Robert Michel of The dark Report recently
wrote on MedLab-L:
Finally, another useful
nugget. Around 2002, after Aurora Health Systems of
Chair of Pathology, Jay
Schamberg, M.D., spoke at the
meeting that year. He stated
during his presentation that, after converting
patient files to the EMR,
his IT department had determined that the
average permanent patient
electronic health record contained lab test
data/information that
totaled about 82% of the total data bits used to story the
patient's full health
record. This statistic maps to the oft-used statement that
about 70% of a patient's
permanent health record consists of laboratory
test data
Mike Collins
BMS3
Biochemistry Automation
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Dennis Huckerby
Sent: 11 July 2011 15:29
To:
[log in to unmask]
Subject: Re: THE 70% THING
Hello to both of you Mike’s
Yes I do remember this paper and some of the discussions that evolved
over the following two or so years all on a high for the benefits of UK
Pathology but as far as I know it never went further than talk. Also the paper
quotes “"We
know that - - - “but where are all the stats for this
“know” documented?? I certainly haven’t seen any and I was
following this line of thought for boosting
So what do I mean now and earlier when referring to specific patient
groups?? Well here my thoughts (and this is not a complete listing ny any
means) based on personal and professional experiences –
GP patients – in all my visits to my GP in recent years, only
very rarely have he/them requested me to have a “path” test before
diagnosing me and writing a prescription. However we have heard in these recent
years that path test requests from GPs have increased by 40% and perhaps these
were occasioned by the GP et al requiring tests to prove that the patient was
suitable/fit enough for a particular pill/treatment and I have had my fair dose
of these.
Patients through Out Patient appointments – again for myself I
have only had one “path” test to rule out diabetes before a
cataract op. No need for “path” tests to diagnose that I needed a
new hip although I had a few before the op to make sure I was still alive and
ready for the op
Patients thru A&E – not too many “path”
tests” prior to diagnosing requested as far as I can see/judge from the
patients they see – well you can easily tell a patient with a so-called
sports injury or being drunk – by the words they use
Patients from Fracture clinics – again not too many
“path” tests needed for diagnosis but plenty needed to make sure
they are fit for the op.
Oncology and cardiac patients – now here is where the
“path” tests escalate but mainly for monitoring their treatment
once they have been diagnosed so does this group confuse the present stats of
70%???
Patients in care/retirement homes – not too many to assist with
diagnosis as the local care assistant/nurse deals with all the minor diagnoses
and treatments
School and young children referred to GP or hospital – probably
best included under one of the above headings unless it is felt necessary to
stat them separately. One interesting point here is that from a local stat some
25% of patients attending our A&E were under 16 – interesting??? Yes
but probably of little relevance to this 70% stat.
Now don’t get me wrong. Even though I have been retired for many
years I do still believe that pathology is a vital service to UK healthcare -
and I have made this point (to many deaf ears and dead eyes it seems to me) in
the many papers I have had published since retirement. BUT let’s make any
stats totally
OK that’s enough of my whingeing for now – I am sure that
many of you will be annoyed at my interference from the depths of retirement in
this discussion but that’s your privilege. However I still remain a
pathology professional and want to see my colleagues best used for the benefit
of
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Hallworth Mike (RLZ)
Sent: 11 July 2011 14:23
To:
[log in to unmask]
Subject: Re: THE 70% THING
Thanks Mike - that is the 1996 paper I
cited in my original post claiming
"We
know that, although the laboratory represents a small percentage of medical
center costs, it leverages 60-70% of all critical decisions, e.g. admission,
discharge and therapy".
It does not support "70% of all NHS
diagnoses depend on lab tests".
Mike
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of
Sent: 11 July 2011 14:10
To:
[log in to unmask]
Subject: Re: THE 70% THING
This is the original paper
http://www.clinchem.org/cgi/reprint/42/5/813.pdf
Mike Collins
BMS3
Biochemistry Automation
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Hallworth Mike (RLZ)
Sent: 11 July 2011 13:29
To:
[log in to unmask]
Subject: Re: THE 70% THING
Not sure I agree - we're supposed to be
scientists! I am fully convinced of the value of lab medicine but am not
comfortable with the fact that the only statistic that seems to be widely used
is based on very flimsy foundations. Cover-ups for political expediency have a
way of getting out.... (Murdoch R, Brooks R - personal communication)
I will summarise the available evidence
in a post in the next day or so.
