Laboratories as gate keepers and health maintenance providers

| May 20, 2011

Laboratories engaged in direct patient care have at their disposal huge amounts of health care information related to both screening and diagnostic tests. 

When it is time for your 6 month dental check up you receive a card or more recently electronic reminder that your appointment you made 6 months ago is approaching or you need to call the office and schedule one.  My ophthalmologist provides a similar service with reminders for routine visits.  

Imagine the laboratory notifying you that "Mrs. Jones it has been 1 year since your last pap smear according to our records.  It may be time to visit your health care provider (like this universal term now) for your annual examination and pap smear (this may not go along with recommendations the provider follows — need to think this one through). The intent of course, much like the dentist or ophthalmologist, that you choose the same provider and he/she chooses your laboratory.  

What about the pathology laboratory sending you a letter about 12 months after you had some atypical nevi removed that were examined by your laboratory that it may be time for another "skin check" by of course "your health care provider".  It won't necessarily say that it may be time to see Dr. Jones at Jones Dermatology but why not?  Particularly if Dr. Jones is still a client of yours.  Presumably Dr. Jones sent out a reminder as well but you know what could happen to those small cards that get mixed in with all the other mail.  

Ditto for cholesterol or glucose tests.  For example. "Ms. Smith, Our laboratory performed blood tests for you about three years ago.  We noticed that you have not had any subsequent testing.  May we suggest it may be an appropriate time to consult with your health care provider for a full physical examination and routine blood work that may be required".  

It is starting to sound like a drug ad — "Call your doctor".  

By the way, have you ever tried to call your doctor.  I spend some of my days calling back results to referring physicians.  "Call the doctor" or "Notify the referring physician of abnormal results" is not as easy as it sounds.  Without fail, you call the wrong office as they are at the "other" office.  Again without fail, the office staff knows they are not at that office, but can't find the number for the other office.  Or a pager.  Or cell phone number.  The directory of physician listings has not been updated since President Bush's administration (the first Bush) and the other office isn't even in the listings. Once you make contact with the correct office you find out they have left for the hospital or other office…

Anyways, laboratories have at their disposal huge amounts of health maintenance data that is one of the keys being discussed with electronic medical records (EMRs), health information exchanges (HIEs) and accountable care organizations (ACOs). 

Laboratories could provide one of the necessary portals and sources of key data for continuity of care whether it is a screening colonoscopy or mammography (assuming their is biopsy material to record), pap smears or serum chemistries or cholesterol testing.  Ditto for drug levels for organ transplant patients lost to follow up.

The lab has the data to mine. Issues about self-referral, lack of patient-physician (health care provider) relationship and potentially unnecessary testing abuses would have to be worked out.  

I think with EMRs, HIEs and ACOs on the horizon, the laboratory should be one of the key organizations considered as potential gatekeepers and data keepers for patient management and outcomes.

In doing so we may be able to lose the term "lost to follow-up".


Category: Pathology News

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