Jonathan is right about this but the problem is perhaps more complex than most people appreciate because of the fundamental shift towards a networked world. What we are seeing is the tip of the iceberg and a hint of what is to come with the rapid development of clinical databases.
 
In the old days (when Dixon pounded the beat - pace JK) reports went to a closed, local group of lab users. Even with EDI the reports were largely presented as text representations of what was printed on the page. As systems have developed the data goes into databases and can be manipulated downstream. The clinical systems are getting bigger and take feeds from multiple sources. Patients also move and now take their data with them (CfH has a GP2GP project to support this.) Consequently data is now handled by people very remote from its point of origin.
 
Understandably clinical users like to look at trends. As scientists we should not be surprised that tables and graphs are being asked for by GPs and their suppliers are doing their best to meet the need. If I was a GP that's what I'd want. That they don't realise the complexities of doing this is the danger and could reflect on our collective failure to educate them in the science behind this - maybe we've made it all too simple!
 
The solutions to this will be complex. Standardisation will be part of the answer but education about best practice is also part of it. Working out how to best display complex data is another challenge - think of the work on MoMs in pre-natal screening as an example of normalisation. Should we report data as multiples of the ref range?
 
As Gifford has indicated this has the attention of CfH and is high on the safety agenda. There is a lot of work for us to do and including understanding the full extent and potential impact of the problem.
 
Can I caution against assuming that all errors are due to transformation. In one recent case a simple Read code error was the cause and the clinical system was behaving as intended.
 
Rick
 
 
Dr Rick Jones
Assoc Clin Director, Yorks and Humber SHA NPfIT
Sen Lect, Yorkshire Centre Health Informatics, Univ of Leeds
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http://www.ychi.leeds.ac.uk <http://www.ychi.leeds.ac.uk/>
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________________________________

From: Clinical biochemistry discussion list on behalf of Jonathan Kay
Sent: Fri 13/02/2009 14:59
To: [log in to unmask]; Richard Jones [Pathology]
Subject: Electronic data interchange for laboratory medicine reports


It's just over 20 years* since started using Electronic Data Interchange for getting Laboratory Medicine reports to general practitioners. It certainly hasn't turned out as we expected.

1 It is better to report plasma urate in micromol/L than in mmol/L because humans make more errors in reading and speaking numbers that start to the right of the decimal point. And both are equally well-formed ISO units.

2 Units and reference intervals are as much part of the report as is the result. They should be retrieved from the report and displayed with the result. They should not be held "globally" and linked to the result. This is because they vary. They vary with age and sex of the patient, within laboratory over time and between laboratories. If they are held globally in the receiving system it requires extra management effort to update them when they change. In practice (and in practices) changes will often be missed.

3 If you would like an enlightening experience go and look at your reports (results, reference intervals and comments) as they are displayed to general practitioners in their systems. These reports are the major product of your laboratory. (You can reword this paragraph in terms of quality assurance, total quality management, risk management, clinical governance or customer service.)

4 Harmonisation of laboratory reports is a good idea. But it will never remove the need for somebody to be responsible for displaying reports to clinicians in a useable, clear, complete, unambiguous fashion. Laboratories carry a large part of that responsibility even when that is a remote commercial system managed by somebody else. This is because we produce the report and the report message, and have the expertise.

Jonathan

* And I've just noticed that the policemen are looking younger.


On 13 Feb 2009, at 09:17, Jordaan Marieke wrote:



We have had a similar experience. A GP rang up to discuss some results and quoted the PTH levels in her computer as being 72.57 and 85.77, whereas we had sent out levels of 7.7 and 9.1 (ng/L). It turned out that System 1 had introduced a calculation to convert the results that we report in ng/L to values in pmol/L. (By clicking on the result the GP could see the values in the original units as we had reported it). The GP had not been informed that this was happening and neither had we. We will now look into whether / which other results appear differently to the way we report them.

Whereas we should have put our own house in order and standardised units by now, we feel that this effort by a GP supplier to do so for us can lead to misinterpretation and have possible medico-legal implications and would like to know what has been happening in other areas.

Marieke



Dr Marieke Jordaan
Consultant Chemical Pathologist
Mid-Yorkshire Trust
Pinderfields General Hospital: (01924) 317060 or 08448118110 ext 57060
Pontefract General Infirmary: (01977) 606238 or 606681


________________________________

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Colley, Michael
Sent: 04 February 2009 14:18
To: [log in to unmask]
Subject: Units

We've just had a problem with Units for PSA, Ferritin and Folate and for Urate.

The TPP GP computer system has just, apparently unannounced, introduced a "units checking" function into its software. This is throwing error messages because we report PSA,FER and Folate as ug/L, whereas they have decided it should be ng/ml . Similarly we report Urate as umol/L whereas their system has mmol/L.
They now appear to be happy that ug/L is the same as ng/ml. However, the urate gives results a factor of 1000 different numerically. Are we the odd ones out in still reporting as umol/L - given that the NEQAS values are in mmol/L? Could be a big information and computer exercise to change over. However, in the interests of Harmonisation (pace J.Berg) we're happy to comply with the consensus view if there is one.
Michael

Dr C M Colley
Consultant Chemical Pathologist
Great Western Hospital
Swindon SN3 6BB



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community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
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