Dear ACB Brain(s),
Tim's pragmatism of 'buckets per swimming pool' worked well in the world where the request/report cycle involved one lab and one client group. However the world has moved on with lab data being combined in large databases for GP clinical records, cancer registries, chemotherapy systems, GP2GP transfers etc etc. In this world users of the data who are not the requesters will need to understand not just units of measurement and reference range differences but also whether it is suitable to assume its OK to combine data when from different and unknown labs. This environment requires for patient safety reasons a single code linked to an analyte, its unit of measurement, preferably an agreed reference range and a code to indicate suitability to assume data combination when information from a number of different labs is being considered in patient care. All this is being developed through a number of routes with governance for the whole process being provided by the National Laboratory Medicine Catalogue Governance Board hosted by RCPathology. More on codes for data combination can be found at www.ychi.leeds.ac.uk/pmipunits
As an example from data gathered from a GP system receiving results from several labs this is some of the variance in unit representation for HbA1c.
ReadCodeExpansion UoM
HbA1c level (DCCT aligned) %
HbA1c level (DCCT aligned) % total Hb
HbA1c levl - IFCC standardised mmol/mmHb
HbA1c levl - IFCC standardised mmol/mol
Aren't we supposed to be scientists and didn't we sign up to SI units? We weren't aware Hb was measured in millimetres!
It seems critical that the pathology professions agree a robust and monitored approach to secure these developments - especially in an era when there is a direction towards patients accessing their laboratory data. We cannot expect patients to understand our variations!
Regards
Concerned Consultants of Brighton and Leeds
Dr Gifford Batstone MBBS, BSc, MSc, FRCPath
Dr Rick Jones MA, DM, FRCPath
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