It’s after midnight, do you know where your reports are?

After the tests themselves, the second most important thing that a Pulmonary Function Lab needs to do is to report results. Like a tree falling in the woods, if a report hasn’t gotten in front of the person that ordered the tests, has anything happened? A successful PFT Lab needs to manage its reports effectively.

An obstacle that many labs will need to overcome is the reporting software that comes with their testing systems. I think that for many of the PFT equipment manufacturers reports are an afterthought at best. The ability to format reports to a specific lab’s needs is often limited and is just as often is a difficult and time-consuming process.

For example my lab maintains approximately eight different report formats, each tailored to the most common mix of tests we perform. If we need to change an item in patient demographics (and we have) then that means that this change needs to be made separately in each of the eight different formats. If this change requires more space on the report and that other report elements need to be moved to accommodate this, then this has to be done on each of the report formats as well. The software has no ability to copy or share changes between report formats (which I am sorry to say is ridiculous since I remember having reporting software in the DOS era where this was possible).

Despite the trouble of maintaining this many report formats, we think think it is worthwhile and that is because results need to be reported in a concise and pertinent manner. To be useful reports need to be readable and reporting too many parameters is almost as bad as reporting too few. There are over 30 different items that can reported for an FVC test but it is unlikely that any more than five or six need to be on a report. More than once however, I have seen reports from other labs with nearly twenty FVC parameters that were taking up most of a page, not even including the graphs. It is possible that the medical director of those PFT labs asked for this but far more likely that it was a default report format included with the equipment that the lab never modified.

Don’t be intimidated by your report formatting software and don’t be afraid to modify report formats. Your hospital’s Medical Records department may have guidelines for demographic information that you will need to follow (our does and is very picky about where the patient names, ID numbers and dates need to be placed) but you should be able to decide for yourself what test data should be reported. Poll the physicians whose patients you see and find out what they want to see on a report. You should try to satisfy your physicians but you should also try to limit what you add to a report. Simple and clean is better than complicated and cluttered. You may not think you have time to “play” with report formats but remember that reports are the primary face your lab presents to the world and as such they deserve your time.

There are, however, two major components that go into a report: the test data and an interpretation. The lab is responsible for the test data but the interpretation has to come from a physician. How these come together is often an idiosyncratic process and there may be elements to it that are there for historical reasons and may not be logical or efficient so reviewing the interpretation process can be worth the effort. It may help to write out and detail the steps that are involved. Often, when you see a process in black and white the problems become more evident.

Timeliness matters for lab reports and it matters a lot. One partial solution we’ve used for several years is to print preliminary (uninterpreted) reports as a PDF file which is emailed to the ordering physician (automatically for the Pulmonary physicians and on an “as-requested” manner for other physicians). This gets the test results in the physician’s hands more or less immediately but that does not mean it reduces the pressure on the lab to produce an official interpreted report in a timely manner as well.

Improvements in the interpretation process should not be approached in an adversarial manner. You can’t “make” a physician interpret reports in a way that makes it easy for the lab. Their time is valuable and they have the final say in how they will handle report interpretation. Other than a sense of professionalism and concern about the patients about the only “carrot” you can offer is the reimbursement for the interpretation. The quicker an interpretation is done and can be billed, the less likely it is to be denied. (Be very careful however, about when an interpretation is billed. Medicare audits have turned up situations where the billing for the interpretation was performed well ahead of the interpretation itself and that has been costly for the institutions involved.)

This doesn’t mean you can’t point out solutions that make it easier for the physician even though it may mean extra work for your lab. I know that none of us are looking for more work but it may be necessary for your lab’s staff to take on extra tasks in order to be able to get reports out faster.

Historically, my PFT lab has had the lab staff type the report interpretations. This was “extra” work for the lab but I think it has been worthwhile because it has given the staff a much better appreciation about what the test results mean. It also touches on a philosophy of work that I have and that is that technicians should be able to do everything that needs to be done in the lab and everything includes reports. A number of years back, at the urgings of the administrator I was reporting to at the time, we hired a part-time clerical worker to handle some pieces of the reporting process. I saw the technicians quickly develop a “it’s not my job” attitude to reports and that no matter how much free time they had and no matter how far behind the clerical person was they no longer cared about getting reports out the door. When that clerical person left after a half a year (to a better job) I adamantly resisted replacing them because the “it’s not my job” attitude ended up exacting a toll in morale and overall efficiency that more than offset what work the clerical person was able to do.

The final part of managing reports is tracking reports and making sure that nothing gets lost “between the cracks”. This is probably a bigger problem for high-volume labs than for those with a limited number of patients. My lab sees on average over 150 patients a week and this continues to be a weak link in our report management system. We have methods to track reports and even though the number of “lost” reports is small, we have never managed to get that number to zero. This is due at least in part to the fact that although the lab has a complex networked computer system and the most recent version of its lab software report tracking still has to be performed manually. I’ve already said that reports seem to be an afterthought to the lab software developers and that seems to be even more true of overall report management. Given what I know about the lab software’s database it should be possible, even relatively simple, to track a report from the time a patient is first seen, but this is not done. We do always find the missing reports towards the end of our report management process, but that can be a week or more after they were first supposed to have been reviewed and that is far from ideal.

[I would urge you to let your equipment manufacturer know when you have problems with reports (or any other aspect of their software, of course). I think that many PFT labs are not as happy as they could be with their test equipment’s reporting functions but don’t say anything because either they don’t think it matters or that they won’t be heard. I think that the manufacturers too often assume that if nobody complains then everything must be fine but I also think there is a certain amount of willful blindness on their part as well. I may be wrong (and feel free to correct me) but I don’t know of a single PFT equipment manufacturer that has an official (or public or open) process for handling customer suggestions and complaints.]

Both the patients you see for testing and the physicians that order the tests are your customers. They are both served best by pertinent, timely and readable reports that are also the public and virtual face of your PFT lab. I think that any Pulmonary Function lab that wants to be successful needs to control their report process as much as possible and to treat reports as an important part of daily operations.

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PFT Blog by Richard Johnston is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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