In message
<[log in to unmask]>
, O'Connor John (Royal Devon and Exeter Foundation Trust)
<[log in to unmask]> writes
> This email is directed at labs which send their results to PROTON a
>renal information system used by 50% of Renal Units in the UK. We are under
>immense pressure to release non clinically validated results directly into
>this system, so that patients can be discharged promptly.
>
Dear John,

You are certainly not the only one to be faced with this problem of
proton. I have faced a fifteen year battle to get them to accept
clinical comments on the system. For example, I have asked them how
they know a sample is haemolysed (a canned comment) on their system to
be told they "just know". Because all results are downloaded, they
shred the printed results, although, to be fair, the renal unit staff
are instructed to save any forms with comments on. However, they have
ignored clinical comments pointing out monoclonal gammopathies in the
past so their system is not foolproof.
Proton has another characteristic that means that it sometimes muddles
samples taken close together, because it does not recognise samples with
different laboratory numbers as being different.
Because of these problems, I have refused to release our laboratory EQA
results so that they can contribute to some of the comparisons in the
Renal Registry. Slightly dog-in-the-manger I know, but I have no
confidence that what is stored on their computer is what we originally
reported.
Having got that off my chest, I have to say that the access that we in
the lab. have to their system is really valuable for the clinical
information I can get is vastly superior to the "CRF" put on most
requests. It is an interesting anachronism that the data personally
input by medical staff and used by them, a sort of electronic medical
notepad, may be more useful than the technological filing cabinet for
results which, due to poor programming, misses the useful bits
(comments) and occasionally misfiles the rest.
As far as authorisation is concerned, our renal unit is in a slightly
privileged position in that its samples are fast-tracked by us. (When
they moved to NGH the renal unit got us a new laboratory so I do owe
them one!). All such samples have their results sent to the hospital
computer once they have been technically authorised, and so are
available on the renal wards (flagged unauthorised) although I believe
that they do not get on to Proton until clinically authorised. Results
which are changed at authorisation overwrite the hospital computer
output (although the original is kept in background) so we can do that
safely as it is little different from phoning results off the analyser.
During the day, there is little delay in full clinical authorisation,
but this can obviously stretch at night although we do authorise from
home via a modem at about 10.00 p.m. I agree that clinical
authorisation is useful and would guess that we pick up quite a few
issues each day. The key is to have a good algorithm for picking up
oddities in your laboratory system. This was something that Telepath
with its sophisticated range planes and delta checks could manage. Now
we have Apex and it cannot manage checks on more than two analytes
before the system runs out of flags. As a result we either have to set
it to miss alerts or to put a vast amount into authorisation. For
better or worse we have chosen the former as authoriser fatigue in
ploughing through every renal report can equally result in missing
important results.
So I support your view. Proton is an imperfect tool which has not been
improved despite much prodding. The more people can feed back about its
problems the more likely it is that the software company will adopt
better practices.
Trevor
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU

0114 271 4309

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