10_PatientResults

10. Manage patient results

Staffing

Consideration

Identify the appropriate staff to reach out to patients prior to the patient being tested.

Decide if there are staffing differences to consider for positive vs. negative results.

Manually calling each person can be resource intensive.

Voices from the Field

“We don't start testing with anybody unless it's very clear who is going to be the ordering provider for them and who will provide the follow-up. This includes following up with negatives as well.”
“All the results that come back to us it goes to a nurse pool that calls the patient, both whether it's positive or negative”
“They receive a direct call from one of our providers, a physician who is assigned to whatever test site we have.”
“If a PCP is involved, then the PCP is contacting the patient. If the PCP is not involved or they are being ordered by a physician out of our rapid evaluation center, then they contact the patient.”
“We get a daily list of every negative result that will go into our drive-through sites and we have a whole other team, their job is just to just go through and make negative calls for negative notifications all day.”
“If the patient is to [get tested] today it is my responsibility to make sure the patient [receives their results from] a physician.”
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Electronic notification systems

Consideration

Apps and on-line portals are efficient but may limit meaningful provider follow-up with patients needing care.

OSCTCs may require patients to register in an EMR to streamline communication of results.

Read-receipts and built-in provider follow-up can support a strong follow-up process.

Voices from the Field

"Amazon [could]... I believe to sort of provide some sort of text follow-up so if you are positive, they have some type of a text that goes to that patient to just check and see how they're doing from a symptom standpoint if they tested positive."
“If you just went down as a community citizen, you would be handed a pamphlet that says please login to this [name] portal and access your own account so you would have the ability to login and create an account so as soon as [name] posts your results, you would get real-time notification of when your results are up.”
“We offer a platform which helps you schedule, report daily symptoms, receive your test results, and if you consent to sharing test results with your employer or your institution”
“We have some concerns about it [app with contractor giving results] just because it takes the provider out of kind of getting those results to the patient”
“It's really critical these results are put in their electronic medical records as soon as are available.”
“Every person getting tested is getting a record created in Epic and then they have access to what is called, “My Chart” which is the ability to go into Epic and look up your own record.”
“…it pops up on your phone, is a HIPAA compliant closed-loop system where we send results to people by the same text message-based interface that we include in our intake form…
“We can see when we send a message to somebody if they open the message, so we know if somebody got the results or not…when we see that people don't open their results. We then pursue every other channel of communication method for them.”
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Know the best way to contact patients

Consideration

Discuss options for getting the patient their results prior to conducting the test.

Offer alternative ways to get patients their results.

Voices from the Field

“We communicate by text message. That's great for some people about 85% plus of our people can handle that. Some don't have a cell phone with no smart phone with text message capability. Some want an email. Some want a phone call. We have visited homes to deliver messages to people. We have walked around assisted living facilities to deliver messages, but the key is that you, on the intake, you find out every possible mechanism of getting information to a person and incorporate in that, the consent to share that information. So, we have the first question which is: do you have a cell phone, “yes, great” Do you have a home phone? If not, “No” Do you have a phone at the facility where you are residing? “No” Do you have a relative or friend? In all these iterations to try to make sure you can close the loop. …we are ….continually culling through data to try to make sure that nobody gets left hanging.”

Homeless populations

Consideration

Getting results back to the homeless population can present challenges.

Being clear about when OSCTC staff will come back to their testing location with their results may be a solution when no contact information is received.

A central, well-publicized hotline, may be an effective way of allowing patients to call to get their results.

Voices from the Field

“a lot of them didn’t have a phone number or an address so we would tell them, contact us at this time, come by here and will have the results for you. And they would just stop by, we would hand them an envelope, we would have a nurse come out and speak with them.”
“I can't have them sit around for a couple of hours because it takes the guards some time to be able to run every single test … through the Abbott machine. I have them come back around 1:30-2 o'clock because at that time I would definitely have their results. And I have to say that they all came back. And they were grateful, and they just wanted to know what their status is.”
“There’s a hotline…you can call to see if your results are back”
“The key is that you, on the intake, you find out every possible mechanism of getting information to a person and incorporate in that, the consent to share that information…. sharing with shelters or other facilities.”
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Employer-sponsored testing

Consideration

Results may be directly shared to employers if this authorization is included in the consent process.

Identify key contacts at each facility that will receive results.

Consider using electronic platforms to streamline the process of sharing results for large numbers of employees.

Voices from the Field

“... consenting for sharing information with an employer, if it is an employer derived testing program…sharing with facilities if they are assisted living facility residents, sharing shelters or other facilities." 
“At our nursing homes or assisted livings, we usually have a point of contact at each one of those so that we immediately get results back…each facility has a portal that they can directly log into and look at their results. So, each facility is able to go in and monitor their staff and residents as we perform the testing in those facilities.”
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Public health data requirements

Consideration

Test results also need to be shared appropriately and timely with public health officials.

Race and ethnicit data was frequently reported as challenging to receive.

The diversity of types of tests, laboratories doing testing, and increased number of point-of-care tests may require new systems to be built to ensure all results are captured centrally.

Moving away from faxes and using electronic systems will help ensure that all required information, including race and ethnicity, is collected during testing and transferred appropriately to health departments.

Voices from the Field

“[It] had been a paper system and we needed to scale up, we needed this online order entry system, we needed a provider reporting system online, …we needed to be able to deploy it to the state system for understanding results overall, (it’s what the public health case investigators use), and then locally in the county there's a shared health information exchange and we wanted to be able to integrate results into the HIE.”
“...public health data set… are fraught with problems, like missing race and ethnicity to data that is 60% missing”
“...racial data was not necessarily transferring from being taken at the initial test and so what it meant was that public health department had to track down the racial demographics during contact tracing”.
“There's a lot of data that we're looking for with lab results that are really challenging, and I'm thinking specifically race ethnicity data and … right now in the era of contact tracing we really need more reliable data addresses, phone numbers, things like that, and even have some medium sized labs in the state that are routinely sending up labs without that information and it makes it very challenging.”
“...trying  not to rely on manual processes as much as possible…”
“We needed a way for them to collect that information and send it to us beyond faxes because we were just getting a load of faxes early on. So, the team developed an electronic reporting portal and then spends a lot of time working with those clinics helping them understand how to input that information.”
“If it’s a positive case it is faxed immediately over to our public health team so that they’re notified and faxed to the ordering provider, so whoever that ordering PCP was would also get the fax notification.”
“One of the things that has been both a real boon for getting adequate testing in the communities as well as a challenge for us to meet that mandate is that there are a lot of new groups out there testing who have never before had to report to the state… The larger labs, the clinical labs are all use to that they just had to switch in their system what lab results are coming to us, but research labs that are coming online, … and then these independent point-of-care tests, all of those have really been having to work hard to make sure that the results are reported to us… we have an Epi person, a lab person, and this contract lab, and then we basically shepherd them through the process”.
“From a data collection standpoint, who is going to own all of that information and where does it need to be reported and what kind of data format? … right now, you have also got this mishmash of people are looking at some of the CDC reporting standards. Does it go to the Department of Health? Does it go to who? You don’t really know. If you do that in the private sector, do you still have the same requirements…”
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