Pathology Reporting- Enabling patients to self-manage their health

The NHS IT strategy focuses on the power of information to deliver the ambition for patient-centred healthcare.

“ Pathology is an information business.
   Pathologists provide useful answers to good questions.”

Evidence, safety and quality – an information strategy for NHS Pathology (Royal College of Pathologists, 2008)

If pathology is an information business, how can pathology deliver the ambition for patient centered care?

By 2015 pathology reports are to be made available directly to patients. For pathology, reporting is a principal means of conveying information.

‘The move to patient online access to GP records – including test results – by 2015, and eventually to fully integrated electronic health and social care records, will be transformative in the relationship between health professionals and patients, and between patients and their health and wellbeing’ (National Pathology Programme: Digital First: Clinical Transformation through Pathology Innovation)

Currently, pathology reports are sent back to the requesting clinician, who acts as an intermediary between the patient and the information that they would like to know about their  health.  

Here is an example of a typical lab report:

This  pathology report is written in bio-medical code. They are abstract- if taken out of context. They need interpretation- expert clinical or expert patient interpretation. They answer a question posed by a clinician, not a patient or at least mediated by a clinician. Do they deliver information in a format that is patient friendly? Do they answer the questions that the patients really need answering? Do they transform the relationship that the patient has with their own health and wellbeing? Do they enable more active self-management?

NHS England and the RCGP are looking towards self-management to transform the outcomes for patients with long-term conditions and meet the challenge of an aging population.

NHS England and the RCGP support a new model of care for long-term conditions , ‘The house of care’, that also aims to be ‘transformative in the relationship between health professionals and patients, and between patients and their health and wellbeing’

Pathology plays a large part in long-term chronic disease management. Chronic disease monitoring bloods make up more than 50% of all bloods requested in primary care. These blood tests are central to monitoring disease progression and therapies and thus enabling the NHS outcomes framework domains:

Domain 1: Preventing people from dying prematurely
Domain 2: Enhancing quality of life for people with long-term conditions

These blood tests have become systematic care processes in primary following the introduction of blood monitoring processes and targets in the GP quality and outcomes framework (QOF) contract. However, outcomes from QOF have been disappointing, one of the reasons being that it is not enough to just perform a process, such as a blood test,  processes need to be acted on- and ultimately by patients.

The house of care model aims for a transformation of the relationship between health professionals and patients. Information is to be owned by patients, clinicians facilitate a personalised action plan.

Pathology reports can facilitate the house of care model and this transformation of care, by providing reports for long term conditions for patients, not clinicians, and thus enabling patients to self-manage.
Can pathology infographics do this? Can this format deliver information in a way that is useful to patients in managing their own health?

(test report by Dr John O’Connor, consultant biochemist RDE Hospital)

Order comms and chronic disease order sets could facilitate these reports by automatically coding the request as a chronic disease review. Reporting algorthims could be agreed with all stakeholders and the reports could become more personalised as IT becomes more integrated and other measures such a weight and BP are available to the lab to incorporate into the reports.

The reporting IT platform could also be linked to more innovative  patient information, tele-health monitoring or social media self care communities that support each other.
The lab could also agree referral criteria and make onward e-referrals to specialists ie: renal physicians and diabetes specialists (innovative direct referral pathways)

Enabling further innovation:  for cardiovascular disease, diabetes and renal disease, the pathology lab could co-ordinate all care processes into a personalised care report for patients. You could see, for these longterm conditions, at least, the lab taking on the co-ordination of all monitoring processes. For chronic disease, where complexity is low, the lab could   provide better  standardisation of care through agreed reporting algorithms?

This can free up clinical time in primary care to focus on relationships/ action planning and holistic care/ discussion of personalised reports……which may improve outcomes in a way that QOF has not delivered.

What will we need to do to make this happen?

• Good pathology and GP collaboration- in the use of order comms and chronic disease order sets and reporting
• Working on an IT solution to deliver reports that work for patients, primary care and secondary care and enable lean patient pathways and facilitate further patient self-care
• Primary care, pathology and specialist algorithms/ pathways
• Working with patients to find out what they really want to know
• Working with public health and behaviour change specialists, medicines optimisation teams- how should we be presenting information and what information is useful to patients?