CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Kevin B. O’Reilly
February 2015—When you go looking for problems, you’re bound to find them. That truism is especially pertinent in the arena of interface validation, as the team at New York’s North Shore-LIJ Health System discovered recently.
The laboratory professionals there were charged with helping to implement the first phase of a joint venture with New York City’s Health and Hospitals Corp. (HHC), in which North Shore-LIJ would serve as the massive public health system’s primary reference lab. Their job was to interface through middleware and validate, in just eight months, 840 HHC tests coming from 21 of that system’s sites. Meanwhile, the North Shore-LIJ team has had to contend with validating the plethora of electronic health record systems at more than 300 physician clients’ offices, as well as a customized smartphone application. North Shore-LIJ Laboratories has long performed interface validations, but they learned just how arduous it can be when so many have to be performed at once.
The essential task of interface validation is incontrovertible, required by CLIA regulations and accrediting bodies such as the CAP. Laboratories must ensure that ordered tests are correctly submitted to the laboratory information system and results are accurately sent to the electronic interface at the other end, displayed properly on screen, and able to be faxed or printed without becoming garbled.
The opportunities for potentially patient-endangering fumbles from one end to the other are nearly too numerous to count. A recent Q-Probes study, “Validating Laboratory Results in Electronic Health Records,” found that of the 1,064 results the 45 participating institutions looked at, 99 percent were found to have been transmitted accurately from the LIS to the EHR. But 30 percent of the time the results transmitted were incomplete. And only 91 percent of the test results were formatted appropriately. (See “LIS to EHR: Is results transmission what it should be?” CAP TODAY, January 2015, page 42.)
So the team at North Shore-LIJ, along with its counterparts at HHC, set out to ensure accurate reporting of patient lab results. They worked at multiple levels—LIS, medical leadership, quality management, and laboratory staff—to establish the plan, execute the validations, and provide direction when changes in the validation process became necessary. “Failure wasn’t an option for either party,” says Hannah Poczter, MPH, DLM(ASCP), assistant vice president of laboratory services at North Shore-LIJ Health System Laboratories.
Poczter
What did they find, despite much planning and discussion? Unflagged abnormal results, improper or illogical user display of results, report formatting problems, truncated test result text or comments, incorrect reference ranges or units of measure, and scrambling of complex reports that had a lot of text and tables.
The team also discovered, however, that the validation process itself had to be fixed if they were to have any hope of finishing the job on time and without spending a fortune. What began under the leadership of the LIS department, Poczter says, came to require a broader view to ensure success and handle a high-tech future that will see an ever-increasing number of interfaces that require validation.
“I’m a little more at ease, knowing that I have a team of people here and that we have created a template for how to do the validations, and what to look for,” Poczter says. “We already know the obstacles and should be able to continue doing the validations in a timely manner, making sure the end user gets an accurate report.
“It’s a very good journey from where we started to where we are right now,” she tells CAP TODAY. “It’s a very good experience to have solidified the teamwork that we have here within our own laboratories and with our partners as well.”
But the experience was difficult at the start, said Carol J. Sien, MS, MT(ASCP), CQA(ASQ), manager of quality management at North Shore-LIJ Laboratories, based in Lake Success, NY.