[Gnumed-devel] results handling (was Re: [Oscarmcmaster-bc-users] Is there a generic US req?)

[J Busser]

(I have cross-posted this to the gnumed list)

On Jul 7, 2007, at 12:49 AM, Carole White wrote:

> When my associate goes away, I can look at his
> results and acknowledge those that have my name attached to them, but
> they will not go away from his box until he acknowledges them.

I might suggest some value to a subgroup of people getting together  
on the question, perhaps spending 30-60 minutes to think it through  
and to present, to the group, some options. Some of the relevant  
considerations could include:

- the ordering doctor could be required to see the result even if it  
was normal, but where no action on the result would have been  
required, multiple results (even on multiple patients) could be  
easily dismissed (oops... acknowledged) in a single, scrollable screen

- the converse must also be considered however, i.e. the fact that a  
test was normal (and even if acknowledged by someone else) may not be  
the "end of the line"... the "normal" test may have failed to  
identify  the disorder that prompted it, so some way of not  
overlooking the need to proceed to another test, or the need to  
repeat the test at some interval, or the need to recall the patient  
to discuss and possibly pursue other explanations, is needed

- I might wonder therefore if a "covering" physician should not  
acknowledge the "normal" results except if where they are doing more  
than just covering the "danger" aspect and in fact providing  
comprehensive care and followup for the patients including the tests  
that although normal were associated with patients who had since  
needed to be seen... therefore it is possible that for the normal  
results to have been acknowledged inside a patient visit (potentially  
meaning "patient aware") presents a useful distinction

- might it be useful to split the presentation of results between  
patients who have one or more abnormal results (with or without  
normal results) from patients who have purely normal results, and may  
it be useful to split based on whether patients have a followup  
appointment within a useful time frame (say 1 or 2 weeks) or, if not  
"splitting" in this way, having presented to the user on the screen  
the date of the patient's next appointment?

- if a "covering" physician *had* initiated an action as a result of  
a test (even if it had been normal, maybe the patient had asked to be  
contacted about it), maybe it would be desirable to be able to "see"  
that

- if the lab should phone a critical abnormality, the call might be  
routed to a convenient doctor within the group, even though the  
actual ordering doctor would have processed it at their next session  
on the computer within minutes or hours (I am not sure if it  
qualifies as a special case, may depend on the nature of  
documentation required)