2016 RCPA Pathology Update

FullSizeRender1Celebrating its 60th year, Sysmex was proud to be involved with the RCPA annual conference and exhibition held in Melbourne last weekend. The conference is multidisciplinary covering all aspects of pathology and laboratory medicine and attracted over 1200 delegates.

As it is an Australasian event, Sysmex staff from both sides of the Tasman attended the conference, representing the Sysmex product suite – Sysmex Partec flow cytometry, urinalysis, and the health IT portfolio – Delphic AP, Delphic LIS and Eclair.

While the conference programme was predominantly clinical and scientific, the health IT/ pathology informatics content was highly relevant presented by expert leaders in their field – Dr Jonathan Kay of the UK NHS, Assoc Prof Andrew Georgiou from Macquarie University, Dr Sara Bird, Dr Ken Sikaris, Dr Graeme Jones, Dr Rita Horvath plus more.

From a pathology informatics perspective, the key take home messages/themes fell into the following categories:

Safe and effective management of diagnostic requests

Failure to followup diagnostic requests is related to 1 in 4 reported patient safety errors. Interestingly with imaging systems it is often the significant, unexpected non-life threatening results are the ones that are missed.

While Health IT has the potential to enhance performance and safety through CPOE and report acceptance, escalation and followup solutions, problems with poor integration of systems, duplication with IT and paper can also cause problems.

One of the most important aspects of implementing a Health IT solution that manages the request-test-result-acknowledgement -escalation process is the governance model. Establishing and managing this throughout, is essential to ensuring the success.

Other questions that were discussed raised the topic involving the patient in the request cycle. Should patients receive copies of their results to help ensure abnormal results are not missed? What is the pathologist /radiologists role in informing patients? How can diagnostic reports be formatted and presented in a way that is easier for them to understand? How does this work with the patient portal/My Patient Record.

It is exciting to learn about the study underway by health informatics researchers at Macquarie University via the NHMRC Partnership Project grant, entitled “Delivering safe and effective test result communication, management and follow-up”. This study will dig deeper to provide evidence based outcomes on this important area of patient care and safety.

Management of POCT results

Management of POCT results in terms of what, where and who is responsible presents a different challenge, especially with the various connectivity configurations between POCT and LIS/Clinical systems.

POCT can be anything and everything from chemistry profile, urine dipstick, blood glucose, pregnancy tests, cholesterol, blood issue, INR and can occur in multiple settings – on the ward, ED, pharmacy as well as at home.

With POCT, capturing who is accountable and has acted upon or is responsible for the results is complex and the health IT systems need to be sophisticated enough to support different workflows.

POCT result, as with other results, should also be stored a shared repository so they are accessible across both community and hospital providers, for example lab and clinical staff at main hospital should be able to see all POCT results prior that have been performed pre-admit.

The importance of post analytical Quality

In the brain to brain loop, clinician requests the tests and then looks at the results. It is not their job to care about clinical quality. It is the lab’s role to ensure quality and provide the best possible information for interpretation by the clinician. The quality of reference ranges which set the result flags are therefore as equally important as the actual result.

Post analytical errors have impact on clinical interpretation. Errors can be in the form of transcription errors, turnaround delays, report errors – wrong recipient, limitations in critical value reporting.

Data becomes information which becomes knowledge, the lab can provide this by adding to a lab result/data – interpretive comments, clinical meaning and recommendation or actions. Stats show that clinicians want the information from the lab, particularly in primary care.

The LIS plays an essential part in the reporting. The LIS needs to support the lab’s ability to deliver quality, highly interpretive reports. A modern LIS will have a flexible and sophisticated rules engine and /or middleware layer for managing the data and result values from analysers and providing decision support based on the patient demographics and results to automate the addition of interpretive comments.

What else can you do with the data generated by labs?

Clinical laboratories benefit greatly from adopting a data-centric mind-set and are beginning to tap into the enormous benefits of aggregating in regional and national data repositories.

Pathology data can provide a means to identify clinical issues affecting specified populations, perform epidemiologic and public health studies, and provide decision support through clinical alerts and prediction. Diagnostic results are associated with demographic information and temporal data such as geographical location, discharge status, age, date, gestation and the patient’s clinical details. Looking at relational trends in the data can provide a wealth of intelligence for data mining potential to provide a framework for decision support and clinical alerts.

For business management purposes, labs can utilise the data to assess where the work is coming from and where it is increasing.

While the benefits are great, the ability to utilise data mining is limited by the quality of the data and the stability of the population patient ID. Harmonisation of laboratory testing still remains the ‘holy grail’ to ensure lab result aggregation across more than one lab.