Mark Cox read a recent guest blog note (see: More on HL7 Interfaces; the Australian Standard as a Solution) and decided to submit his own contribution on a similar topic. He is a long time colleague and has 25 years of experience in laboratory IT around the world. He worked earlier with Delphic/Sysmex in New Zealand and is now the Regional CEO, Asia Pacific, for the software company ICNet International. His focus is infection control surveillance and antimicrobial stewardship.
I read Grahame Grieve's guest blog note with interest having had a bit to do with the Australian marketplace over the years. Because of the intense competition in Australia between pathology providers, GPs have a huge influence over the format of reports they receive there. GPs would tell a pathology provider that he/she would give them their business if the lab could deliver a pathology report in the desired format. The pathology marketing team would then ask its Internal IT department to tailor the format to suit that particular GP.
For example cumulative reports can be provided in left-to-right, right-to-left, top-to-bottom and bottom-to-top formats. So, depending on the GP’s preference, the latest result could be on the right, left, top or bottom of the paper. I believe that even within a specific clinical practice there could be a variance between doctors, so if you were reading your colleagues reports they could be formatted in a different way. This has resulted in an incredibly complicated lab reporting environment resulting in additional cost with little value to the pathology provider and a high chance of errors because of the number of different versions of reports available. The now retired Ultra LIS from Triple G/GE) excelled in this area. Now we have two forms of the results being sent out. One in atomic form and one as a blob or image. Again, a high chance of something going wrong
I would also question the comments made about “deconstructing the formatting that we have carefully developed over decades on our LISs”. I think the idea of lab formatting was overestimated at the expense of quality and consistency. It seems to me that the key role of the laboratory is now to produce high quality raw data. Good IT systems such as EMRs or portals should enhance the reporting experience. Pathology Informatics should focus on influencing the EMR and portal providers rather than the LIS vendors.
It is interesting that many studies have been performed looking at medical errors resulting from a variation in pharmacy ordering forms. It would be interesting to do a study to look at how many medical errors come from different pathology reporting schemes. Certainly in Australia, it would seem to me dangerous that in half of the reports the latest result is on the left hand side of the paper and on the other half the latest result is on the right hand side.
I would see significant value in quality if all reports in Australia were standardised. I know some standardisation was attempted a few years ago but the competitive pressures of the pathology providers was too high. As mentioned by Grahame, the issue is that the GP system vendors have not invested in developing a product for quality presentation of pathology results along with the lack of standards around pathology formatting. Perhaps with the trend away from paper, the pathology providers should send a buck the way of the GP IT companies and get them to improve their software. This would then remove the overhead within the labs' own internal IT teams and improve the quality of presentation. A whole layer of complication could be removed from the LIS.
But, given the highly competitive nature of the market, pathology providers are afraid to “rock the boat” in order not to lose a customer. As a Kiwi, it is always a good opportunity to have a little jab at our Australian cousins. In New Zealand, most pathology results are (or will be) sent into the four regional repositories called Testsafe where primary and secondary care clinicians see the pathology results presented through a browser in a standard manner. This reduces the chance of error. When this was implemented, I can’t remember any protest from the laboratories about losing an their influence on the format of the reports.
There are still issues in New Zealand with the inconsistency in the quality of GP IT systems and the way they present pathology reports. In an ideal world and with everything networked, GP IT systems would display results from the national repository using a national pathology reporting tool. In a country the size of New Zealand and given the healthcare funding model, this is not impossible. However, this model would be difficult to achieve in a more commercial environment.