The Royal College of Pathologists of Australasia (RCPA) and the Royal Australian College of General Practitioners (RACGP) have warned the Government's proposal to remove the 7-day delay for all pathology and diagnostic imaging reports on My Health Record may lead to misinformation and patient distress.
Both the RCPA and RACGP support sharing healthcare data with patients, but want the current 7-day delay for tests not already available in real time to remain in place. This allows doctors to help patients understand and interpret results in a safe and caring setting. The colleges also request the Government include them in any future consultation.
President of the RCPA, Associate Professor Trishe Leong, said patients should review results with a specialist.
"The RCPA believes that patients should be fully engaged in managing their care, and access to diagnostic information is part of that management," Associate Professor Leong said.
"We therefore support the sharing of information without barriers to access, such as the 7-day rule, overall. However, it is critical that if these delays are removed, consumers are advised to review their results with their GP or other specialist and are also provided with evidence-based information on pathology testing such as Pathology Tests Explained, and contact details for general support services, such as GPs and Lifeline.
"Whilst the RCPA acknowledges that there is potential for improved care through the quicker provision of results and less patient anxiety, we must consider the unintended consequences of a patient failing to return for a clinical appointment because results are within the normal range or misinterpreted. This significantly impacts patient care and requires a system for monitoring. Similarly, the impact on healthcare providers needs to be considered, with increased communication from patients to the referring healthcare providers or directly to the laboratories, wanting to know the meaning of an unexpected abnormal result."
Currently, patients must wait seven days before they can access most pathology and diagnostic imaging reports that have been shared to My Health Record. This delay allows healthcare providers to review and schedule appropriate follow-up with their patients.
Under the proposed changes, the 7-day delay will be removed for all pathology and diagnostic imaging reports, meaning patients will be able to access results as soon as they are shared to My Health Record.
RACGP President Dr Nicole Higgins said the delay gives GPs and patients a vital opportunity to discuss results.
"We strongly support patients having access to their results and medical history," Dr Higgins said.
"GPs and other specialists don't seek to be medical gatekeepers, but we are there to support our patients to understand their results, treatment options and next steps. The 7-day delay gives us and our patients time to make an appointment where we can sit down and have those important conversations.
"Much of the terminology entered into My Health Record, is written for doctors, by doctors, and has to be understood in the context of a patient's medical history and other health factors and conditions. Patients often get good insights and find support by looking into their results, but it's important they know what their results mean for them. That's the value of having a usual GP.
"A pathology result can be stressful, so there's real value to having a two-way discussion with a trusted medical professional. There is also a worrying amount of vague, unapplicable, and outrightly incorrect information online. Patients who have worked with a doctor to understand their health are better supported to know what information applies to them, and what doesn't.
"If this change does go ahead, at the minimum it should not happen without an education campaign for patients so they can understand the risks of interpreting their own results. There will need to be clear advice in the My Health Record advising patients to discuss results with their doctor."
Both colleges recommend some diagnostic tests are considered for exclusion if the 7 day rule is removed. This includes anatomical pathology and cytopathology reports, which are often discussed at multidisciplinary team meetings to determine an appropriate clinical path, and genetic test results which often carry broader, more long-term, and more complex implications than other pathology results.
"Anatomical pathology and cytopathology reports can be very complex, and consideration is required as to whether their immediate release is in the consumers' best interest," Associate Professor Leong said.
"Genetic test results are often probabilistic, have consequences for family members, have potential psychological impacts, can have unanticipated implications, and vary in their actionability and therapeutic options. Post-test counselling is therefore considered crucial to prevent potential patient harm from specific genetic tests and results.
"Pathologists and requesting doctors are best placed to determine when specific genetic tests or results require post-test counselling. To allow for such counselling, providers should have the discretion to delay releasing results for up to seven days when clinically warranted."
Noting that there will be exceptions to immediate publication to My Health Record, the RCPA and RACGP recommend that there is broad consultation on the exceptions. The colleges request that they are a partner in those consultations with Government to ensure there is appropriate oversight and governance of these decisions.
