DCP a safe alternative for distributing pathology results

As discussions continue on devising a method to upload pathology and diagnostic imaging reports to the PCEHR, there are existing tools that can be used to disseminate test results to patients in a safe, GP-curated manner.

One of these tools is the Doctors Control Panel (DCP), a plug-in tool developed a number of years ago by Melbourne GP Anton Knieriemen that provides guideline support and workflow improvements for users of MedicalDirector, Best Practice and Medinet.

DCP has a range of features, including a number of prompts for items such as billing information, adult immunisation status, measurements, medications and pathology and radiology items. Since 2010, the DCP has also been used to allow GPs to distribute routine test results to patients via an online portal, with over a million pathology results distributed to date.

The original portal hosted by the Northern Rivers General Practice Network has been replaced by a dedicated results portal at dcpresults.com, created by Dr Knieriemen to allow the use of SMS notifications and authorisation for patients to see their results.

A yearly subscription to DCP costs $150 and includes all of DCP's existing tools as well as the cost of sending SMS messages. Dr Knieriemen says the cumulative benefits of workflow streamlining, billing improvements and a reduction in time spent on phone leads to a significant return on investment.

Dr Knieriemen estimates there are about 1000 regular users of the DCP, with approximately a quarter of those currently using the results service on a regular basis. And if GPs want to provide access to results for their patients as a way of empowering and engaging with them, then he believes the DCP provides a more intimate and controlled experience than through systems such as the PCEHR.

It does this by allowing the GP to annotate comments to the results when they are uploaded. This allows the GP to recall patients using current recall mechanisms for any abnormal results while providing guidance and assurance to the patient for regular results.

The results are colour-coded as an easy way for the patient to make sense of them, and it also allows the GP to keep control of what is uploaded and when – a major concern for many GPs when contemplated the mass upload of reports being considered for the PCEHR.

“It's an opt-in system – it's not like turn it on and it will upload all of the results,” Dr Knieriemen said. “You actually have to consent the patient and provide an explanation at the time that you’re enrolling the patient in the service.

“It requires that you’ve clicked all the little check boxes that say you’ve done that and that you’ve confirmed the patient’s mobile number. When you later retrieve the results from the pathology service and check them into your clinical software, you basically just bring up a form in the DCP that lists the results that get to be uploaded.”

Using the traffic light system to colour-code the results pre-empts a lot of problems, he said, as questions can often be pre-empted providing extra comments like “We need to repeat this test in six months.” Dr Knieriemen said patients appreciate it more when the results comes with instructions from the GP rather than just a digital list of results.

“You look through them, you can change comments, add comments, and provide guidance to the patient on their individual results,” he said. “If the patient has a result that their cholesterol is slightly high, you can add in comments regarding management or get them to come back. It’s totally up to the GP on how that works.”

While he is in favour of allowing patients to see their results and in greater patient participation in their own healthcare, Dr Knieriemen is sceptical about the value of adding all results to the PCEHR, other than as a first step forward.

One of the problems some GPs have raised about allowing patients to see their results is the fear that those results will be misinterpreted. The CEO of the Consumers Health Forum, Adam Stankevicius, recently told Pulse+IT that he did not believe there would be a major problem with misinterpretation, arguing that good communication between patient and provider can overcome this.

Mr Stankevicius also said that the bigger threat to safety was if the results are not made available to other treating clinicians in the case of emergency, for example.

Dr Knieriemen, however, said his primary concern would be the appropriateness of the individual results to be posted online.

“It has to be handled very sveltely and when you’re just bulk uploading all the results, it takes out any consideration,” he said. “Misinterpretation and the potential to engender anxiety among health consumers via exposure to unfettered or raw results is also concerning.”

This was a fear shared by the pathology industry, which has since been successful in pushing for the full pathologist's report, not the raw results, to be uploaded as a PDF.

“A more appropriate first destination for all results would be a health provider’s portal, allowing providers to instantly access results on all patients, not just those with records on the PCEHR,” Dr Knieriemen said. “I think that would be extremely worthwhile, easier to implement and would save lives.

“Distribution of results to patients is also extremely worthwhile when done correctly. GPs would potentially get on board with a system that provides value to both GPs and patients.”

Posted in Australian eHealth

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