Let’s say — just for fun — that you got a blood test.
Let’s also say you’re female and a heavy smoker.
Your test showed 12.5 grams per deciliter of hemoglobin, which is on the low end of the normal range for women.
That’s good, right?
“When you smoke, you’re sort of starving the body of oxygen,” said Reid Blackwelder, president of the American Association of Family Physicians. “The body’s response is to create more hemoglobin to carry more oxygen to your body. Smokers almost always have a high-normal hemoglobin.”
That illustrates the problems that can result when patients try to interpret their own lab test results without talking to their doctors.
In a move supporters say allows patients more control over their health care, the U.S. Department of Health and Human Services issued a rule this month that allows patients direct access to their lab results. Oregon already has such a law, but people might not know about it.
While the nation’s leading health organizations have come out in support of the new federal rule, they also caution that getting the test results directly should not cause people to think they don’t need to talk to their doctors about them. Whether the tests are normal or abnormal, doctors are able to consider the nuance of individual patients’ conditions.
Oregonians can get results faster
In many offices, the protocol is: If you don’t hear back, that means everything is fine. But Blackwelder said he doesn’t think that’s a safe approach.
“Even in the days of electronic records, something might not get noticed as it should,” he said. “I think it’s a much better process to basically say to someone, ‘I’m going to get back with you and let you know what the results mean. Normal or not, we’re going to have that conversation.’”
The federal rule won’t change much here in Oregon, where state law affords patients much faster access to their results than federal law does. Oregon law requires labs to hand over the results within seven days of a patient’s request. The federal rule gives labs up to 30 days to fulfill the request. Another provision of Oregon’s law allows doctors to request that the lab send the results directly to the patient when they’re ready.
The laws pertain to any and every test doctors order for their patients, but the most common ones are the complete blood count (CBC) test, which measures hemoglobin, platelets and red and white blood cells in the blood, and the lipid panel, which measures cholesterol and triglycerides.
But even the simplest tests can be misleading to someone who’s not familiar with how to read the often cryptic-looking reports.
A test could show abnormal blood-sugar ranges, for example, but that might just be because the blood was drawn after the patient ate lunch, Blackwelder said. And the results of a test that gauges kidney function by measuring a waste product in the blood would mean different things to an older person versus a younger one, he said.
Although most tests are now standardized across the country with respect to how they crunch the numbers, some can turn up different numerical results after testing the same thing. The American Association for Clinical Chemistry has lobbied to have all test results harmonized so that the differences don’t cause confusion.
All lab results should contain standardized information regardless of where they came from: the patient’s name, the date, the date collected, test name, etc. They should also include a reference chart that tells the reader what is normal and abnormal and the units associated with each result, such as milligrams or milliliters, said Catherine Hammett-Stabler, a pathology and laboratory medicine professor at the University of North Carolina at Chapel Hill.
While having that information helps patients become more engaged in their health care, doctors are still in the best position to help them understand the nuances of the lab results, she said.
“They also have to take the responsibility of asking questions,” said Hammett-Stabler, a member of AACC’s government relations committee.
Few people using the law
Federal researchers predict that under the new law, only 0.05 percent of lab results in the U.S. will be requested directly by patients, said Rita Youell, laboratory compliance section manager at the Oregon State Public Health Laboratory, a division of the Oregon Health Authority’s Public Health Division.
Since Oregon passed its own law in 2003, few people have taken advantage of it, she said.
“It has been very, very low, the numbers that I am aware of,” Youell said.
Many Oregonians may not be aware of their right to access their lab results. When the Legislature passed the law, most labs kept quiet about it, probably preferring that patients continue to get the results from their doctors, Youell said. Only one lab, PeaceHealth Laboratories in Eugene, turned it into a marketing tool about six years ago, she said.
“They said, ‘If you come here for your lab work, you’ll be able to get your results from us,’” Youell said. “It was kind of different because since 1969 you weren’t able to do that.”
The new federal rule changes Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow laboratories to give a patient or the patient’s designated representative access to completed test reports on request. It eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to an individual’s right to access his or her protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory.
Making lab results directly available to patients aligns with a trend in health care Youell said she’s been observing: Patients taking more active roles.
“More and more people are getting engaged in their health care and understanding it, making sure that their medical record is correct,” she said. “‘Yeah, that was me that day. I had that blood drawn.’ I think it’s all really good.”
— Reporter: 541-383-0304,
Editor’s note: This article has been corrected. The original version mischaracterized how a blood sugar test result might appear after a meal. The Bulletin regrets the error.