A Modern Healthcare Collaboration

Pathologists and laboratory professionals play a crucial role in diagnosing, managing, and monitoring disease. However, their findings—and the lab as a whole—often remain a mystery to patients. Even after the introduction of the 21^st Century Cures Act, which requires the near real-time availability of test results, medical encounter notes, and pathology reports, many patients still view their diagnoses as coming from the treating physician who explains the results and plans necessary care. Increasingly, though, patients are taking an active role in their medical care—a development that brings with it new benefits and challenges for the lab.

Why lab-patient contact matters

Thanks to new legislation and the widespread availability of electronic patient portals, individuals’ access to their test results is faster and easier than ever. Often, patients see these results before the ordering physician has reviewed them, which can cause confusion, misunderstandings, and anxiety. Laboratory professionals can alleviate these issues and enhance the quality of patient care by interacting with patients to explain pathology reports, lab values, and biopsy slides. Direct contact is crucial for delivering accurate, timely, and patient-centered healthcare services while minimizing potential errors and miscommunications. It fosters a collaborative approach to healthcare—one that treats the patient with dignity and respect and involves them in decisions about their health.

Pathology clinics are a novel way to give patients a deeper understanding of their diagnoses and how their treatment plans are working. “My first experience with a pathologist consultation, over a decade after my breast cancer diagnosis, was transformative,” says Michele Mitchell, a patient advocate who works with the University of Michigan, the American Society for Clinical Pathology, the American Cancer Society, and other organizations. “Reviewing my slides and reports with a pathologist gave me valuable insights into my condition. There is currently an unmet need—and anticipated demand—for direct interactions between patients and pathologists. I have met with many pathologists who have demonstrated that pathology clinics can work in hospital and ambulatory care settings; now, I am applying my passion for patient advocacy by documenting the lessons learned and developing a toolkit through which others can emulate early successes in their own environments. I am working with others in the industry to develop an infrastructure that facilitates and nurtures sustainable practices and emphasizes changing the patient experience through education and direct interactions with pathologists and other laboratory professionals.”

Can patients go without?

“Patients often lack the knowledge required to accurately interpret their test results,” Mitchell cautions. “Misunderstandings and incorrect assumptions can lead to unnecessary anxiety, confusion, or even inappropriate self-diagnosis. It is essential to ensure patients have access to appropriate resources and support—not only to aid in result interpretation, but also to help manage emotions that may arise around any potential diagnoses.”

Even patients who look up individual values may not grasp the full context of their test results or the broader implications for their health. This is especially true when the results require clinical context or medical history to be fully understood. Healthcare providers—who consider a patient’s complete profile when interpreting results—play a vital role in explaining the significance of those results and providing necessary context.

But many patients prefer rapid access to information over longer delays to add context¹ and worry less when given the ability to access and research their own results—even if those results are abnormal.² In response, researchers have proposed improvements to facilitate better contact, including enhanced messaging capabilities (such as customizable settings and notifications), pre-counseling to prepare patients for results, details about when and how patients will be contacted, and the inclusion of clinical laboratory professionals on the care team.³ Some labs are already redesigning reports to use clear, succinct language or add interpretive comments;⁴ others are creating patient-friendly resources to enhance understanding.

Barriers to lab-patient contact

Several barriers can hinder consultations between patients and clinical laboratory professionals. Here are just a few:

• • Limited resources. Many laboratories operate with limited resources, including staffing and time constraints. Laboratory professionals and pathologists often have heavy workloads and may prioritize their primary responsibilities, such as conducting tests and analyzing results. These issues can prevent laboratories from allocating time or personnel for patient interactions—especially when high patient volumes make it logistically challenging to facilitate consultations for all patients who might benefit from them. Furthermore, some healthcare settings may lack the communication infrastructure or systems needed to support direct contact; not all labs have the necessary tools for secure and efficient patient communication.

