Critical values are defined as “laboratory results that indicate a life-threatening situation for the patient.” Because of their demanding nature, the appropriate healthcare professional must be notified urgently of a critical value.
In the field of dermatopathology, the College of American Pathologists defines a critical value as a critical diagnosis such as “a medical condition that is clinically unusual or unforeseen and should be addressed at some point in the patient’s course.”
All laboratories, including dermatopathology labs, are required to exercise effective communication when it comes to reporting critical diagnoses and must have a written protocol in place. This is in accordance with laboratory regulations outlined by CLIA (Clinical Laboratory Improvement Amendments; CLIA ’88) and the Joint Commission (TJC) National Safety Goals.
Dermatology clinics should understand what qualifies as a critical or a significant unexpected diagnosis. By examining how labs identify and manage critical diagnoses, defining the referring provider/lab partnership, and understanding how results are shared, we can expedite treatment and improve patient care.
Management of Critical Diagnosis in the Lab
Immediate and decisive action is required in the dermatopathology lab to identify and report critical diagnoses to the dermatologist as soon as possible. Every dermatopathology laboratory should have a written protocol outlining the diagnoses that are considered critical. In most instances, a new diagnosis of invasive melanoma is considered a critical diagnosis, as well as a life-threatening diagnosis such as staphylococcal scalded skin syndrome, graft versus host disease, or toxic epidermal necrolysis. Unalarming in appearance, each of these skin disorders could lead to serious health complications if not treated quickly.
Once identified as critical or significant, the laboratory is responsible for documenting how and when the results are communicated with the dermatology clinic. If the diagnosis is shared over the phone, there should be a record of who made and received the call. In addition to ensuring the clinic accepts and understands the results, the lab keeps a record to comply with existing laboratory regulations.
The Referring Provider/Lab Partnership
When a clinic and laboratory form a new partnership, the dermatologist and lab open communication lines to clarify the types of results they define as urgent or critical.
Though 75 percent of laboratories have a written policy for handling critical and significant unexpected diagnoses, clinics need to ensure their lab’s processes meet the needs of patients and practices (for instance, if a dermatologist establishes that he or she wants a notification for melanoma in-situ as well as invasive melanoma, or for unexpected cases of Tinea spp). By communicating regularly regarding cases, mutual trust will develop over time between the lab and the clinic.
Sharing Urgent Results
The most crucial step in the critical diagnosis process comes when the dermatologist shares the results with patients and points them towards treatment. The urgency is real, as the rate of survival decreases 5 percent for patients with stage I melanoma treated between 30 and 59 days compared with those treated in the first 30 days after diagnosis.
To ensure fast and precise action, it is helpful when labs share critical values directly to the EMR in addition to a phone call. Full-service dermpath labs like PathologyWatch transfer results and digital images electronically, enabling clinics to correlate with dermatopathologists instantly. At the same time, accessing the diagnosis in the EMR makes it easy for dermatologists to quickly share the results with patients on a tablet or laptop, reducing worrisome waiting periods.
Whenever a dermatology clinic sends a batch of request sheets to the lab, there are chances for revealing critical diagnoses. By clarifying what constitutes a critical value, defining the referring physician/lab partnership, and examining the best way to share results, you can increase optimal treatment and recovery for patients.
Dermatology clinics carry the responsibility of providing patients with correct test results from dermatopathology laboratories. With 9,500 Americans diagnosed with skin cancer every day, the weight of managing pathology orders and results is critical to ensure every patient’s diagnosis is received and shared in an organized, accurate, and timely manner.
Experienced dermatologists know there’s more involved in processing pathology results than sending out request forms and waiting for results to return. By being proactive, defining the lab’s responsibilities, evaluating paper and electronic workflows, and exploring the advantages of an EMR interface, you can ensure your dermatology clinic provides optimal quality of care to your patients.
The Clinic’s Responsibility
Patients hold their dermatology clinics accountable for sharing biopsy results, which means it is up to the providers and their staff to receive, organize, and deliver pathology results directly to patients. While it takes an average of 12 years of schooling and training to become a dermatologist, it only takes a few moments to lose a patient’s trust.
Labs return their reports to clinics through various channels, including fax, web portal, courier, and mail. The dermatology practices keep track of these results and share them with their patients. Proactively opening the communication lines between the clinic and the lab is the best way to make sure nothing slips through the cracks. By checking in with the lab frequently to follow up on cases, a dermatologist can stay on top of any delays or missing reports while answering questions that may help to produce more definitive diagnoses.
According to Tammie Ferringer, MD, open communication between the clinic and the lab is “totally appropriate and should occur.” The dermatopathologist advises, “Calling is absolutely acceptable, and it is usually easier to get ahold of a dermatopathologist than a lot of dermatologists because they’re seeing patients constantly.”
The Lab’s Responsibility
The dermatopathology lab is obligated to deliver case results and alert the clinic of any unexpected or urgent diagnoses. Labs deliver their diagnoses using documented communications, keeping records of faxes, correspondence, and deliveries. However, the lab’s obligation stops once the clinic receives the results. The dermatology practice coordinates and shares the results with their patients.
