Access to Patient’s Lab Results

Clinicians order dozens of lab tests for their patients every day. Currently, those results are first released to the ordering clinician before the patient can have access to them. This practice however, may soon change. As noted on Dr. John Halamka’s blog, a proposed federal rule change may soon provide patients with direct access to their results from the laboratory whether or not the ordering clinician has already viewed the results. This can have both advantages and disadvantages that I will briefly discuss. After all, I can get instant access to my credit report on-line, should the same argument be made for my medical record and lab results?

Advantages:

  • In our new collective patient-centric view, granting direct patient access to the results would conform to this theme. Most of us have experienced some anxiety and frustration as we await lab results. Provider’s offices are usually busy throughout the day and reserve time at the end of the day to call patient’s back with results (if at all!) Allowing patients to directly contact the lab, may easy the anxiety and frustration patients encounter when they are waiting to hear back from their clinician.
  • Patients will have their own copies of results without the need to contact a providers office. Since most providers medical records department/person works during the day, patients can take advantage of the laboratory’s customer service department which usually has expanded evening and weekend hours.
  • This practice also allows the patient to take some responsibility and initiative in the provision of their care. Patient care should be a partnership between the patient and their clinician. Access to lab results can empower patients to become more involved.
  • Providers may be more judicious in ordering superflous lab testing if they know that the patient will get direct access to the results. Perhaps, the cost of care will decrease as only necessary tests are ordered.

Disadvantages:

  • But what happens when a patient gets a result that is abnormal or even inconclusive? This can perhaps evoke the same fear and frustration as they await to hear from their provider to help them interpret their results.
  • Lab testing is not all black and white. Slightly abnormal results may not necessarily indicate a problem. Patients may flock to the Internet in the hopes of interpreting the results which may lead to cyberchondria (assuming the worst possible condition based on search results).
  • The laboratory wil bear the onus of validating the patient either over the phone or electronically. With more patient’s being granted access, can we assure that the proper security is maintained so the result is going where it should (especially in the very real threat of identify theft)?
  • Should all results be made available? What about ultra-sensitive results like HIV results of sexually transmitted infection results?
I believe this is mostly a good thing towards patient centered care. I think the details still need to be worked out and that there needs to be a way for the clinician to “sign off” on the result prior to final release to the patient. This in part, is being driven by the push for providers to get on board with electronic health record integration. Here is an example of what the future of health care might look like once we have a robust and interconnected health information exchange.  It is certainly interesting to ponder!