Cures Act - lab results to patient before ordering MDs

[Med Director New England]

Not uncommon for me or someone in my group to release AP results later & under new rules the data is pushed to EMR unaltered for patient to view.

Had a case a couple of weeks ago in my group signed out ~ 130 on a Friday before a holiday that freaked out the patient who read it in their EMR. Patient could not get ahold of their doctor, on call doctor covering refused to discuss results with patient. Patient tracked down the number into the lab. I got a call from one of my weekend managers asking if would I talk to this patient (who was hyperventilating, demanding to speak to the pathologist about the case, threatening legal action). It was basically a hot mess.

All this was over a non malignant diagnosis too.

When I spoke to the clinical group the following week - they actually suggested the lab somehow hold results on outpatient biopsies until the next working day if released after normal hours. I politely said this is not possible for many reasons. (and specifically go against the cures rules on making patients own data immediately accessible). Also this was a case released mid afternoon - the phones were on answering service coverage really early that Friday I guess.

This is the most extreme ancetodal story but I have a couple of other similar things happen since the new rules came to be.

One patient thought they had HIV when they didn’t (screen +, confirmatory -) same with syphillis.

we are contemplating a standard statement on all AP and CP results stating please discuss results and any questions with your ordering provider…or similar.

Wondering if anyone else has experienced this

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[octopusprime]

Yes; given the patient access to EMR portals, I sometimes hold malignant diagnoses on Fridays, especially over long weekends, but will call clinicians to let them know. I've had clinicians specifically request I NOT sign out cases until Monday, which I've honored and just vague prelim'd instead.

I've been on the receiving end of this too, several friends and family members obtaining results on Friday via a patient portal prior to their physicain having time to review the results. I always explain that "this is what you wanted..."...patient control, patient access, ASAP, regardless of innate inability to interpret/contextualize.

 

[SunBakedTrash]

Not sure why people don’t expect these potential findings when they are getting a biopsy for a breast mass or whatever. Our hospital IT has considered putting a message that if you can’t handle the potential information, don’t open the result on the patient portal.

 

[octopusprime]

We've thought about that too...a "warning" or disclaimer to appear on the portal with all lab results RE relevant clinicians/providers have not necessarily had time to review these results etc .

 

[Guest8]

I've had some clinicians ask me to not release reports until they can speak to the patient, and I will try to do so in those instances. But personally I don't do anything like hold Friday diagnoses, etc. This is the fault of a stupid law. If enough clinicians push back on it and lobby for it to get changed, that's up to them. I'm signing out my cases when I'm ready to sign them out like I always have.

 

[mike-sheree]

They can threaten legal action all they want. There is no case there worth an attorney’s time. You did your job. Rest easy and blow them off. The disclaimer to discuss results with their physician is nice window dressing. This is not your policy or your doing.

 

[octopusprime]

signing out a prelim is easy for a friday; but we call all malignant diagnoses anyway (excluding skins) so we notify clinicias anyway.
actually think this protocol (hospital required) can put the clinician in a bind in cases like this...as I call the clinician Friday or leave a message with a nurse, document that in my report, patient doesn't find out until the following Thursday, reads report that states clinician was notified a week prior, etc...