Dermatology clinics have the option of sending requests and receiving diagnoses via traditional paper or electronically. Even though 70.2 percent of dermatologists report using an EHR in their practice, many still prefer to use paper when communicating with labs.
One disadvantage of paper is the task of matching outgoing orders with incoming results. With some dermatology practices seeing 40–50 patients per day, managing a paper workflow can create a bottleneck and impact the time to deliver results to patients.
Current events also point towards electronic records as a safer solution for clinics to consider. “We’re in the era of social distancing, so it’s time to embrace EMRs and other technologies that make it safer for us to do our jobs,” notes Mark D. Kaufmann, MD, FAAD. “This will help us be responsible in the COVID-19 era, as well as create new efficiencies in terms of billing and coding.”
Interfacing the EMR
Working with a lab that interfaces electronically with a dermatology clinic’s EMR introduces a new level of streamlined reliability. In an instant, office staff can see which orders are still outstanding and which diagnoses are ready to be reviewed and shared with patients, with some interfaces using color codes to flag new or urgent results.
In addition to simplifying sorting, searching, and managing requests, an EMR interface, like the one provided by PathologyWatch, includes immediate access to whole-slide images and access to academic-level dermatopathologists. PathologyWatch makes it easy to pull up digital images and review them independently or with the patient.
Your dermatology clinic moves quickly to ensure your patients receive accurate results with an acceptable turnaround time. If you take time to evaluate your practice role, understand the lab’s obligation, compare paper and electronic workflows, and consider an EMR interface, you’ll find ways to improve the management of pending specimen lists and report distribution to serve your patients better.
Dermatology patients rely on their physicians to provide accurate diagnoses and effective treatment plans. With three out of four providers indicating electronic medical/health (EMR/EHR) systems enhance patient care, integration with pathology reporting is a valuable transition every clinic should consider.
You want the most cost-effective and reliable method to link information between your dermatology clinic and the laboratory’s lab information system (LIS). By breaking down the limitations of traditional paper communication, learning about interfaces, examining the two types of integration, and understanding the interface challenges, we’ll cover all of the basics you need to know about integrating an electronic interface to elevate your practice and improve patient care.
Many dermatology clinics continue to rely on traditional paper when it comes to lab correspondence. When ordering tests, these practices handwrite requisition forms and manually create carbon copies, so a record stays in the office. Once received by the lab, the requisition information is typed into the LIS and matched to the biopsy. When the lab completes the patient report, the paper is attached and sent back to the clinic via fax, mail, or courier.
The exchange of paper between clinics and labs is tried and true for many; however, it does open the door to certain errors that can impact patient care, such as the amount of time it takes to write out forms and re-enter the same data into the LIS. The longer it takes to process and receive information, the longer it will take a patient to receive a diagnosis. It also increases the chance for errors to occur during user translation. Repeatedly entering the same data into patient records invites opportunities for human error. Despite these drawbacks, many clinics continue to use paper as a standard, especially if an efficient electronic health record is not being utilized.
While working with paper can lead to inaccuracies or delays, an electronic interface can decrease turnaround times and errors. These benefits appeal to tech-savvy dermatologists, who have a 63 percent adoption rate of EHR technology.
A significant benefit of integrating the clinic EHR with pathology reporting is that fields and data entered into one system can communicate with an entirely different system. As a result, users from the clinic and the lab can search the same patient data or perform quality lookbacks through their EMR using their current systems. This reduces data entry errors and can also allow for identification of improperly labeled specimens, reducing patient risk.
Types of Interfaces
Choosing the right electronic interface can help increase a lab’s efficiency and workflow.
There are two types of interface for you to consider: unidirectional and bidirectional. A unidirectional interface can only transmit information one way. It can either send orders from the clinic to the lab or receive results from the lab to the clinic. The latter requires clinics to continue to submit paper orders.
Using a bidirectional interface provides a convenient two-way line of communication between the clinic and the lab. Sending and receiving digital orders can reduce time and mistakes, though a bidirectional interface requires programming for both locations. Both types of interfaces are utilized with success, depending on the unique workflow of each practice.
Once an electronic interface is selected, real work is required before it can be activated. As more than half of dermatologists see over 50 patients per day, the initial investment of time and effort will pay off in the long run with productivity and dependability.
Interfaces are not simple plug-and-play systems. Individually coded, they require IT support to set up a secure line using a unique virtual private network (VPN) or other similar structure. Programmers use health language 7 (HL7) to reliably transfer patient records and study orders between the clinic and the lab. Full-service dermpath labs like PathologyWatch are designed to shoulder the burden of integrating an electronic interface into your practice.
Today’s EMR systems are full of complexities and functionality, with one leading vendor providing 3,100 automated treatment plans and procedures for dermatologists. By looking at the differences between a paper and digital workflow, exploring different types of integration, and understanding installation, you can assess whether integration with pathology reporting can help you get the most out of your EMR and your practice.