Review period mooted for pathology uploads to PCEHR

The design of the system that will allow the uploading of pathology reports to the PCEHR will be reviewed after 12 months of operation to assess whether it is working effectively, with statistics on 'exception cases' reported at six- and 12-monthly intervals.

According to the minutes of the most recent consultation workshop on the design of the PCEHR pathology model, held in Melbourne on November 26, some of the concerns of the general practice and private pathology sectors appear to have been taken on board, including those relating to pathology results that potentially should not be uploaded, even if the patient has given standing consent.

A series of consultation workshops held over the last year have led to an agreed high-level solution design that will see pathology reports uploaded as a PDF by the pathology provider, which will be viewable by both the requesting doctor and other registered healthcare providers immediately but will not be available to view by the patient for seven days.

This will allow the requesting doctor to receive the results by routine point-to-point messaging and recall the patient if necessary, but will also allow other healthcare providers to see the results in emergency situations.

While one observer at the November 26 meeting said there was now “begrudging acceptance” that the seven-day delay method is going ahead, there are still a number of issues that need to be overcome before the model can be finalised.

One of the most urgent is what to do about the relatively small number of pathology requests that are currently transmitted electronically. For the system to work, the patient's Individual Healthcare Identifier (IHI) must be entered into the pathology provider's system, but as most requests are still paper-based, how to enter the 16-digit number electronically still needs to be decided.

Also still to be decided are how to effectively provide patients with the ability to withdraw their consent to have a specific report uploaded or a report to be removed, what to do about tests that for legal or policy reasons should not be automatically uploaded to the PCEHR, and what to do about exception cases following a discussion between the pathologist and requesting doctor.

This refers to cases in which the result is unexpected or raises additional questions about whether more tests should be performed or an error has occurred. It has been agreed that the requesting provider decides on the appropriate response but that guidelines need to be developed.

In these cases, if the requesting doctor is not able to contact the patient then it has been suggested that the report is still uploaded after 30 days, with a view that it is preferable that a patient is informed on exception results via the PCEHR than not at all.

This has led to the proposal that pathology providers keep statistics on the number of exceptions and the time it has taken to resolve them, with the stats to be assessed at six and 12 months.

It has also been decided that the design of seven-day delay model will be reviewed 12 months after implementation, with the terms of reference for the review to be decided early this year.

Posted in Australian eHealth

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