Autoverification is the process by which LIS-based rules are used to verify clinical laboratory test results without any manual intervention. It's a process that all sophisticated clinical labs need to adopt, particularly for routine chemistry and hematology tests, to decrease labor costs and test turn-around-times (TATs). A recent article in the on-line Journal of Pathology Informatics described autoverification in the chemistry core lab at the University of Iowa Hospitals (see: Autoverification in a core clinical chemistry laboratory at an academic medical center). Below is an excerpt from the results portion of the abstract:
The autoverification rate for tests performed in the core clinical chemistry laboratory has increased over the course of 13 years from 40% to the current overall rate of 99.5%. A high percentage of critical values now autoverify. The highest rates of autoverification occurred with the most frequently ordered tests such as the basic metabolic panel ..., albumin (99.8%), and alanine aminotransferase (99.7%). The lowest rates of autoverification occurred with some therapeutic drug levels...and with serum free light chains (kappa/lambda), mostly due to need for offline dilution and manual filing of results. Rules also caught very rare occurrences such as plasma albumin exceeding total protein (usually indicative of an error such as short sample or bubble that evaded detection) and marked discrepancy between total bilirubin and the spectrophotometric icteric index (usually due to interference of the bilirubin assay by immunoglobulin (Ig) M monoclonal gammopathy).... Our results suggest that a high rate of autoverification is possible with modern clinical chemistry analyzers. The ability to autoverify a high percentage of results increases productivity and allows clinical laboratory staff to focus attention on the small number of specimens and results that require manual review and investigation.
Delving back in my memory of a few decades ago, I recall some degree of anxiety involving the CAP inspection of our labs in relation to our use of autoverification rules. There was a requirement at that time that a medical technologist must "manually" verify each batch of test results prior to release to ensure that they were "reasonable" or some equivalent word. One of the technologists in our hematology lab had a burning interest in autoverification and had succeeded in that goal such that most of the routine hematology tests were being autoverified.
The autoverification rules for hematology tests must accommodate to a large number of patients with very high or low white blood cell and platelet counts. This was accomplished by taking into account the "delta" between the current day's value for a patient and that of a previous day. Patients with high WBC counts today probably had high counts yesterday. I seem to recall that the lab was achieving autoverification rates for hematology routine tests in the range of about 70-80%. We worried that our use of autoverification rules might get us into trouble during an inspection. We decided that we had adopted a modern approach to workflow and would just explain this to our inspector if need be.