• • Communication issues: Effective communication with patients requires specific skills, including empathy, patience, and the ability to convey complex medical information in an understandable way. Not all laboratory professionals possess these skills. Even for those who do, complicated medical tests and conditions may require specialized knowledge to explain and interpret. Laboratory professionals may be hesitant to engage in direct communication due to concerns about accurately conveying complex information to patients. Communication-based barriers may be further enhanced by language or cultural differences. Patients and providers from diverse cultural backgrounds or those who speak different languages may face additional challenges in direct interactions.

• • Laws and policies: Concerns about potential legal liability can dissuade clinical laboratory professionals from engaging in direct consultations. They may worry that providing information directly to patients could lead to misunderstandings or legal disputes. Even when legal considerations are not in play, institutional policies and protocols vary widely in healthcare settings. Some institutions may have strict policies that discourage direct contact between laboratory professionals and patients.

• Lack of patient awareness: Patients may not be aware that they have the option to request direct consultations with pathologists or laboratory medicine professionals. Some may not even be aware of the work of these providers, so may not know to seek out consultations.

Since 2020, many doctor-patient relationships have shifted from in-person to virtual appointments, a change that can create barriers to effective communication. Although direct communication with a treating physician should remain the gold standard when receiving a difficult diagnosis, it is not always possible on a timely basis—and the waiting period can lead to increased stress, anxiety, and uncertainty. To alleviate this emotional burden, healthcare systems are exploring new ways of facilitating patient-provider contact via telehealth clinics, electronic messaging portals, and new approaches to patient and family education.

Increasingly, patients are taking an active role in their healthcare decision-making—and using new technologies like artificial intelligence (AI) to do so.⁵ By becoming more informed and involved, patients gain a sense of control and a willingness to engage with treatment protocols, which in turn leads to better outcomes and a more positive experience. Healthcare providers also benefit from better communication (with one another and with their patients), more efficient data sharing, and improved care coordination.

However, the lack of trustworthy and understandable patient-facing information online is still a problem. To overcome it, Mitchell recommends that healthcare institutions develop clear policies and procedures, invest in training and resources, and provide patient education to facilitate direct contact between patients and laboratory professionals.

AI’s pitfalls…

AI, like any novel technology, can only enhance the patient experience when patients believe that it offers them an advantage, such as more time with their clinicians, more accessible information on their care decisions, or personalized interventions that target the outcomes of interest to them.⁶ Some patients use generative AI tools to obtain information while they wait for the ordering physician to reach out regarding test results—but the outcome may be as distressing as the test findings themselves, Mitchell cautions. “Troubling results from a genetic test were recently posted on my husband’s patient portal before his neurologist contacted us. I asked an AI tool to explain the findings, but the response I got was just as confusing and anxiety-inducing as the report—an experience that underscores the importance of trustworthy, plain-language health information.”

Other potential issues include “hallucinations” (in which AI tools create or refer to nonexistent information), the amplification of existing biases and stereotypes, and the perceived impersonality of receiving medical information from a chatbot instead of a physician. Furthermore, most medical chatbot studies have involved carefully written cases with one correct diagnostic outcome, which is not always the case in real-world situations. Patients accessing chatbot services for their own health concerns may omit critical information or fail to accurately describe their symptoms.⁷

Finally, pathologists and laboratory professionals have expressed a need for standards and guidance with respect to security for AI and other third-party applications. To address this concern, more than 20 healthcare leaders have come together to form the Health 3rd Party Trust (Health3PT) Initiative and Council, which seeks to explore the vulnerabilities of health GPT and introduce new standards, automated workflows, and assurance models to the third-party risk management (TPRM) conversation. In July 2023, the council released the Health3PT Third-Party Risk Industry Survey, whose findings demonstrated that current TPRM processes are not considered efficient or effective and that most organizations face challenges related to time, resources, audit/questionnaire variability, and customers’ willingness to accept third-party assessments and certifications.⁸

Generative AI holds great promise for improving contact between patients and clinical laboratory professionals—but it’s essential to ensure that these systems adhere to privacy regulations and ethical guidelines and that they are designed to complement, rather than replace, human healthcare professionals in patient care and communication.

