I would suggest that best practice would have signed agreements stating
where responsibility lies for standard and urgent results and the
methods of delivery for each category. Seeing as most clinical packages
do NOT produce HL7 ACKS then the best the path companies can do is prove
with an ack that their download client received the files.
My system provides these acks and I believe at least one case
surrounding a missed abnormal PSA found against the GP and not the path
company where a result was lost to follow up.
I think the responsibility for following up a test result should 100%
lie on the shoulders of the requesting doctor :) You order it, you make
sure you get a result. There are so many reasons where the chain can
break down and these are beyond the pathology firms responsibility and
control. From my standpoint if I have a fax transmission log or an
electronic ACK that your practice got the result and something untoward
crops up - it aint my fault.... The college had some concerns about the
"medicolegal exposure" of elecronically ordered tests that patients
never went to have especially relevant when maybe 20% of tests never
get done -(what do you do if the dr orders a PSA and the patient never
presents? how far do you go? how far do the courts expect? like pap
smears and failure to return for a smear with multiple letters etc?)
That said I am of course committed to ensuring to the best of my ability
that results are delivered and acknowledged to referring doctors, i
routinely send critical diagnoses by 2 delivery methods regardless of
"standard" for that practice - eg melanomas get a fax and an electronic
copy or a hard copy.
On a practical note most IT issues lie at the receiving end and relate
to variable quality of implementation within GP and specialist practice.
I would recommend you all immmediately harass your clincal software
vendors to make sure they institute HL7 acks and complete the chain and
institute internal followup/matching of requests and results. That is
vital to avoiding misses.
JD
nexus pathology
syan tan wrote:
I would have thought the path company and the gp is likely to get sued
first as cojoint responsibility for a break in the communicating of
important results. The path company could then get out of responsibility
if they can prove that they contacted the gp directly (spoke to the gp)
if it was an urgently critical result. Don't think sending an urgent fax
to an unmanned clinic would be good enough.
Sometimes the path company will deem a result semi-urgent, like grossly
abnormal liver function results that aren't likely to indicate complete
liver failure, merely obstructive jaundice, or hepatitis, and just fax
it, or send it the next day, have had that experience.
Apparently they have a manual to say which abnormal results need direct
communication.
With non-urgent results, if the path company can just prove they sent
it through normal channels, usually mail and electronic together,
the onus would be on the gp to chase up unarrived results . It helps
to ask the patient to do the chasing, by ringing up for the results,
or making an appointment to discuss the results, but if they don't do
it, and the result is critical and it is missed, the courts would
probably not favour the gp. What do the MDOs say ?
On Thu, 2007-03-08 at 16:17 +1100, Chris Scott wrote:
What is the 'lists' understanding of whose legal responsibility it is
to monitor the receipt of inbound messages (Path, DI, DS etc) into
Practice software from download applications?
It appears that generally download applications will normally notify
the sender of receipt. The GP clinical software may or may not be set
up or capable to pass acknowledgement back through the system to the
sender.
Chris.
Chris Scott
Chief Information Officer
Hunter Urban Division of General Practice
Tel: 02 4925 2259
Mobile: 0413 945 564
Help Desk: 02 4929 1000
http://www.hudgp.org.au
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