Just a though to add to the debate. The comments we are generating for primary care requesting would lend themselves quite nicely to this system 

-----Original Message-----
From: IT working group of the Association of Clinical Biochemists [mailto:[log in to unmask]] On Behalf Of Anthony Mottram
Sent: 17 March 2006 15:20
To: [log in to unmask]
Subject: Re: Solution to Interpretative comments - off the shelf

Without placing any commercial slant on my reply, I find this discussion particularly interesting, in light of the fact that I have input into
HL7 UK Lab messaging forum, as well as our provision of currently conformant laboratory messages and interfaces into LIMS. I agree that the benefits offered by Lab Wizard are worthwhile and my thought is that it may be possible for us to interact with the Lab Wizard, in order to address the UK specific LIMS requirements, so LIMS interfacing and to investigate the impact of more verbose clinical comments within the messaging arena.

Tony

--
Anthony Mottram
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Senior Technical Manager Indigo 4 Systems Ltd Aizlewood's Mill Nursery Street Sheffield S3 8GG
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Rick Jones wrote:
> It's a fully birdirectional lik to teh lab system so teh comments are written back to the LIMS and reported from there. You can think about it as an interfaced instrument which takes data requests from teh lims adds its value and then puts it back.
> 
> Best to contact Glenn for technical details.
> 
> 
> There are some ppt s on the pks site which show teh configuration
> 
> Rick
> 
> 
> 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
> 
> 
> 
>>>>[log in to unmask] 16/03/2006 07:30 >>>
> 
> Hi Rick,
> 
> Looks interesting.
> 
> A question:
> 
> As you say old systems can be a problem.  I'm assuming that the lab 
> Wizard would intercept the result output stream from the laboratory 
> system, that the consultant biochemist would use LabWizard as the main 
> front end for reporting, but that other consumers of those reports 
> such as other lab staff or clinicians, would still be looking at the 
> original system report, but with interpretive comments added by LabWizard.
> 
> Would interfacing then be bidirectional i.e. the comments are added to 
> the old laboratory system reports so that they'll also be visible in 
> the original system?  And to what extent does this interfacing require 
> cooperation by the lab system supplier? Bidirectional could be tricky 
> - any way that you could envisage getting the benefits just with a 
> uni-directional feed which would be easier to implement.  It would be 
> interesting to know if there have done previous work linking LabWizard 
> to any of the main suppliers in the UK.  We have Apex from iSoft for example.
> 
> Regards
> 
> Dr Paul Schmidt
> 
> Acute Medicine Unit
> Queen Alexandra Hospital
> Portsmouth Hospitals Trust
> 
> 
> -----Original Message-----
> From: IT working group of the Association of Clinical Biochemists 
> [mailto:[log in to unmask]] On Behalf Of Rick Jones
> Sent: 15 March 2006 07:40
> To: [log in to unmask]
> Subject: Solution to Interpretative comments - off the shelf
> 
> 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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