Article Figures & Data
Tables
Variable N
(Mean)% (SD | Min |
Max)Sex Male 4 26.7 Female 11 73.3 Mean age (years) (38.4) (11.8 | 26 | 63) Education Highest degree completed Associate 1 6.7 Graduate 11 73.3 Bachelor 3 20.0 National certifications* CLT(NCA) 1 67.7 MLS(ASCP) 11 73.3 MT(ASCP) 3 20.0 Other (ASCP) 3 20.0 Professional practice information Mean time in practice (years) (12.3) (11.4 | 1 | 41) Current position information Mean length in this position (years) (5.9) (6.3 | 1 | 25) Mean shift (hours) (9.0) (1.4 | 8 | 12) Shift type Days 10 66.7 Evenings 3 20.0 Nights 2 13.3 Position title MLS 11 73.3 Laboratory manager/director 2 13.3 Specialty supervisor/coordinator 2 13.3 Area of the laboratory worked Blood bank 2 13.3 Core: chemistry and hematology 3 20.0 Generalist 6 40.0 Microbiology 2 13.3 Other specialty 5 13.3 Laboratory setting Hospital (medium/large >100 beds) 10 66.7 Hospital (small <100 beds) 3 20.0 Reference/independent 2 13.3 Notes: ASCP, American Society for Clinical Pathology; CLT, clinical laboratory technician; MLS, medical laboratory scientist; MT, medical technologist; NCA, National Credentialing Agency for Laboratory Personnel; SD, standard deviation.
↵* Percentages do not total 100% because some MLPs hold >1 certification.
- Table 2.
Domains and categories describing MLPs’ knowledge and perceptions of patient direct access to laboratory test results via web portals
Domains Themes Knowledge of how the laboratory’s systems report results to patients • Autoverification versus manual entry of results
• Information systems and patient portals
MLPs’ opinions, perceptions, and attitudes about DPA • Tests that can and cannot go straight to patients
• Perceptions of patient understanding of CLTRs
• MLPs and other health professionals as patients
Implications of DPA for the patient–laboratory relationship • DPA and differences in patient–laboratory communication practices
• DPA and changes to visibility of the laboratory profession
Notes: CLTR, clinical laboratory test result; DPA, direct patient access; MLP, medical laboratory professional.
Differences in Result Entry by Area of the Clinical Laboratory Core (chemistry/hematology)/generalist Blood bank/microbiology/molecular • Process a large number of automated tests
○ “We aren’t manually doing a lot of things anymore, so I mean technology has changed […] the ability to quickly produce results within a timelier manner because of the automation” ∼RED.
• Driven by autoverification
○ “70%–75% of the samples” (INDIGO) have their results autoverified into the EHR.
○ “if it is nonreactive it goes directly to the LIS and into the patient’s result and gets autoverified. But if it’s you know if it’s a reactive, there’s a hard stop on it and doesn’t get sent out” ∼BURGUNDY.
• Autoverification was minimally or not at all implemented
○ “[E]very result is entered into the patient’s medical record number not necessarily manually but somebody has to look at it so it might transition from the instrument into the LIS […] before the results are saved and then further moved into the electronic health record” ∼GRAY.
• Tests can have serious implications for patients, were diagnostic or complex in nature, or required pathology review
○ “we have numerous complicated testing, we do FISH, we do flow cytometry and we do next generation sequencing testing, and all of those results are given to a pathologist for their interpretation” ∼MAGENTA.
Notes: LIS, laboratory information system.
- Table 4.
Variation in MLPs opinions, perceptions, and attitudes about direct patient access
Characteristics of Tests That Can and Cannot Go Straight to Patients Appropriate Not appropriate • Normal/routine
○ “Tests as a part of either a yearly physical or periodic follow-up for conditions are acceptable or in cases where the patient is well aware of his or her clinical condition and has the ability to take steps in order to rectify the situation” ∼GRAY.
• Comply with rules of autoverification
○ “if the values are all very agreeable […] I feel like the majority of those samples should be able to go to the patient chart right away.” ∼BLUE
• Examples of tests: complete blood counts, blood types, chemistry panels, renal panels, creatinine clearance.
