TABLE OF CONTENTS
Introduction
Following the great new SystmOne feature release, we are excited to announce the arrival of the new Ardens Auto-Review Results resources.
This new functionality on SystmOne has great potential to increase your efficiency and save you considerable time when reviewing results. It is essential however that clinical safety always come first for you, your practice and your patients.
Ardens has developed its new Auto-Review Results resources with clinical safety at the forefront to avoid automatically
reviewing results if clinical input is required.
Process
Once a result is received it is automatically filed into the patient record (which allows the result to be viewed in the patient record and included in reports, protocols and other resources) but it still needs reviewing. The auto review system allows certain results to be marked as auto-reviewed if they pass certain rules. If the result does not pass these rules they will remain in the pathology inbox to be reviewed manually.
For auto-reviewing results to be implemented safely and efficiently there has to be an understanding at point of requesting the test what you would like the follow up action needs to be:
- Do you still want to follow-up the patient up?
- If so, book them in now, or
- Mark as ‘not for auto-review’ to ensure results will remain to be manually reviewed where follow-up can be decided
- What safety netting advice +/or advice about drug treatment/dosing should you give to the patient? Ideally, this should be explained when the test is ordered
Reports, Batteries & Results
A result is a single numeric result returned for an indices, such as HbA1c.
A battery is a grouping of a number of different indices, such as Full blood count.
A report is a grouping of a one or more batteries requested at the same time
Result Types
Blood Tests
- FBC/UE/LFT
- Urine Tests
- ACR
- Bence Jones
Stool Tests
- FIT Tests
- Faecal Calproctectin
Microbiology Tests
- Urine
- Stool
- Chlamydia
- Wound
- TB culture
Radiology Imaging
- USS
- X-Ray
- CT
Cancer Screening
- Bowel cancer
- Cervical screening
Safety
As always with any Ardens resources safety is paramount, during the development of these resources we became aware of Pathology labs have:
- Differences in reference ranges so normal/abnormal thresholds vary
- Differences in Units Of Measure (UOM) so conversion errors can occur
As a result of this Ardens normal ranges have been created from multiple laboratory sources and national guidance resources.
Based off this we have included a number of safety blocks to prevent results from automatically being reviewed. These include:
- Haemoglobin drop of 15 (9-11%) despite being in normal range
- On DMARDS & trend in last 1 year
- FBC - Drop in WCC/neutrophils/platelets or rise in eosinophils/MCV
- U&E - Rise in Creatinine
- LFT - Rise in ALT (excluding AST), drop in albumin
- FBC + haemoglobinopathy (including sickle cell) - As may have different ranges or targets
- HbA1c + haemoglobinopathy (including sickle cell) - As may have different ranges or targets
- HbA1c + severe anaemia (latest Hb <8g/dL) - As may have different ranges or targets
- ESR + polymyalgia rheumatica, temporal arteritis/GCA - As any rise may be significant
- TSH + thyroid cancer or hypopituitarism - As may have different ranges or targets
- Clotting/INR + on anticoagulant - As anticoagulant affects result
- Folic acid & iron + on oral supplementation - May consider stopping supplements
- HbA1c + medical history
Trends ignored as very specific.
If changing medication, either make follow-up or mark as not for auto-review
DM Type 1 will never be auto-reviewed
- Aged <18 years or pregnant
- Different normal reference ranges
- Different thresholds for intervention
- Importance of pregnancy coding
- Clinical Override (Results for this patient are not to be auto reviewed (Y408b))
- Cases that may need additional clinical input rather than Auto-review:
- Ideally at the time of request Or as a Practice-wide decision – examples include:
We have included some reports to help highlight potential patients you may wish to record this on proactively -
Enable
'Setup > User & Policies > Organisational Preferences', under 'Pathology >Auto-Reviewing' tick the 'Use auto-review pathology rules' option and add appropriate staff from the left-hand list to the right to give them permission to manage the pathology rules.
Create
Setup > Workflow Support > Pathology / Radiology Results Auto-Review Rules Engine
Who creates the rules is a challenge due to:
- Number of laboratories
- Laboratory changing codes, text or ranges
- Laboratory misses one result from normal battery
- New NICE guidance
- Different clinician tolerance thresholds
- Updating rules + communicating to practices
Activate
Go to 'Setup > Workflow Support > Pathology / Radiology Results Auto-Review Rules Engine'. On the 'Scope' picklist, select Arden's Ltd and click 'Subscribe'.
Subscribe
You can only subscribe to rules published by one organisation group e.g. Ardens. This is to prevent any conflict between two rule sets acting on the same investigation (You can change who you are subscribed to at any point)
Click 'Yes' on this next popup
NB: If your organisation has any rules already set up and subscribed to, you will no longer be subscribed to that set of rules. The rules will not be deleted but just become inactive.
Subscribe
Subscribed rule sets are not active by default, each rule set must be made active by ticking the active column.
Apply
Apply Rules - Individual
Pathology > Right click patient > Apply Auto-Review Rules
Apply Rules -Bulk
Select ‘Apply Auto-Review Roles’ button to run all active rules against new reports, which have not yet been run through the engine
Auto-review rules run across the whole inbox, regardless of recipient
If you filter to registered practice, then only runs for these patients if you doing shared administration
Audit
To view an audit of which rules were applied and failed - Right Click > View Auto-Review Audit 
Expand rules to view a breakdown of why the result failed to be auto-reviewed.