able to “cut and paste” numerical values from test results and add them to the patient's record.

Professor Khong said the college strongly opposed any method in which atomic data from test results was separated from the pathologist's full report and interpretation.

“Originally all the major providers, including the National Coalition of Public Pathology (NCOPP) as well as Pathology Australia and the college, got together with the government and NEHTA representatives, and we said the safest way is that the reports as they are generated are uplifted to the PCEHR,” Professor Khong said.

He said the ability to just take a number – for example, from a test for haemoglobin levels – and “plonk it” on the PCEHR was inherently dangerous, especially considering the fact that different pathologists still use different units of measurement and equipment calibration may not be exact.

The RCPA has recently developed a standard for units of measurement in pathology following several years of work on its Pathology Units and Terminology Standardisation (PUTS) project. PUTS developed a series of reference sets of terminology for pathology requesting and reporting for the different pathology disciplines, along with preferred units of measurement for results.

This project is continuing through the Pathology Information, Terminology and Units Standardisation (PITUS) project, which is concentrating on the implementation of the standard within medical practices and pathology providers.

The aim is to remove discrepancies such as one pathologist using millimoles per litre for blood glucose, for example, while another uses milligrams per decilitre.

Professor Khong said this project would ensure that there is clarity about what units are being used, “so my 130 will be the same as your 130”.

“The second issue is that if you just lift up numbers, it might be done by different pathology providers and although they can be from the same platform, [with] some of the testing equipment, the calibrations can be a little out,” he said.

“What you want is assurance that what you are looking at is a comparison that is the same between one episode and the next.”

Professor Khong said the college's preferred model was for pathology results to be added to the PCEHR as a complete report in its entirety, including the pathologist's interpretation.

“We believe the safest way is to have PDFs go up to the PCEHR,” he said. “What we don't want is the current, proposed model as we understand it, where people will be able to cut and paste from a pathology report.

“Let's say I want the haemoglobin of this episode today, so I'll cut it out and put it on the PCEHR. Now the patient could go to the same pathology provider the next day and have another haemoglobin, that's fine, you can cut and paste that. But if we go to a different provider, there is a danger.

“And the results need to be looked at in their entirety. You can't say you will only look at the abnormal ones and you're not interested in the normal ones. A pathology episode is just like a patient – you need to look at the whole patient and you need to look at the whole pathology result.”

He said the college was also worried about the interpretation of results in terms of patient safety. “If you just strip off the numbers or whatever, you lose the clinical interpretation,” he said.

“We might say your haemoglobin is low and we think you should have further tests, or we think it might be due to a bleeding disorder or an infection or it might be your usual status. Those interpretations will be cut out. That in a nutshell is what we are concerned by.”

Pulse+IT approached NEHTA for information on the technical model being proposed, but received a statement from the Department of Health and Ageing instead. A DoHA spokesperson said there was "no proposal" for healthcare providers to cut and paste pathology reports into the PCEHR.

"The Department of Health and Ageing is in fact discussing this with key stakeholders, including Pathology Australia and the Royal College of Pathologists of Australasia, and we have assured everyone that we wish to engage them on the design for the inclusion of pathology reports in the PCEHR," the spokesperson said.

"We will be consulting with all key stakeholders, including and not limited to Pathology Australia, the National Coalition of Public Pathology, other private pathology providers [and] the Royal College of Pathologists of Australasia, on the proposed model for including pathology reports in the PCEHR in way that is safe, cost effective and as easy as possible for health care providers to adopt.

"There is no proposal for health care providers to cut and paste pathology reports into the PCEHR."

"Of course, patient safety will be a priority, just as it is for all other aspects of the eHealth record."

Posted in Australian eHealth

Comments   

# Henry 2013-08-05 14:40
Cut and past is open to many errors and should never be an option in this situation..

Standardisation of methods is important between methods but something that won't be around for some time, albeit the efforts being made, Until such time Doctors will need to understand that the abnormal flags are posted in the message and this should prompt an alert if it is highlighted and different from the previous result... Look at the units/reference range.
Privacy of results is possibly a bigger hurdle than all of the above.
All results Biochemistry, Haematology, Microbiology, Anatomical and Cytology results should be available to the Clinician as well as Patient, Order and Result comments from the provider for PCEHR to be of use.
# Tom 2013-08-06 09:21
The lack of pathology is so often a contributor to delay of treatment that this should be a priority. PDF upload would be the best option as an attachment at this stage until Pathology can have their computed results added directly to the PCEHR to take another step out.
# Peter MaIsaac 2013-08-07 08:51
Integrating the Healthcare Enterprise (IHE) is the international standards development organisation that developed the underpinning standards selected by PCEHR vendors. IHE has an Australian branch that is willing to work with any health provider sector to explain the standards and options available to link business requirements to standards based IT systems . At the recent HIC 2013 conference IHE demonstrated with the participation of seven health IT vendors a model for regionally based, potentially PCEHR compatible, health information exchanges which included radiology reports, diagnostic images, clinical photographs along with the standard PCEHR documents. IHE profiles support several ways of including pathology reports and previous IHE Showcases have demonstrated the conversion of the current HL7 report messages to formats that are PCEHR compatible. IHE's role is to bring professional associations (representing users) together with their Industry's IT vendors to solve health communication and complex service delivery problems. For further information about this years IHE Showcase go to

http://ihe-australia.wikispaces.com/showcase+2013+handout+about+participants

To contact IHE Australia admin@ihe.net.au
# Richard DH 2013-08-09 17:27
The pathologists points are well understood and acknowledged but we also need to move to standards that have the material available in both original human readable and also machine readable form to support clinical decision support - pdf's alone do not provide that and are not well designed to work with contemporary mHealth platforms increasingly being taken up by clinicians. I hope the vision is not lost in the politics.
# David Guest 2013-08-19 21:10
Is it envisaged that the PCEHR is just an aggregator of data linked to an IHI or is there a view that there is some overall structure to the health record?

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