Block the docs?

Physicians fear proposed HHS rules will cut them out of the lab test loop

While the physician community generally supports patients having access to their own laboratory test results as proposed by the Department of Health and Human Services, they are also concerned about being inadvertently left out of the care equation.

At issue are proposed new HHS regulations that would grant patients or their personal representatives the ability to access lab results over the Internet. The rules would amend the Clinical Laboratory Improvement Amendments of 1988 and HIPAA privacy regulations.

J. Fred Ralston, MD, past president of the American College of Physicians, has come out against the proposal, as has Yul Ejnes, MD, chairman of the ACP Board of Regents. Published reports have the ACP representatives expressing concern about the new rules removing the key component of the lab test process, “which is the physician’s interpretation of the results.”

Robert J. Hitchcock, MD, vice president and chief medical informatics officer for Dallas-based T-System, agrees that patients have the right — and the responsibility — to unfettered access to their healthcare information. To be sure, “patients are the best stewards of their own healthcare,” he said.

Yet as a physician, Hitchcock is wary about patients directly accessing their records and not following up with their practitioner for an interpretation.

“Healthcare delivery is a joint project between patients and providers and this takes the jointness out of it,” said Hitchcock, who also serves as an emergency physician at Manatee Memorial Hospital and Lakewood Ranch Medical Center in Bradenton, Fla. “These results shouldn’t be actionable except to take to their healthcare provider. Raw data that goes directly to patients will be truly ‘raw’ because it is not interpreted in the context of their healthcare. In this case, I don’t think the positive outweighs the negatives.”

While he understands why some physicians don’t like the idea of patients having direct access to their lab results, Oleg Bess, MD, CEO of Culver City, Calif.-based 4medica, concedes that patients are “legally entitled to have them.” The key, he said, is to incentivize patients to follow up with their clinicians once they get possession of the results.

“There has to be some give and take,” he said. “The patients are entitled to see their results, but they must understand that they need to contact their doctor about it. Perhaps it would be feasible to have the payer cover the cost of a consultation.”

Mary Ann Holt, partner with Chadds Ford, Pa.-based IMA Consulting, points out that another legitimate physician concern is liability.

“If the patient has the information, doesn’t follow up with the physician and there is a complication, that poses a problem,” she said. “We live in a litigious society and if the doctor doesn’t follow up with the patient, it could become a question of where the physician’s responsibility begins and ends.”

Even so, “the same risk exists whether the patient follows up with the doctor or not,” says Eric Mueller, president of Seattle-based WPC Services. “Patients still have a level of accountability, whether it is adhering to a drug regimen, diet or exercise. In that instance, it comes down to transparency for the physician.”


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