Mike
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of IAN WATSON
Sent: 11 July 2011 11:56
To:
[log in to unmask]
Subject: Re: THE 70% THING
Quite so: no political benefit in
potentially shooting ourselves in the foot……..!
Ian
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Dennis Huckerby
Sent: 11 July 2011 09:51
To: [log in to unmask]
Subject: Re: THE 70% THING
Yes that wording has also intrigued me over the years and I guess it
wouldn’t need much analytical expertise to come to that figure?? However
it would be nice to find out where the original figure came from but would it
be in the best interests of pathology to delve too
deeply??...........................Dennis
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Colley, Michael
Sent: 11 July 2011 09:28
To:
[log in to unmask]
Subject: Re: THE 70% THING
The telling point is that it actually
says “Up to 70%” i.e. anything from zero to 70.
Michael
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Dennis Huckerby
Sent: 09 July 2011 22:19
To:
[log in to unmask]
Subject: THE 70% THING
Hi Mike, Rick and all
My reason for entering this chat line was because I
remembered writing a paper about this 70% and following an exchange of emails
with you Mike over the weekend, I realised that the ref in my earlier email was
not the answer. So digging around in my files I found my paper (MLW Sept 2002
Conspicuous by its absence P 6 et seq) and apart from identifying the first
quote of the 70% figure in an HSC Report, I was annoyed/disturbed/disgusted at
the time to find that neither the IBMS nor the ACB were represented as
organisations in the list of witnesses interviewed even though they may well
have been there as individual members.
However to cut a very long story short here is the ref
for the HSC Report and I then copy the intro to the Pathology Section. You can
read the rest for yourselves - -
http://www.parliament.the-stationery-office.co.uk/pa/cm200102/cmselect/cmhealth/308/30802.htm
|
Session 2001-02 |
Health - First
Report Here
you can browse the report together with the Proceedings of the Committee. The
published report was ordered by the House of Commons
to be printed 1 May 2002. CONTENTS –
You can read these for yourselves when you go to this site. As promised/threatened above here is the intro to the
Pathology section – please
note #141 – but who/where was
the analysis carried out?? |
VI PATHOLOGY AND PUBLIC PRIVATE PARTNERSHIPS
139.
Our terms of reference extended to Public Private Partnerships. As we noted
above, The NHS Plan outlined
areas for further collaboration between the NHS and the independent sector. We
chose to focus on pathology, one of the key areas where the Department
anticipates growth.
140.
The estimated total NHS expenditure on pathology services was £742 million in
2000-01, an increase of nearly £200 million on the figure for 1998-99.[231]
The Royal College of Pathologists estimates that pathology consumes around 6%
of the NHS acute services budget.[232]
There are around 300 services in England, usually based in acute trusts, and
about 1700 separate laboratories (principally haematology, microbiology,
biochemistry, histopathology, immunology). Historically, pathology laboratories
developed on-site in hospitals, serving local catchment populations. There are
also approximately 250 private sector laboratories. There are a further 46
Public Health Laboratory services.[233]
141. Up to 70% of
all diagnoses in NHS patients depend on laboratory tests, hence NHS pathology
services are critical for the day to day evidence-based care of patients. Fewer
than 5% of test requests ("hot tests") require a response within 24
hours. The NHS undertakes some pathology work for the independent sector, but
very little NHS work is currently undertaken by the independent sector. In
addition, the reprovision of laboratories has been included in a number of PFI
projects. Only about 5% of pathology work undertaken in the
I have to admit that I have not read thru the total
report and it may well mention somewhere more about the work carried out to
support the 70% figure. However if not then I am sure there are amongst you
those who will know and be able to contact some of the more prominent Pathology
personnel eg – Prof. Sir John Lilleyman and Karen Ward to mention just
two
So hope this ramble helps you identify the source and
accuracy of the 70% figure and then I hope you will publish your
findings----------PLEASE
Happy reading
everybody……………………Dennis
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