• Abnormal, esoteric results; complex testing; tests that are not frequently performed or not in the common vernacular; critical values
○ “HIV, hepatitis… probably would be better if you know the doctor told them […] a drug test, I suppose that would be another one… so that they don’t interpret the results incorrectly” ∼CYAN.
• Results that could understandably cause distress for patients
○ “if it’s like a cancer antigen that may be high [but] they haven’t got a diagnosis of cancer” ∼AMBER.
• Examples of tests: bacterial susceptibilities to drugs, blood crossmatch results, anatomic pathology, STD tests.
Perceptions of Patients’ Understanding of CLTRs Patients are knowledgeable Patients are not knowledgeable • If the patient has adequate understanding of their disease and can use the information that they find in the portal
○ “let’s say you have a patient that is a known diabetic they try their best to manage their diabetes […] if they are well aware of their condition […] those results are fine to release to the patient” ∼GRAY.
○ “the patients are able to like see […] right away before they see the doctor and they can gather up information and ask their provider beforehand” ∼GREEN.
• If seeing test results could have a positive impact in the timeliness and quality of their care
○ “I mean we do our rapid test for our Biofire this have, you know, respiratory panels and stuff like that. I don’t think it would hurt for a patient to know that they have a cold right away” ∼RED.
• Concerns with emotional response to laboratory test results
○ “[W]hat if the patient saw the critical value before the physician […] they’d be freaking out […] things that could I guess really put fear in a patient’s heart […] because they don’t understand what some of those tests really mean” ∼JADE.
○ “I guess it would freak them out if they don’t understand what they’re reading” ∼GREEN.
• A clinician should always be available to explain the results
○ “they are able to add information about whether they saw a high or low… something flagged the results, rather than just the result without any interpretation.” ∼BLUE.
○ “Any life-changing experience like a very serious diagnosis we should intercept the patient first” ∼FUCHSIA.
Healthcare Personnel’s Understanding of CLTRs MLPs as patients Other health professionals as patients • Some MLPs said that their specialized knowledge allows them to better understand test results
○ “I had an incident recently where I had some blood work drawn and they called me 2 days later to let me know that my glucose was abnormally high […] I recognized that it’s literally one number over their top range but I also knew that I had forgotten to fast… so I knew that my glucose levels were fine” ∼MAGENTA.
• MLPs who disagreed, said they do not know everything
○ “I feel like with the profession I’d then be able to know […] not necessarily that I can interpret all the different lab reports from all the areas I definitely cannot” ∼BLUE.
○ “I think that [MLPs] should be treated like maybe someone who doesn’t have medical experience […] because you don’t know how much they know and how much they don’t” ∼ORANGE.
• Depending on their scope of practice, some healthcare professionals can comprehend and use CLTRs
○ “So like nurses, you know, they should be able to get it and understand what’s going on; dieticians yeah maybe they should too […] but it kind of just depends on… on the patient… you know? and how active they are in… in their health care” ∼CYAN.
• Some MLPs were more skeptical about other healthcare professionals being able to use the test information
○ “I would say that they are more like regular patients […] They just lack that understanding and knowledge base” ∼MAROON.
○ “I don’t know if they are aware exactly what everything represents because they’re really the only people who can interpret lab tests are supposed to be doctors” ∼YELLOW
Sharing Information With Patients Relationship No relationship • Name of patient is familiar, someone they see frequently, may take added significance
○ “even if I don’t know the patient. I think in blood bank particularly you know we see names so… and we work on everyone individually and so we’re preparing something for that patient in addition to just testing so I think it takes on a little added significance” ∼MAROON
• Knowing the impact of a result for someone they know
○ “so, there is someone that I know that gets urine cultures done quite often I have never talked to the person about it. I don’t know why but I just happened to see their name quite often” ∼ORANGE.
○ “Mom was in dad’s chart. Dad’s cancer spread. She was worried. I told her I didn’t know what it meant, but I did” ∼FUCHSIA.
