Re: [Gnumed-devel] state of test results handling

[James Busser]

On 30-Mar-08, at 4:30 AM, Adrian Midgley wrote:
> Our lab reports results with a _reference range_ rather than making a
> statement about normality.

Most labs do the above, they just may or may not additionally provide  
an accompanying "flag" value (high, low, abnormal). For some tests,  
labs will maintain threshold values for "critical" that require the  
technician to inform the lab doctor and for one of them to contact  
the ordering doctor or, if they are unable to contact an involved  
doctor, the patient, however they tend to not communicate the second- 
level flag as part of the results, but this is not necessarily always  
true, I suspect some use * and ** to denote mild vs more marked  
abnormalities.

> Some patients have a congenitally different result on some measurement
> from the general run, a large but trivial example is those with
> GIlbert's syndrome having a higher bilirubin.

For patients who do have a chronic abnormality (like the above, or  
macroamylasemia, or even chronic renal failure with ... say... a  
creatinine of 400) using the target range to set a value for the  
patient, below which the abnormalities could be clinically ignored  
(even though they are clinically relevant or significant). This seems  
already supported in the contextual note expansion per result.

Some labs can indicate when test results have significantly changed  
from their last value(s).