Direct-to-Patient Laboratory Test Reporting

Young, Michael J.; Scheinberg, Ethan; Bursztajn, Harold J.

doi:10.1001/jama.2014.5823

Cited by 19 publications

(15 citation statements)

References 2 publications

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“…1 In addition, recent regulatory changes to Clinical Laboratory Improvement Amendments (CLIA) of 1988 enable direct patient access to pathology reports from CLIA-certified dermatopathology laboratories. 7 While increasing medical record transparency will undoubtedly increase patient engagement in healthcare, many patients may be confused by the diagnostic terms they encounter, raising risks of psychological harm and increased demands for subsequent and potentially unnecessary procedures. 8 Communication problems might be mitigated and pathology reporting improved through use of classification schemes such as MPATH-Dx.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

Lott

Elmore

Zhao

et al. 2016

Journal of the American Academy of Dermatology

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Background Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care. Objective To evaluate the Melanoma Pathology Assessment and Treatment Hierarchy (MPATH-Dx) scheme, a five-category classification system for melanocytic lesions. Methods Participants (n=16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when provided, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Inter-rater agreement [95% CI] and correlation between MPATH-Dx categorization and treatment suggestions were evaluated. Results Most participants were dermatopathologists (n=12), age ≥50 years (n=12), male (n=9), US-based (n=11), and primary academic faculty (n=14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement following MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 [0.68, 0.71] and 0.72 [0.71, 0.73], respectively, while correlation between MPATH-Dx categorization and treatment suggestions was 0.91. Limitations Small sample size of experienced pathologists in a testing situation. Conclusion Varying diagnostic nomenclature can be consistently classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

Lott

Elmore

Zhao

et al. 2016

Journal of the American Academy of Dermatology

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“…The burden on labs to reformat test reports must also be considered. Lab expenses related to re-formatting of reports, information technology and increased patient engagement from requests for results may be recovered through preparatory fees [ 19 ] or clinical consultation fees for patients requiring further assistance to understand the lab report (such as a phone consultation). Prior to the broad implementation of patient-friendly lab reports, assessments of providers’ preferences for a single lab report or separate reports (patient and provider) as well as the impact of the patient-friendly report on practices will also be needed.…”

Section: Moving Towards a Patient-friendly Test Reporting Formatmentioning

confidence: 99%

“…Greater access to test results may help to promote more effective and satisfactory patient-provider engagement, patient understanding, shared decision-making, and adherence with clinical recommendations [ 5 – 16 ]. However, a lack of patient comprehension of genetic and genomic information may substantially limit the benefits of patient access to their reports, as has been shown with other types of medical information [ 17 – 19 ]. For example, patients who do not understand their health information may show lower engagement and satisfaction with their care [ 20 ], display poor adherence to recommended interventions [ 21 – 25 ], and experience anxiety [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding

et al. 2014

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With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients’ health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.

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“…A recent ruling by the Department of Health and Human Services 4 in February 2014 now allows patients direct access to their medical laboratory reports. This decision reverses prior limitations within the Clinical Laboratory Improvement Amendments of 1988 (CLIA) permitting only “authorized persons”—as defined by state law—access to this information.…”

Section: Dermatopathology Reportingmentioning

confidence: 99%

Dermatology in an Age of Fully Transparent Electronic Medical Records

2015

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More than 4 decades have passed since the call for "giving patients their medical records" was first proposed to increase patient engagement in health care delivery. 1 Today, this vision -once considered radical-is quickly becoming reality, with millions of Americans routinely accessing their medical records through web-based patient portals. 1 The electronic health record content that patients can access online is expanding to include physicians' documentation of patient visits. Recent studies evaluating OpenNotes, a patientcentered initiative enabling online access to providers' clinical notes, have demonstrated high levels of patient utilization and improved self-reported understanding of care planning and medication adherence, resulting in patients "feeling more in control of their health care." 1 One year after implementation of OpenNotes in 3 diverse health care environments in 2010 (Beth Israel Deaconess Medical Center in Boston, Massachusetts; Geisinger Health System in northeastern and central Pennsylvania; and Harborview Medical Center in Seattle, Washington), more than 99% of patients wished to have ongoing online access to clinicians' notes, paralleled by similar rates of primary care provider satisfaction. 1 Open-access notes have since become standard of care at several large health care systems, 2 including the Veterans Health Administration; as of January 2014, more than 1.4 million veterans have registered for full online access to their clinical notes. 3 However, medical specialties may face distinct challenges consequent to adoption of openaccess medical records. As more patients seek-and demand-comprehensive online availability of open-access notes, what will this mean for the field of dermatology? We

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Direct-to-Patient Laboratory Test Reporting

Cited by 19 publications

References 2 publications

Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding

Dermatology in an Age of Fully Transparent Electronic Medical Records

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