• Contact with patients is outside of the laboratory’s role
○ “[T]here is no relationship between the lab worker and the patient other than the lab worker receives the patient sample, they perform the testing, they result the testing” ∼GRAY.
• Patients are deidentified
○ “it doesn’t register for me it’s not important really what the name is. How you usually go with not with the patient’s name you know I go for the identifiers I look for the numbers […] the date of birth and the MR numbers and all that” ∼BURGUNDY
• No time to form a connection
○ “I mean if you see the patient a lot it makes you like ‘oh I know this patient’ but then it’s so busy […] you move on […] there is no time to wallow” ∼GREEN.
Contact No contact • Participating in procedures at the bedside
○ “I have direct contact with [patients] especially if I go up on a bone marrow and ended up crying inside the room because you know their story” ∼GREEN
• Knowing the likely implication of a test result for a patient
○ “I was fairly confident with my own observation that the patient probably had leukemia and they were wanting a copy of their results and […] I really didn’t want to give them the results […] they could tell from my apprehension that there was a problem” ∼AMBER.
• Desire to remain anonymous
○ “lab people—their personalities tend to be that kind of person they just want to be in the background […] they don’t want anybody to notice them” ∼CYAN
○ “[W]e need to remain anonymous, that way [patients] don’t like ask us […] questions because that might affect the professionalism” ∼GREEN
Practice Setting and Communication Medium/large hospital Small hospital/independent • Get phone calls from patients but usually redirect them and try not to communicate about results
○ “we do sometimes get calls from patients; we direct them to MyChart for example […] it’s not a direct communicative relationship” ∼KHAKI.
• Specific laboratory policies prevent verbal communication of laboratory results to patients
○ “I can’t give you results over the phone directly. I’m not a clinician, so please contact either your clinician or medical records at this number” ∼INDIGO.
○ “so, for us we essentially have to tell them that unfortunately we can’t give out test results directly we can’t even give them to outside hospitals” ∼ORANGE.
• Interacted with patients constantly
○ “I have some patients that do come in and pick up copies of the results” ∼CYAN.
○ “I actually enjoy it when… um patients come in and say explain this to me and I always have to say “you know I can’t interpret it. I can’t tell you what you can do about it, but I can tell you that an AST is related to your liver” or just some of those facts of what the lab test is” ∼JADE.
• These individuals were confident in their ability to speak with patients.
○ “[W]e’re so small and everybody knows everybody […] I don’t mind discussing with them or trying to figure out [as patient] ‘well why did the doctor order this for me?’ is like [as self] ‘well do you have this going on?’ […] they trust us to give them the right information” ∼AMBER.
Implications for Visibility of the Laboratory DPA impact on visibility for MLPs Other efforts that can increase visibility of MLPs • Some MLPs believe that patients being able to see their test results directly can be positive for increasing visibility of their profession
○ “I think it would increase visibility because patients would know that we’re actually the ones doing the tests, right? […] We have no visibility because any results to patients come through a doctor or clinician, right? And so, I think it would increase the visibility to lab” ∼INDIGO.
○ “[W]ith a patient seeing all those different results and seeing how many there are and how many different results are… I think that could definitely spark someone’s interest to wonder how they all got there and who did them” ∼BLUE.
• Others said DPA alone would not make much of a difference
○ “I use the portal as a… as a patient I don’t think about the people who are running the test. I just see it myself and I’m curious to talk to the physician about it I mean the although I’m in that profession I don’t think about the people who are running the tests as a patient” ∼BURGUNDY.
• MLPs should engage in other efforts that can help them gain visibility
○ “I think the visibility has more to do with the legislation I think… because nurses… nurses are more visible they have more unions and stuff like that, and we don’t have any of that you know? I mean we don’t get that kind of exposure I don’t think this would be one way to do it.” ∼BURGUNDY.
○ “it comes down to just promoting ourselves […] nobody’s going to promote the lab except us, and we have to do that whether it’s taking the time to explain to a patient what their test involves. Simple things like giving tours of the lab… just getting us out there because nobody will get us out there but us. […] And let them see what the lab actually is” ∼JADE.
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