Spreadsheet: 139498d1328276114-excel-2007-copy-data-from-cells-in-one-workbook-to-another-based-on-the-cell-headings-jama-eletters-data
Sheet:  305 18 1890

305 9 923 | Response ID | Status | Title, Author | Responder | [NAME] | Response
 | jama_el;750 | P | Ms. [NAME], April 26, 2011 | [NAME],  MBA, Six Sigma, Lean  None | [EMAIL] | Communication with hospitals and specialists is best when a patient has insurance that requires a referral from a primary care physician, because the communication chain is established with the referral, and the PCP takes ownership of the patient's documentation and next actions. Primary care physicians generate the referral notices patients and are always listed to receive documentation for medical services provided. Also, the PCP office tags the patient file for an incoming review action. If the PCP does not receive information about the referred visit, the PCP office can and will call for the missing information. Communication with hospitals and specialists that are not made through a referral from the PCP office can and does break down, because the communication chain is not established, and there is no clear owner of the patient's documentation and next actions. Most importantly, the communication process lacks an error proof hand off of the patient's documentation and next actions to the primary care physician. When the patient goes directly to the hospital or a specialist, the PCP may or may not be aware of the other medical services being provided, and by which provider. Patients are asked before each visit if they have done any tests or had any procedures done, when and by whom. However, this often has a lot of blanks. It is difficult for a PCP to own the outcome and next steps from visits that are not reported or have a lot of missing data provided by the patient.   There needs to be a medical standard for the hand off of a patient's medical documentation and next actions, between hospitals and specialists to the primary care physician. Given that the PCP may not know of the alternate medical care and findings, it should be a standard of care that all hospitals and specialists that treat a patient with a PCP, should notify them with the findings via: 1) A written copy of the visit, procedures and/or tests performed via standard mail or email copy. 2) Either a phone call to the PCP or an email directly to them. 3) A requirement that the sender receive an acknowledgement of receipt and understanding of the care given and findings by the hospital or specialist.   Without the requirement for a primary care physician to acknowledge receipt and understanding of the new information and next actions, patients will continue to have missing information in their health files and delays that would have expedited their situation.   Submitted by: [NAME], a Certified Lean Specialist   Conflict of Interest: None declared
 | jama_el;746 | NR | Ms. [NAME], April 26, 2011 | [NAME],  MBA, Six Sigma, Lean  None | [EMAIL] | Communication with hospitals and specialists is best when a patient has insurance that requires a referral from a primary care physician, because the communication chain is established with the referral, and the PCP takes ownership of the patientâ€™s documentation and next actions. Primary care physicians generate the referral notices patients and are always listed to receive documentation for medical services provided. Also, the PCP office tags the patient file for an incoming review action. If the PCP does not receive information about the referred visit, the PCP office can and will call for the missing information. Communication with hospitals and specialists that are not made through a referral from the PCP office can and does break down, because the communication chain is not established, and there is no clear owner of the patientâ€™s documentation and next actions. Most importantly, the communication process lacks an error proof hand off of the patient's documentation and next actions to the primary care physician. When the patient goes directly to the hospital or a specialist, the PCP may or may not be aware of the other medical services being provided, and by which provider. Patients are asked before each visit if they have done any tests or had any procedures done, when and by whom. However, this often has a lot of blanks. It is difficult for a PCP to own the outcome and next steps from visits that are not reported or have a lot of missing data provided by the patient.   There needs to be a medical standard for the hand off of a patientâ€™s medical documentation and next actions, between hospitals and specialists to the primary care physician. Given that the PCP may not know of the alternate medical care and findings, it should be a standard of care that all hospitals and specialists that treat a patient with a PCP, should notify them with the findings via: 1) A written copy of the visit, procedures and/or tests performed via standard mail or email copy. 2) Either a phone call to the PCP or an email directly to them. 3) A requirement that the sender receive an acknowledgement of receipt and understanding of the care given and findings by the hospital or specialist. Without the requirement for a primary care physician to acknowledge receipt and understanding of the new information and next actions, patients will continue to have missing information in their health files and delays that would have expedited their situation.   Submitted by: [NAME], a Certified Lean Specialist   Conflict of Interest: None declared
 | jama_el;738 | NR | Responsibility for Our Patients [NAME], April 26, 2011 | [NAME],  MD  Queen's University | [EMAIL] | I am responding from Ontario where this issue is clearly addressed by our regulatory body i.e. The college of Physicians and Surgeons of Ontario. Their guidelines seem to be rational and to assign responsibility for test results in such a way as to safe guard the patient.   The ordering physician of any diagnostic test is deemed ultimately responsible for ensuring follow up of the test results he/she initiates. It does not mean that they must provide such follow up, simply to ensure that the patient is aware of the result and that follow up is organized. All physicians receiving test results about any patient are also held responsible, to a lesser degree, for making sure that the patient has been informed of the result of their testing. This creates a safety net which reduces any likelihood of an important test outcome being overlooked. It is not the patient's responsibility to seek out results other than as specifically instructed e.g. to return for an appointment to review test findings.   In our healthcare system patients cannot self refer to specialists, so it may be more clear as to who is to receive information from consulting physicians. Assigning responsibility to all involved, based on the above stratagy, seems to provide reasonable assurance that patients will be made aware of their test results and that they will receive follow up care as deemed appropriate.   In the case of this 60 year old man, such an approach would have likely have resulted in him being made aware of his renal mass in a more timely fashion. Though the ultimate outcome may not have been altered, the patient would not have lost trust in his caregivers and may have avoided some of the anxiety and frustration associated with such an experience.   Conflict of Interest: None declared