Guidelines for Patient/Consumer Access to Pathology Test Reports (2001)
Description
This paper sets out guidelines for pathologists where a consumer/patient decides to seek access to pathology test reports directly from the pathology provider. They were written in response to amendments to the Commonwealth Privacy Act 1988 which came into force on 21 December 2001. These amendments allowed a Commonwealth statutory basis for patients/consumers to request and obtain access to health information by themselves that is held by organisations, including from pathologists. They extended this to the private sector as legislation was already in place in some States and Territories for providing access to medical records. Each organisation holding personal information was therefore required under the legislation to have procedures in place to accommodate these new requirements.
Grant Recipient
Quality Use of Pathology Committee (QUPC)
Aim
to provide guidelines for pathologists where a consumer/patient decides to seek access to pathology test reports directly from the pathology provider.
This aim was achieved by this project.
Findings
The QUPC supports the general principle that patients/consumers should consult with their treating practitioner before directly approaching the pathology provider for access to pathology test reports.
The QUPC recognises that the primary advice relationship is between the patient/consumer and the requesting practitioner who is in the best position to interpret the pathology test reports within the context of the patient’s/consumer’s history, and all other information including other diagnostic procedures.
In circumstances where the patient/consumer decides to seek (obtain) direct access to pathology test reports, the QUPC encourages pathology providers and requesters to follow the process set out in recommendations two to five below.
Recommendations
The patient/consumer should always, in the first instance, approach the requesting practitioner for access to their pathology test report.
Subject to the policy and procedures which it has put in place to deal with the new legislative requirements, where the patient/consumer contacts the pathology provider directly for access to the pathology test report, the pathology provider should recommend that the patient/consumer contact the requesting practitioner. In most instances, the requesting practitioner will provide a copy of the pathology test report to the patient/consumer with an appropriate interpretation.
If the patient/consumer requests access to the pathology test report from the pathology provider, then the pathology provider should consult with the requesting practitioner to ascertain whether or not a copy of the pathology test report should be provided by the pathology provider directly.
If the requesting practitioner agrees that the pathology provider should provide a copy of the report, then it is recommended that the pathologist gives a printed copy of the report to the patient/consumer and sends a copy to the requesting practitioner with a dated notation that a copy of the report has been provided to the patient/consumer.
The pathologist should keep documentation of the discussion with the patient/consumer. If the patient has any questions concerning their test results, the pathologist should direct the patient/consumer to raise these issues with the requesting practitioner.
If, after discussion with the requesting practitioner, the pathologist determines the results should not be provided, then the pathologist should advise the patient/consumer that the results are being withheld. The reasons for not providing the pathology test report directly to the patient/consumer should be conveyed to the patient/consumer, preferably in writing and signed by the pathologist. Reasons for withholding health information, including pathology results, as provided for in the Privacy Act, include:
a serious risk to the life or health of the individual
that the privacy of others may be affected
that the request is frivolous or vexed
existing or anticipated legal proceedings
that access would be unlawful
that denying access is required or authorised by or under the law
law enforcement and national security reasons
commercially sensitive evaluative information.
If the pathology provider determines that the pathology test report should not be released directly to the patient/consumer, for reasons the pathology provider considers to be in accord with the Privacy Act and any other relevant legislation, and the patient/consumer still desires a copy of the test results, then the pathologist should advise the patient/consumer to submit a written request to the requesting practitioner. (This is recommended on the basis that the requesting practitioner is likely to be the best person to determine whether the provision of the pathology test report to the patient/consumer would constitute a serious threat to the life or health of the individual).
If the pathology provider and the requesting practitioner refuse to provide a copy of the pathology test report to the patient/consumer, the patient/consumer can seek redress through the Health Care Complaints Commission or the complaint mechanism provided under the new privacy legislation.
AUSLAB Retest Interval Trial Project (2003)
Description
The AUSLAB laboratory information system is implemented in 34 public pathology laboratories across Queensland. Over 20,000 tests are ordered per day on this system. Certain tests are frequently repeated on the same patient within an inappropriately short time period, mostly because the requesting doctor does not realise the test has already been requested/performed. The Retest Interval functionality in AUSLAB was trialed and activated for three months at Rockhampton Base Hospital and Logan Base Hospital for the following tests judged to be the most suitable for this intervention:
antinuclear antibodies (ANA)
folate
glycosylated haemoglobin (HbA1c)
Hepatitis C antibody (HCV Ab)
iron studies
lipids (cholesterol, triglycerides, +/- HDL)
syphilis serology (RPR, TPHA)
thombophilia screen
Thyroid function tests (TFTs)
Vitamin B12.
Grant Recipient
Queensland Health Pathology & Scientific Services (QHPSS)
Aims
to implement the retest interval functionality in AUSLAB to prevent over ordering of pathology requests
to notify medical staff if their pathology request in contraindicated due to recent previous test.
The first aim was achieved by this project although the report did not specifically state if medical staff were notified if their pathology request was contraindicated.
Outcomes
The project saved $4,494.90 over three months by rejecting pathology tests that had already been ordered.
The project was very successful in stopping pathology re-ordering for tests already ordered within a pre-determined time frame.
The most common pathology tests rejected using the interval were:
TFTs 5.8%
HbA1c 12.0%
lipid profiles 8.9%.
The benefits realised were:
a 6.2% decrease in the amount of inappropriate ordering of the pathology tests selected in the trial
improved communication resulting in increased awareness between requestors and pathologists
changes to pathology ordering patterns by senior clinicians
alteration to chemistry pathology ordering criteria of renal patients at Rockhampton Base Hospital.
significant additional requests for supplementary tests to be added to the intervals.
The number of “Retests” decreased over the three months of the trial at both Logan Base Hospital and Rockhampton Base Hospital.
There were two reported cases of medical staff phoning the laboratory and requesting additional testing on a sample that had originally been rejected by the retest algorithm at Logan.
Findings
Using the current test codes in the retest project would save an estimated $18,000 per year in unnecessary pathology ordering at Rockhampton and Logan district health services in 2003. An estimated $360,000 per year would be saved in unnecessary pathology ordering if these were expanded to the whole of Queensland Health. If extra test code intervals were added the potential saving could be greater than $500,000 per year.
The reasons tests were re-ordered can be summarised in three main areas:
medical staff were unaware the test had already been ordered by another clinician due to not having access to AUSLAB terminals, the information was not recorded in the patient’s chart and the lack of clinical information system or ward ordering system
junior medical staff attempting to be sure they had ordered ALL tests required by their consultant. This may be due to a culture in some clinical environments were junior medical staff are reprimanded for not ordering the appropriate pathology tests
clinical practices that order “default ordering” in certain areas. For example, renal patients have lipids ordered when any other chemistry test is ordered.
Recommendations
A subsequent project is supported to implement the AUSLAB Retest Interval functionality at all QHPSS laboratories.
Investigate the option of expanding the range of tests.
A review of the project at Logan Base Hospital identified the following requests (subject to finding for a project officer to expand the retest algorithm) by medical staff:
additional testing length’s be added to the test codes used in the trial
additional tests be added to the AUSLAB algorithm
a central contact be provided for managing changes and new requests.
Key Project Learnings
Senior clinical staff at Rockhampton and Logan applauded the trial.
There were five requests by other districts to implement this function.
There was no significant impact on other QHPSS laboratories.
