The answer to this overload problem is already available and has been for more than a decade. I suggest you check out Lab Wizard which is based on
technology developed by Glenn Edwards (Chemical Pathologist) for Pacific Knowledge Systems in Australia. This is an intelligent reporting system which 'learns' the comments from experts and once a body of comments is developed can run with minimal maintenance making good use of expert time and providing back-up
support for more junior staff.
I have been trying to get this into the UK for some time. The blocks are availability of modest funding to support interfacing and the fact that our IT systems are old and the suppliers are confused by CfH. The system is up and running in Holland
http://www.pks.com.au/products/lab_wizard.htm
If anyone would like to join in to try to get this technology into trial I and Glenn would be glad to hear from you as Muir Gray has suggested funding
may become available for such a trial through the DOAS programme. If a consortium were to get together on this it is likely the lab suppliers would
play ball.
Glenn has ample evidence of effectiveness of this system and it is a far cheaper short-tem option than intelligent requesting. The literature in this area is littered with reports of very expensive failure. (see my talk at CPD4IT http://www.cpd4it.org.uk for refs - Dec 2005 meeting in Past Events) Incidentally PKS
also have clever request intervention software which an also control requesting.
JK - could this go on your workshop agenda - Glenn is over in Europe fairly frequently.
Rick
PS I have no financial interest in PKS - just a desire to get the UK up to
21st Century information handling standards.
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of gordon.challand
Sent: 10 March 2006 17:00
To: [log in to unmask]
Subject: Re: Interpretative comments
Dear Brian
One of the charms of our subject is that there is seldom a 'single right
answer'. How can we define the 'best use' of a professional's time? Even if
we are totally simplistic, and try and define this in terms of 'maximising
patient benefit' (probably defined in terms of trying to produce the
greatest good to the greatest number) there is no simple solution and I do
not believe there is a simple solution or even a single solution: so much
depends on non-quantifiable variables such as the abilities (analytical,
clinical and communicative) of the lab professional, the clinician receiving
the report, and the patient whose treatment and well-being are the end-point
of the process. Trying to define 'cost-effective' solutions based on
personal opinion is untenable; and as both Jonathan and I said at the start
of this thread, research is needed (but a purely personal opinion is that
this is unlikely to help produce a single solution). Basing the argument on
'more effective' education may be naive; again a purely personal opinion is
that the Family Doctors least in need of further education are the ones most
likely to attend further education sessions (or am I being heretical?) Best
wishes Gordon
----- Original Message -----
From: "Brian Shine" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, March 09, 2006 10:52 PM
Subject: Re: Interpretative comments
This paper is interesting. There was a lowish response rate in both surveys
(about 50 %). Respondents were offered only yes/no options in the initial
survey. The reduction in errors could be due to a lot of factors other than
the presence of an interpretation service. The main question could only be
answered by a properly randomised trial. What I have seen so far would not
convince me that it was worth spending a lot of expensive expert time (and,
in particular, my time) on producing individualised comments. As someone
who has come almost full circle from no comments to lots of comments to
almost none, I feel that the only cost-effective solutions are interventions
at the requesting stage (using smart computerised requesting) and links so
that clinicians can find their own interpretations, with live experts being
available to answer questions about results or subjects that do not fit into
neat categories.
To take our situation, we get about 150,000 thyroid function requests per
year from a population of 600,000+. About 75% come from GPs. About 13% are
"complicated" - from Endocrinology, Paediatrics, toxic, on thyroxine. Of
the rest, about 87% have a TSH between 0.20 and 5 mU/L and get no further
tests. If the TSH is outside these limits, we do a FT4 ± FT3. If we looked
at and commented on all results, and allowed 10 seconds per sample, this
would equate to about 0.25 of a person's time. Looking at all the
"complicated" results and those samples where additional tests were done,
about 36,000 samples, would take several hours a week (assuming that 10
seconds per sample is sufficient for this task). Even this may not be a
good use of our time!
In the long run, time spent educating doctors and especially clinicians, who
are getting quite a lot of experience of looking at thyroid function test
results since on average they order about 0.2 tests per patient per year, as
to what the results mean and where they can get help (through web links or
e-mail or live conversation) if they need it may add more value.
Best wishes,
Brian
Dr Rick Jones
Clinical Biochemistry & Immunology
Leeds Teaching Hospitals Trust
Leeds General Infirmary
Great George St
Leeds
[log in to unmask]
[log in to unmask]
Tel: 0113 392 2340
Fax: 0113 392 5174
LS1 3EX
http://www.ychi.leeds.ac.uk
http://www.thehungersite.com
>>> Joseph WATINE <[log in to unmask]> >>>
Those who believe that comments added to individual reports have very little
future would better read this:
http://arpa.allenpress.com/pdfserv/10.1043%2F1543-2165(2004)128%3C1424:PSOAL
M%3E2.0.CO%3B2
This is only one of the many reports that suggest that comments added to
individual reports can be very useful, provided that they are written by
well trained professionnals.
Good day,
Joseph Watine, Rodez, France
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