Managing Patient Information Longitudinally
Commentary about Management of Laboratory Test Results in Family Practice
The third step is to document the notification of the patient by placing the original laboratory report in the medical record. Perhaps more important than simple notification is placing the information in the context of a patient’s problem or life goals. Then we should document how patients understand and interpret the information we provide within the context of their goals.7
The fourth step, assuring that recommended follow-up for an abnormal test result occurs, had no best method. Physicians may assume that this step goes beyond their legal responsibility and that it is the patient’s responsibility to use the information provided. However, follow-up may be the shared responsibility of both the patient and the family physician. We must provide the information patients need to make good decisions. Then we need to document the decisions that patients make and how these decisions may change over time.
It’s about time
In family practice, we watch and wait. While we are waiting, other competing demands intervene. We may be distracted by a new problem, a patient’s reluctance to prioritize the problem, or we may simply forget to follow-up. We attempt to keep our clinical antennae tuned for potential hazards along the traditional diagnostic and therapeutic paths. Our habits remind us to always check twice or to call the laboratory if we remember that a result is tardy. Unfortunately, we depend on our own memory, because we simply do not know a better way.
We often treat time as our ally. It allows us the opportunity to study, revisit, and recheck. However, events can quickly turn, and time may become a formidable enemy. Management of information over time is central to quality systems in primary care. Mold and colleagues have begun the process of assessing our management of laboratory testing and finding opportunities for improvement. In their study, many times no system was in place. Even when a good system was present, 15% of laboratory tests ordered had no results found in the medical record.
It is time we develop systems to aid us in attaining high-quality patient care. We should realize that time is neither our friend nor our foe, but one more resource that we need to manage effectively to help our patients. Developing systems of information management that can retrieve information and remind us to perform certain tasks should be an important priority for future practice-based research.
