Canada Health Infoway defines the electronic health record (EHR) as a “secure, integrated collection of a person’s encounters with the health care system

Canada Health Infoway defines the electronic health record (EHR) as a “secure, integrated collection of a person’s encounters with the health care system; it provides a comprehensive digital view of a patient’s health history.”1 The use of EHR has steadily increased across Canada with coding of information occurring at hospitals, clinics, palliative centres and other health facilities by trained and authorized personnel. Put forth by Infoway, the organization has a mandate to ensure all Canadians’ laboratory test results are coded and stored in information repositories and available for health care professionals. As of 2014, an outstanding 81% of Canadians had their laboratory information captured within a laboratory information system (LIS).2 This has come a long way considering the first commercial LIS was only introduced into North America in the 1980s by clinical analyzer manufacturers. The rise of LIS integrated EHRs has demonstrated its benefit in various ways, including the ability to decrease informational gaps as patients transfer between medical facilities such as hospitals, family physicians’ offices and long-term care. The aggregated system also provides greater monitoring capabilities for history and treatment information in chronic disease cases and timely access to more complete data sets that improve decision making capabilities.3,4 In a study conducted by the University of Toronto, nine physician-based clinical practices were followed to examine electronic report usage and identify any benefits. It was found that electronic reporting systems had the least number of steps between ordering a lab test to reviewing the final report when compared to paper-based process flows. In fact, when compared to paper, the time to sort, archive and retrieve an electronic lab report was 87% faster and 50% faster for scanned results. Depth of review was also examined and it was found that electronic and scan-based clinical practices reviewed 31% more lab reports than those with only paper reports.5 These significant numbers help promote change from traditional paperbased practices to the modern online patient record. One of the greatest impacts LIS integrated EHRs have on lab staff is the ability to reduce resources and costs by identifying patterns in duplication of tests and recognition of unnecessary tests. For example, it is estimated that for every 1,000 lab tests, there are 150 duplicate tests performed. Although some of this is required for emergency care or confirmation testing, duplication also occurs due to lack of accessible information. It has been calculated that if there was a reduction of 2-3% in duplicate tests, this could result in approximately 1.3 million fewer unnecessary tests being completed.6 Another important area of impact on laboratories is the extension of EHRs to patient portals. A patient portal is a “controlled and secure computerized pathway between a patient (wherever the patient is located) and the personal health information (PHI) about the patient, which is held by health information custodians, stewards or trustees. The goal is to actively engage patients in awareness and self-management, and to improve care coordination. For patients, a portal has the potential to act as the cornerstone for monitoring and evaluating their health status.”7 As the health care system absorbs EHR as the norm, it naturally builds the infrastructure for patients to access their full or partial medical records. Given that “patient consumerism continues to raise demand for transparency and timely delivery of health care, more self-care options, and alternative service delivery options”8 , patients are adding pressure csmls.org 25 directly and indirectly for this movement. As an example of their desire to obtain information independently, one study found that only 11% of patients reported primary care physician was their first line of information seeking, while a noteworthy 49% used the internet.9 Canada will continue to move toward greater patient portal adoption in line with the international stage.10 In early 2014, the US Department of Health and Human Services (HHS) issued patients the ability to have direct access to their laboratory results instead of retrieving the information from the doctor’s office.11 “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule… Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans”12 described the HHS Secretary Kathleen Sebelius. The patient portal movement has been spurred by arguments such as the information savvy patient who represents a wellinformed consumer and seeks better medical attention through knowledge and ability to discern quality facilities / professionals. It suggests that, ultimately, this will provide health professionals with the incentive to produce better services in order to maintain a full practice. In addition, supporters also propel forward potential increased compliance of patients for test and treatment completion and/or medication consumption in accordance with instructions.13 Patient portals are “increasingly being deployed with the underlying belief that they will empower patients and improve health outcomes.”14 Despite the suggestive evidence supporting the ability of portals to deliver care, improve outcomes and increase patient and clinician satisfaction, contradictory appeals have been made.15 For example, some patients prefer to seek medical guidance through direct communication from doctors, nurses, and hospital staff rather than the internet.16 In another study, patients were identified as passive health care consumers of physician services. The authors highlighted the importance of decision support tools in consumerdriven health care systems to support the patient’s ability to learn to be active consumers in this respect.17 