… and its promises

“My experience with [AI] has been very positive,” says Mitchell. She sees the potential for patients to educate and empower themselves via generative AI in a number of ways, including:

• • Simplifying complex results and terminology. “Generative AI played a pivotal role in helping me understand the intricate terminology embedded within the findings of my recent laboratory tests and computed tomography (CT) scans. Its ability to swiftly decode technical language proved immensely beneficial. I also use AI to decipher medical jargon and translate it into more patient-friendly terms. Its quick responses and user-friendly language are impressive, giving me a clear understanding in seconds.”

• • Enhancing understanding and facilitating questions. “The AI system helped me grasp the intricacies of a recent medical diagnosis, providing comprehensive insights that facilitated my comprehension and decision-making. It then generated a preliminary set of questions to pose to my surgeon for an upcoming appointment, allowing me to engage more meaningfully with my care.”

• Suggesting relevant studies: “I relied on AI-generated recommendations to identify studies and research materials relevant to a recent diagnosis. Its tailored suggestions helped me gain a more comprehensive understanding of my health condition.”

Generative AI can also improve the quality of patient-doctor interactions by making communication faster and more efficient, automating status updates for patients with long wait times or complex tests, and bridging barriers in language and comprehension. It can even enhance ongoing care by generating personalized lifestyle recommendations, checking in with patients on treatment adherence, and sending reminders to schedule follow-up appointments.

Despite its many potential advantages, though, it’s possible to rely too heavily on AI. Many patients value human interaction and the ability to ask questions of healthcare professionals directly—especially when dealing with unfamiliar lab tests and concepts. Some may also struggle with technologies they haven’t used before or express concerns about the privacy and security of their health data. That’s why it’s so important for labs to be transparent in the ways they use AI and other technologies and to reassure patients that, as always, human laboratory professionals remain at the heart of their care.

“A transformative movement is taking root—one that fosters interaction between pathologists, laboratorians, and patients,” says Mitchell. “Can we seize this moment to bridge the gap between medical expertise and patient engagement? The time is ripe for bold steps and innovative endeavors that combine knowledge and compassion to redefine the course of patient care.”

References:

1. 1. Hulter P et al. Patients’ choices regarding online access to laboratory, radiology and pathology test results on a hospital patient portal. PLoS One. 2023;18(2):e0280768. doi:10.1371/journal.pone.0280768.

1. 1. Steitz BD et al. Perspectives of patients about immediate access to test results through an online patient portal. JAMA Netw Open. 2023;6(3):e233572. doi:10.1001/jamanetworkopen.2023.3572.

1. 1. Everson J. New Study Shows Patients Prefer Immediate Access to Test Results and have Unmet Information Needs. HealthITbuzz. March 20, 2023. https://www.healthit.gov/buzz-blog/information-blocking/new-study-shows-patients-prefer-immediate-access-to-test-results-and-have-unmet-information-needs.

1. 1. Vasikaran S. Interpretative commenting. Clin Biochem Rev. 2008;29:S99 –S103.

1. 1. Booth AL et al. “Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience. Arch Pathol Lab Med. 2019;143(7):852–858. doi:10.5858/arpa.2018-0379-OA.

1. 1. Voelker R. The Promise and Pitfalls of AI in the complex world of diagnosis, treatment, and disease management. JAMA. 2023;330(15):1416–1419. doi:10.1001/jama.2023.19180.

1. 1. Reardon S. AI Chatbots Can Diagnose Medical Conditions at Home. How Good Are They? Scientific American. March 31, 2023. https://www.scientificamerican.com/article/ai-chatbots-can-diagnose-medical-conditions-at-home-how-good-are-they.

1. 1. Health 3rd Party Trust. The State of Healthcare Third-Party Cyber Risk Management. July 27, 2023. https://23868910.fs1.hubspotusercontent-na1.net/hubfs/23868910/Health3PT%20Cyber%20Risk%20Management%20Survey%20Results.pdf.