Providing patients with a view of pathology results

Adelaide-based eHealth technology expert Eric Browne has developed what he believes is the first method to take coded data from HL7 messages and render it into meaningful information that can be read by clinicians and patients.

What began as a way to improve the quality and safety of HL7 messages has now developed into a prototype viewer through which patients themselves can read their pathology results and see diagnostic images. The viewer also has the potential to be used to display and store data on personal health records such as the PCEHR.

No great fan of the PCEHR, Dr Browne said it was his partly his concerns over the safety of the system, particularly what he calls a lack of scrutiny of the quality of data in CDA documents that are being posted, that led him to develop what he is calling the Healthbase Results Viewer for viewing existing pathology and radiology messages.

Dr Browne, who manages the Healthbase Australia website for health information technology, had already created a pathology message validator that he has now adapted into a viewer. As he manages a large database of the different coding systems used in healthcare, including some of the new pathology units and terminology being developed under the Royal College of Pathologists Australasia's (RCPA) PUTS project, his technology is able to “intercept” codes in HL7 messages, decode them and then render them so clinicians and patients can understand them.

The viewer can display embedded reports coded as HL7 formatted text, PDFs, RTF and HTML, and even render images in PIT or JPG format directly.

“I have tables and tables of codes like SNOMED and LOINC and AMT and various other code sets,” Dr Browne said. “There are probably 100 of them that need to be looked up in an HL7 message. The message itself is very cryptic, but I keep all of those codes so I can pull them out and decode them and present them in what I think is a meaningful way.”

Dr Browne said the viewer was not yet overly patient-friendly, although it is clear enough for clinicians to understand. What it can do for patients is add value to pathology reports by inserting links to online resources such as LabTestsOnline – a site that is managed by the Australasian Association of Clinical Biochemists (AACB) and which explains for patients what the many pathology tests are and what they are testing for – and the RCPA manual.

This would allow patients to cross-reference their results to better understand why the test has been taken and what the results mean.

Dr Browne didn't set out to develop a results viewer for patients, but as he was building the system, it became obvious that this was its potential. As a consumer health advocate – he is a member of and often a spokesperson for Cancer Voices Australia – he believes that patients will begin to demand access to their information more often.

For clinicians, the idea of building the viewer was not necessarily about any need to view common HL7 messages that they receive in their clinical software every day, he said.

“I do think it is of interest to clinicians who take an interest in safety and quality,” Dr Browne said.

“There are programs around such as the Australian Primary Care Collaboratives (APCC) which extract data from GP systems via the CAT tool or the Canning tool. They extract that data and seed it in to the APCC and to other programs like BEACH, but they take at face value the quality and content of the data that comes through their systems.

“I believe that no one anywhere in Australia or possibly anywhere in the world has actually looked at the quality of the content of the HL7 message themselves.”

Dr Browne said there was a lot of anecdotal evidence that there is a great deal of variability in the quality of the data being extracted from GP systems. And in the hospital setting, there are tens of thousands of HL7 messages being sent every day, but again, no one was looking at the quality of those messages.

“A typical large pathology lab like Pathology SA pumps out probably 40,000 messages a day just into the hospital system, and it also sends messages out to GPs as well,” he said. “That gives you an idea of the scale but nobody ever looks at the quality of the data. Technical people can look at the fields of code but no one has a good handle on this quality. I'm a member of HL7 Australia and sit on Standards Australia committees and we publish these standards but even we don't know what the quality of the data is.”

Dr Browne said that in addition to improving the quality of data in HL7 messages by being able to render them meaningfully, another motivation is to try to provide consumer access to their test results. While he recognises that many doctors are not keen on this – he points to last year's Accenture surveys of both doctors and consumers, which shows a marked disparity in what doctors think patients should have access to and what the patients themselves think – he believes this will change in Australia and we will follow countries like the US and France in legislating for greater patient access.

“In France, the law has been for a long time that pathology results go to the patient, and they changed the law a week or so ago in the US to make it illegal for states to stop patients from getting access to their pathology results. Apparently some states were allowed to do that.

“It will take much longer here but it is in the interest of the consumer, and the interest of the clinicians and of the whole health system, for consumers to have access to certain parts of their information. This will also help lift health literacy.”

Interested parties can test drive the viewer at the Healthbase website to see how it can convert the coded data in HL7 messages to a meaningful view of results and images for clinicians and patients.

Dr Browne has not yet decided on how to further develop the product, although he has been talking to many interested parties following his announcement of the creation of the viewer in November last year. This includes the US National Institute of Standards and Technology (NIST), which controls the testing procedures for the US meaningful use legislation.

Meanwhile, he is thinking of what can be done for patients here in Australia. Last year's discussion on how to load and display pathology results on the PCEHR seemed to coalesce into a decision to try loading them as PDFs – something the system was never built to do – but Dr Browne believes his technology may help.

“The machinery for setting up patient log-ins to portals isn't particularly onerous, and this could go into the PCEHR or some other better system. The Department of Health is talking about putting them up as a PDF, and that certainly helps the consumer in that it's better than nothing, but they still don't have those nice added extras like links to things like LabTestsOnline.

“I'm not suggesting it is done through my viewer but I'm showing that it is possible to do so. It would be nice if there is some further investigation around how clinicians can interpret and present results to patients.”

Posted in Australian eHealth

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