Easing the Panic

One of the intentions of the 21st Century Cures Act – first passed in 2016 – was to ensure that patients have full, portable, cost-free access to their healthcare information. Over the past few years, many concerns have been raised among pathology and laboratory medicine communities in preparation for compliance with the Act. Among these concerns, the risk of potential psychological harm to patients sits at the top of the list. Having a biopsy is stressful enough and waiting to receive the report can add even more layers of anxiety – but, at the same time, understanding these highly technical reports can be challenging for patients. At my organization, we pathologists wanted to offer supportive resources to ease the panic our patients might feel when reading their report without fully understanding it and before speaking with the treating provider. We tried to put ourselves in our patients’ shoes and, after talking with several pathology groups, we decided to offer three main services:

1. Providing a link to an approved online glossary of pathology-related terms.
2. Making the patient aware that they may be seeing these results before their treatment provider has seen them.
3. Offering a method for patients to directly contact a pathologist.

Though the first two goals were relatively easy to implement, the third was something we had not seen elsewhere – providing our Epic Beaker Analysts with an implementation challenge.

As an outpatient, predominantly biopsy-driven pathology lab, we are in a unique position to act as general pathologists. Because we can answer a variety of questions, we created a pathology message pool that allows patients to directly message us with questions about their pathology reports. Through a link on the report, patients can send messages via our patient portal (although we clarify that we prefer patients to discuss results with their doctor first and then message us if they have additional questions). Expected response time is three business days, but we usually answer questions within two. We also make it clear that the message pool is not for urgent clinical communication or a second opinion for reviewing slides.

The pool is currently monitored by a weekly rotating group of five pathologists. They have reported enjoying the interactions with patients and being able to answer questions that put people’s minds at ease. Monitoring the message pool has not affected normal workflow and is done in addition to normal service workloads.

Since going live six months ago, the pathology message pool has had 30 patient messages, each taking approximately seven minutes of a pathologist’s time to answer. Questions were mainly about skin and GI biopsy results, which is not what we anticipated; we expected to receive questions about cancer reports, particularly from our breast cancer patients. Some patients asked about the next steps they needed to take based on their reports and others had questions about terminology and the meaning of their diagnosis. In some instances, we were able to help our patients get in touch with appropriate clinicians for follow-up and treatments.

Overall, we have enjoyed implementing this service and we know of no other pathology group providing direct contact via the patient portal. Patient feedback has been positive, with many thanking us for our prompt attention. In the few months since its implementation, we have seen a decrease in the frequency of messages through the pool, but we continue to let clinicians know the service exists and encourage them to bring it to the attention of patients undergoing biopsy. Going forward, we hope to increase our message volume and continue to provide this novel service – connecting patients with pathologists and making their healthcare journey more transparent.