My morning ritual after unlocking the office door, carrying in the paper shredder, trash can and turning on the K-Cup Coffee maker is to directly import laboratory results into the EHR. Usually three to five patients a day, and most have a patient portal, a very easy and mindless process. Once in the EHR inbox, electronically I send the laboratory results along with a letter template individually modified to the launching pad, just a few clicks and in seconds completed. My nurse will take the ball from there, but will send, “Dear Mr. X, Included is a copy of your laboratory results which we can discuss at your upcoming appointment,” along with the laboratory results to the patient via the portal and on average three days before the visit. My patient will have already been instructed by my nurse to watch for the results, to allow time to review, compare to last years results, print up and bring to the office with notes in hand prepared and ready for the visit.
During the office visit after turning on the TV and attaching the Chromebook, all of this mindless and fairly effortless work comes to fruition. When I get to the laboratory discussion, after visually reviewing vitals, past histories, medication reconciliation & allergy, and health maintenance items, the results can be better interpreted by both of us with all of this in mind.
The HL7 imported laboratory results are easily viewed and compartmentalized, first the complete blood count then the comprehensive metabolic panel and lipids. I will click on individual parameters and if for instance the total cholesterol is elevated, I can then project the past three years of results on a graph. The graph is easy to understand and very powerful information since we just discussed past medical history and medication treatment, so response to care easily demonstrated. Any of the laboratory results individually can be thrust onto the large TV screen for discussion, and printed to paper or sent to the portal if requested.
My patients appreciate having this option to review laboratory results in the convenience of their home on the device of choice before the visit, and also to visually integrate the results with me at the office visit.
For me, I have to pinch myself with each encounter, because I never thought I could practice in such a way just a few years ago. The simple affordable tools in the correct setting makes this possible and truly remarkable from an internist’s point of view.