Sofaer and Gruman (2003) argued that the conditions under which patients can significantly affect their own health are unlikely to be met.18 From a different perspective showing caution when using portals, research has demonstrated that physicians with more consumerist patients are substantially less likely to believe that they can deliver high-quality care. Given that there is an unlimited number of health care delivery models and multiple differences between portal platforms, provider endorsements of portals vary. These inconsistencies can affect the patient’s ability to engage in portal usage and/or use the portal as intended and to its full capacity.19 This variability likely accounts for some of the negative study results arguing for caution in portal usage. Overall, there is little evidence indicating that personal health record access supports improvement of patient empowerment or improves health outcomes according to recent systematic reviews, but researchers have noted possible increases in treatment compliance and patient perception of control with portal use.20 In Canada, patient portal usage is relatively new and there is even less supporting evidence based material to demonstrate widespread effectiveness and benefit. Nonetheless, positive results have been identified and it is important to recognize the potential for this. In an integrated health care organization, it was demonstrated that a large percentage of patient portal users accessing laboratory results experienced primarily positive feelings when viewing these results online.21 What the lack of evidence derived to date speaks to, is the required mindfulness needed when contemplating the creation of a portal and the critical eye in developing, implementing, monitoring and sustaining patient portals. As one meta-analysis suggests, the direction of future research on patient portals should focus on identifying specific populations and understanding contextual considerations to target populations that would benefit the most from usage. There is a common understanding that positive results of patient portals are limited, but important, and here are some examples that are of interest to the laboratory community: • Financial Case: Patient portals have the potential to significantly decrease costs when adopted. For example, a minimum of 63 cents can be saved every time we do not mail a lab result (HealthPartners). It is possible to recoup $17 every time a The Canadian Society for Medical Laboratory Science (CSMLS) supports the use of online health information portals for providing laboratory testing results and relevant information to patients and care givers. It is the expectation that a portal should allow users to be engaged and active participants in health care matters, promote health literacy, increase transparency of the medical health record for the individual, as well as support new access to care models. View and download the full position statement “Patient Portals for Laboratory Based Health Information” at csmls.org under the About Us tab. SCIENTIFIC SECTION 26 CJMLS Spring 2017 billing query is made online rather than by phone and $7 for online scheduled appointments (Northshore University Health System).22 • Health Impact: Diabetic patients using an online patient portal accessed appropriate education material, laboratory results and a messaging system to communicate with diabetologist and other staff. A higher proportion of users achieved, when compared to non-users, a reduction of A1C by ≤7% at follow up (56% vs. 32%; p=0.031), resulting in improved glycemic control.23 • Abnormal Results: Health care Professional Stakeholders: Researchers conducted structured telephone interviews with 13 patients and primary caregivers to understand patient experiences accessing abnormal test results of all kinds through a portal system. There was strong favouritism toward having access to abnormal test results but general concern for timely notification and ability to interpret and understand relevance of the result.24 • Portal Usage: In a group of oncology patients, participants’ most common lab-related portal actions were viewing lab test results (37%), viewing and responding to clinic messages (29%) and sending communications for medical advice (6.4%). Although results can vary between studies, the current research found significant association with portal usage for younger adults, Caucasians and patients with specific malignant diseases. Similar results have been found in other studies.25 Patients used the portal approximately a third of the time to log-in and make medical advice requests outside clinic hours.26 As we dive into the next phase of EHR and embrace patient portals, medical laboratory professionals have a blossoming transformative role as informational leaders for patients (and professionals) in the dissemination of diagnostic and treatment testing information and ensuring comprehension. The complexity of patient care; increased demands on the health care system; and the sheer dramatic increase in the number and complexity of tests will pressure the communication of test results to occur within the patient experience rather than through a third-party health care professional. The patient portal is one way that will shift the profession in this regard. As we move forward, let us remember a few important points: • Patient portals have the potential to create positive and widespread change for patients and health care professionals. The medical laboratory community should be involved in spearheading this movement given the potential professional role that can be played.

Question: Outline current issues and trends and what might be strengths and challenges that a millennial may help to facilitate via social networking, text messaging, and other channels? Would this communication work with everyone? Please explain your rationale. 

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.