26-May-2017
26-May-2017
In the interest of disclosure… 3
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The Vision Standardised Pathology Information Improved healthcare & wellbeing Record, Communicate, Decide & Analyse 26-May-2017
Why standardise? 26 May, 2017
This stuff matters
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Much harm is done • It is unacceptable to continue to do so much harm • Post-mortem examination shows diagnostic errors contribute to ~10% of patient deaths • In Australia that means 7 times the road toll! 35 /100k/yr VS road toll of 5 /100k/yr 9
Errors are mostly outside the lab • Much greater likelihood that an error occurs at the interfaces • Most pathology errors are pre-lab or post-lab. • There is no reason to believe this is not true of radiology 10
Why standardise? Standardisation of test requesting and reporting for the electronic health record Clinica Chimica Acta 15 May 2014 Volume 432 Michael Legg School of Medical Sciences, University of New South Wales, High St, Kensington, NSW 2052, Australia Pathology Informatics Advisory Committee, Royal College of Pathologists of Australasia, 207 Albion Street, Surry Hills, NSW 2010, Australia Michael Legg & Associates, 12 Dianella Street, Caringbah, NSW 2229, Australia 26-May-2017
Standards for interoperability • Transmission of data • Identification policies • Information structures • Common terminology • Common understanding • Behavioural agreement 12
Status: Completed in 2014 26-May-2017
Project summary • Standardise pathology information, terminology and units for safety and quality • 14 sub-projects led by the profession • Around 70 pathologists, GPs, specialists and other clinicians, scientists, informaticians and consumers volunteered • Standards development work from June 2013 to June 2014 • More than 400 others responded to surveys and other consultation 26-May-2017
26-May-2017
Pathology requesting Additional 261 terms added to the Requesting Pathology Terminology Reference set A total of 488 request tests linked to a SNOMED-CT-AU code SNOMED-CT-AU for requesting 26-May-2017
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Pathology reporting Engaged key stakeholder experts Assessment of safety and quality concerns Survey to identify common practice and variation in reporting Survey of requestors and report recipients for preferences and reasons 26-May-2017
Common practice and variation? Lab Survey focusing on cumulative reporting Targeted Chemical Pathology, Haematology and Coagulation departments 114 responses to survey 35 example reports received Wide selection of features on a cumulative report identified 26-May-2017
Report features preferences? Survey of general practitioners, physicians and other clinicians, pathologists, and health informaticians 438 responses received Participants provided: – Preferences in how cumulative pathology reports are presented – Reasons for each preference they selected 26-May-2017
Rendered report features Header Latest and results bolding Box indictor Time Direction Result flag “L” or “H” 26-May-2017
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Adult Reference Intervals Australasian Adult Reference Intervals - Chemical Pathology Harmonised adult I nterpretation of age I nterpretation of Reference Analyte Age ( days) reference ( units) reference limits for 11 Sodium 18y to <120y 6574 ≤ d ≤ 43829 135 ≤ x ≤ 145 mmol/L (135–145) mmol/L (LN-RCPA: 2951-2) analytes Potassium 18y to <120y 6574 ≤ d ≤ 43829 3.5 ≤ x ≤ 5.2 mmol/L (3.5–5.2) mmol/L (LN-RCPA: 2823-3) See note 1 Chloride 18y to <120y 6574 ≤ d ≤ 43829 95 ≤ x ≤ 110 mmol/L (95–110) mmol/L (LN-RCPA: 2075-0) Developed by AACB Bicarbonate 18y to <120y 6574 ≤ d ≤ 43829 22 ≤ x ≤ 32 mmol/L (22–32) mmol/L (LN-RCPA: 1963-8) Harmonisation Committee Creatinine Male (LN-RCPA: 14682-9) 19y to <60y 6574 ≤ d ≤ 43829 60 ≤ x ≤ 110 umol/L (60–110) umol/L See note 2 Female 19y to <60y 6574 ≤ d ≤ 43829 45 ≤ x ≤ 90 umol/L (45–90) umol/L Calcium Agreed by the 18y to <120y 6574 ≤ d ≤ 43829 2.10 ≤ x ≤ 2.60 mmol/L (2.10–2.60) mmol/L (LN-RCPA: 2000-8) Calcium corrected for pathologists and albumin 18y to <120y 6574 ≤ d ≤ 43829 2.10 ≤ x ≤ 2.60 mmol/L (2.10–2.60) mmol/L (LN-RCPA: 29265-6) scientists attending the Phosphate 20y to <120y 6574 ≤ d ≤ 43829 0.75 ≤ x ≤ 1.50 mmol/L (0.75–1.50) mmol/L (LN-RCPA: 14879-1) AACB Harmonisation Magnesium 18y to <120y 6574 ≤ d ≤ 43829 0.70 ≤ x ≤ 1.10 mmol/L (0.70–1.10) mmol/L (LN-RCPA: 2601-3) workshop on 29-30 April Lactate dehydrogenase 18y to <120y 6574 ≤ d ≤ 43829 120 ≤ x ≤ 250 U/L (120–250) U/L 2014 (LN-RCPA: 14804-9) See note 3 Alkaline phosphatase 22y to <120y 6574 ≤ d ≤ 43829 30 ≤ x ≤ 110 U/L (30–110) U/L (LN-RCPA: 6768-6) Total Protein 18y to <120y 6574 ≤ d ≤ 43829 60 ≤ x ≤ 80 g/L (60–80) g/L (LN-RCPA: 2885-2) 26-May-2017
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