By SiriusRx|Education for practices

Clinical review pending. This article has not yet been reviewed by a licensed clinician, and we would rather say so than print a name that does not exist.

Many cash-pay service lines use labs as part of the visit. When the office workflow is loose, the problems are predictable: a result nobody reviews, a patient who sees a flag in a portal before a clinician does, and a chart that cannot show why a decision was made. A written workflow fixes most of that.

This article covers office workflow. It does not interpret a result, name a target number, name a lab vendor, or name a product. Clinical decisions stay with the practice's own prescribers.

1. Decide who orders, and when

  • The practice's reference materials should say which labs the practice considers at the start and at follow-up. The prescriber decides what to order for each patient.
  • Write down who may place an order under the practice's delegation agreements.
  • Order what the practice's own materials and the question at hand call for. A long list of extra tests creates flags the practice then has to follow.

2. Set expectations before the draw

  • Tell patients in plain language why labs are ordered, what they cost, and when they will hear back.
  • Give timing and preparation instructions in writing, since some results depend on time of day or on fasting.
  • Explain how results will be communicated. Results may appear in the patient portal before a clinician has reviewed them. A clinician reviews every result before the plan changes.

3. Review every result, on a clock

  • Assign a named reviewer for each order and a deadline the practice chooses. A common office pattern is a few business days for routine results and the same day for results the practice has already defined as urgent.
  • Build a results queue so nothing sits unreviewed.
  • Write down which results the practice treats as urgent, and how staff escalate them.

4. Communicate results the same way each time

  • Do not set a blanket hold on portal results until a clinician reviews them. Federal information-blocking rules generally do not allow blanket delays of routine results. Narrow exceptions exist, such as an individualized determination to prevent harm, or a delay the patient requests. Prepare patients to see results first.
  • Use one results message: what was ordered, that a clinician reviewed it, and the next step. Staff do not interpret results for patients.
  • Document every patient contact about results.

5. Document the decision

Every chart should show the link between the labs and the plan:

  • What was ordered, and why the prescriber ordered it.
  • Who reviewed it, and when.
  • What decision followed, including a decision to repeat, refer, or stop.
  • The follow-up schedule.

Virginia's Board of Medicine requires timely, accurate, legible, and complete patient records, kept for at least six years after the last encounter for most patients (18VAC85-20-26).

6. Know when the practice refers out

The practice's own materials should name the findings that send a patient to primary care or a specialist. This article does not write that list. Make the referral, document it, and follow up.

7. Patient handouts

If the practice gives patients a handout about labs, keep it general, cite a public source, and send it through the claims review step. A handout should not suggest that one number decides care, and it should not promise an outcome.

How SiriusRx helps

The SiriusRx Peptide Program includes reference materials that name labs to consider at the start and at follow-up, without naming a lab vendor, plus charting templates, results scripts, and staff training. The practice's prescribers make every clinical decision.

General education, not legal or medical advice.

Sources

  • 45 CFR Part 171, information blocking, including section 171.103: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-171.
  • ONC FAQ, would the Preventing Harm Exception cover a blanket several-day delay on the release of laboratory or other test results: https://healthit.gov/faq/would-preventing-harm-exception-cover-blanket-several-day-delay-release-laboratory-or-other/.
  • ONC FAQ, can an actor grant a patient's request to delay the release of test results: https://healthit.gov/faq/can-actor-grant-patients-request-delay-release-patients-test-results-eg-laboratory-or-image/.
  • 18VAC85-20-26, Patient records (Virginia Board of Medicine): https://law.lis.virginia.gov/admincode/title18/agency85/chapter20/section26/.

For practices

Contact us.

This is education for licensed practices. It is not legal, medical, or pharmacy advice, and it does not tell a practice what to prescribe. Contact us with questions about the program.