There are a number of difficulties here and some excellent comments.
costing model proposed assumes "set based" rather than test or specimen based
also we already use auto commenting and auto authorisation processes, should
these be counted or not?
our laboratory computer is APEX which is test based, so teasing out to a set
based commenting would not be very productive.
Report authorisation as already noted here is not just about commenting
and one of our (very good service) reference centres does sometimes send back
reports with
"all results normal" - unclear if automated or not -and at other times very
abnormal results with no comment.
From a poster I submitted Bailey IR. Rule-based further requesting,
interpretation, addition of comments and authorisation by computer. Annals
of Clinical Biochemistry 1998 (suppl): 92.
which was predominantly about thyroid auto commenting, which freed up time to
consider the less obvious thyroid results, which appeared to go up in
quantity and time of implementation
(and there will be a loss of this automation process with CfH requesting as
clinical details will not be coded, an important aspect when auto commenting,
see Mike's point about removing inappropriate comments, nor is there any
proposal to automatically include known chronic disease states of diabetes
and renal failure for example in requests note this applies to London, I do
not know elsewhere)
so when considering further automation of commenting should this be at
clinical end where all (?) relevant information should be available?
How do we count interpretations we have been asked to add to work performed
in the private sector?
We need to be able to quantify the quality and added value aspects of this
process, ? best done by "customers" not us!
Ian
Dr Ian R Bailey
Consultant Chemical Pathologist, Bromley Hospitals NHS Trust,UK
email: [log in to unmask]
Tel: 01689 864281
-----Original Message-----
From: IT working group of the Association of Clinical Biochemists
[mailto:[log in to unmask]] On Behalf Of Smellie Stuart (RXP) Consultant
Chemical Pathologist
Sent: 10 May 2006 09:35
To: [log in to unmask]
Subject: Re: Costs of Report Comments - invitation to share info
We discussed this at ACP chem path committee and there were different views.
One thing I would point out as a caution is that of equating the added cost
of a consultant to the clinical comments reflects only a small part of the
job, and risking the rest being forgotten, which would make commenting look
expensive.
The 'package' of added value the consultant gives is a mix of
commenting/protocol advice/troubleshooting odd results etc. of which actual
comment adding is only a part.
We should be careful that by peeling off only one part of that package, the
other bits which are less easily 'unitised' could be perceived as being of no
added value and stripped out.
In DGHs many feel that systematic commenting often has limited added value -
time is spent producing logic rules so we can use a lot of computer
generated protocols for more standard stuff - a bit like PBR, if comments
were itemised, we could see a spurious industry of artificial wealth
creation!
It may be that a list of the activities which consultants do to contribute to
the extra 10p cost or whatever per test could be produced in parallel.
-----Original Message-----
From: IT working group of the Association of Clinical Biochemists
[mailto:[log in to unmask]] On Behalf Of JA Muir Gray
Sent: 10 May 2006 07:29
To: [log in to unmask]
Subject: Re: Costs of Report Comments - invitation to share info
Agree+++++++
In times of danger ; stick to your principles and be bold
On 9/5/06 17:20, "Rick Jones" <[log in to unmask]> wrote:
> Yes but if we don't cost it how do you justify having expensive medics at
all.
>
> Rick
>
>
> Dr Rick Jones
> Clinical Biochemistry & Immunology
> Leeds Teaching Hospitals Trust
> Leeds General Infirmary
> Great George St
> Leeds LS1 3EX
> [log in to unmask]
> [log in to unmask]
> Trust: 0113 392 2340
> Univ: 0113 343 8033
> Fax: 0113 392 5174
> LS1 3EX
>
> http://www.ychi.leeds.ac.uk
> http://www.thehungersite.com
>
>
>>>> [log in to unmask] 09/05/2006 09:00 >>>
> Costing of comments is very dangerous. If for example you calculate
> that each comment costs £10 then the PCT might decide that they don't
> want to pay for that part of the service and will ask to strip that
> from what they pay the lab. What happens then - redundancies?
>
>
>
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> -----Original Message-----
> From: IT working group of the Association of Clinical Biochemists
> [mailto:[log in to unmask]] On Behalf Of Rick Jones
> Sent: 08 May 2006 16:22
> To: [log in to unmask]
> Subject: Costs of Report Comments - invitation to share info
>
>
> Dear ACB-IT,
> I'm interested in working out what it costs labs to manually put
> clinical comments on reports principally to see what the relative
> economic value of a more automated approach might be.
>
> I've developed an excel model to try to work this out in relation to
> staff time and report volumes.
>
> If anyone were interested in using this to capture & share data about
> their own service or indeed in refining the model I'd be pleased to hear
from you.
>
> If we were to get a number of estimates I'd be happy to put them
> together and share the info after suitable anonymisation.
>
> With best wishes
>
>
>
> Dr Rick Jones
> Clinical Biochemistry & Immunology
> Leeds Teaching Hospitals Trust
> Leeds General Infirmary
> Great George St
> Leeds LS1 3EX
> [log in to unmask]
> [log in to unmask]
> Trust: 0113 392 2340
> Univ: 0113 343 8033
> Fax: 0113 392 5174
> LS1 3EX
>
> http://www.ychi.leeds.ac.uk
> http://www.thehungersite.com
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