Finding Success With Open Results

Releasing test results to ICU patients and their families is surely a bad idea… right?

I’m always thankful for colleagues who do great work. One of our former residents, Jonathan Sprague, co-authored a report called “Divergent Care Team Opinions about Online Release of Test Results to an ICU patient.”

At its root was the issue that we routinely sign up outpatients for our patient portal called My Health Connection. We also release all laboratory test results immediately to the portal, with no time delay. This means physicians and nurses often saw the result after a patient received it online. Despite the anxieties of such an approach, we had decided back in 2008 that all our lab results would be delivered this way; we have released over 2 million results with negligible problems and highly satisfied patients.

In fact, our urology practice, which was initially hesitant to adopt these “open results” policies, found that:

1. Likelihood of missing a prostate cancer recurrence was less, since patients were assiduous at checking their own results online and then checking in with their clinic team; and
2. One-third of their telephone volume disappeared because patients would routinely call and ask “what was my PSA result this time?” Now, they’re one of our biggest proponents of information transparency.

In this case, a patient in transplant clinic signed up for the portal, got used to viewing results online, and then shared his account with his wife. When he was admitted to ICU after transplant, she continued to check results and found that in-hospital and even in-ICU results showed up on her tablet even before the ICU nurse was aware.

You can imagine the surprise the nurse felt when she responded to the call button: “What are you going to do with this high potassium result? What about that low oxygen result on the blood gas?”

In the end we resolved it peacefully, and our organization took another step forward, formalizing that inpatient test results would follow our outpatient results release rules:

• All lab results are immediately released with no time delay, except that qualitative HIV and broad genetics panels ordered by genetics clinic are never shown online.
• All radiology and ultrasound are released immediately except CT, MRI, PET are delayed 7 days to allow for possible cancer diagnosis to be communicated by physician to patient
• All pathology is delayed 14 days to allow multidisciplinary tumor boards to develop a complex treatment plan before releasing the result

CMIO’s take?

1. Nothing ventured, nothing gained.
2. Open Results policies work well for patient satisfaction, patient engagement, and do not adversely impact physicians and staff if well-communicated and expectations and guidance are put in place. We’ve done this for 10 years and have reaped the benefits.
3. Even inpatients can handle test results, it turns out.

This piece was originally published on The Undiscovered Country, a blog written by CT Lin, CMIO at University of Colorado Health and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.