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| | text = This is sublevel1 of my sandbox, where I play with features and test MediaWiki code. If you wish to leave a comment for me, please see [[User_talk:Shawndouglas|my discussion page]] instead.<p></p> | | | text = This is my primary sandbox page, where I play with features and test MediaWiki code. If you wish to leave a comment for me, please see [[User_talk:Shawndouglas|my discussion page]] instead.<p></p> |
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| ==Sandbox begins below== | | ==Sandbox begins below== |
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| ===Broad feature set of a pathology information management solution===
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| A pathology information management solution (PIMS) ...
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| * '''automated reflex testing''': Some PIMS vendors include pre-loaded, customizable lists of reflex tests associated with certain pathology procedures and their associated diagnoses. Optimally, these reflex texts are automatically suggested at specimen reception, based on specimen and/or pathology test type.<ref name="NovoPathSoftware13">{{cite web |url=https://www.novopath.com/content/pdf/novopathbrochure.pdf |format=PDF |title=NovoPath - Software Advancing Patient Diagnostics |publisher=NovoPath, Inc |date=2013 |accessdate=05 September 2020}}</ref><ref name="PsycheWindo">{{cite web |url=https://psychesystems.com/enterprise-laboratory-information-software/windopath/ |title=WindoPath Ē.ssential |publisher=Psychē Systems Corporation |accessdate=05 September 2020}}</ref> Examples of pathology-driven reflex testing in use today include testing for additional biomarkers for non-small-cell lung carcinoma (NSCLC) adenocarcinoma<ref name="SundinPath19">{{cite journal |url=https://www.medlabmag.com/article/1619 |title=Pathology-Driven Reflex Testing of Biomarkers |journal=Medical Lab Management |author=Sundin, T. |volume=8 |issue=11 |page=6 |year=2019}}</ref>, HPV testing in addition to cervical cytology examination<ref name="FDANewApproaches19">{{cite web |url=https://www.fda.gov/media/122799/download |title=New Approaches in the Evaluation for High-Risk Human Papillomavirus Nucleic Acid Detection Devices |author=U.S. Food and Drug Administration |publisher=U.S. Food and Drug Administration |date=08 March 2019 |accessdate=05 September 2020}}</ref><ref name="StolerAdjunctive15">{{cite book |chapter=Chapter 9: Adjunctive Testing |title=The Bethesda System for Reporting Cervical Cytology |author=Stoler, M.H.; Raab, S.S.; Wilbur, D.C. |editor=Nayar, R.; Wilbur, D. |publisher=Springer |pages=287–94 |year=2015 |doi=10.1007/978-3-319-11074-5_9 |isbn=9783319110745}}</ref> (discussed further in "adjunctive testing"), and additional automatic testing based off routine coagulation assays at hemostasis labs.<ref name="MohammedDevel19">{{cite journal |title=Development and implementation of an expert rule set for automated reflex testing and validation of routine coagulation tests in a large pathology network |journal=International Journal of Laboratory Hematology |author=Mohammed, S.; Priebbenow, V.U.; Pasalic, L. et al. |volume=41 |issue=5 |pages=642–49 |year=2019 |doi=10.1111/ijlh.13078 |pmid=31271498}}</ref>
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| * '''adjunctive testing''': Adjunctive testing is testing "that provides information that adds to or helps interpret the results of other tests, and provides information useful for risk assessment."<ref name="SegensAdjunct11">{{cite web |url=https://medical-dictionary.thefreedictionary.com/adjunct+test |title=adjunct test |work=Segen's Medical Dictionary |date=2011 |accessdate=05 September 2020}}</ref> A common adjunctive test performed in [[cytopathology]] is HPV testing.<ref name="FDANewApproaches19" /><ref name="StolerAdjunctive15" /> The FDA described this as such in 2003, specifically in regards to expanding the use of the Digene HC2 assay as an adjunct to cytology<ref name="FDANewApproaches19" />:
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| <blockquote>In women 30 years and older, the HC2 High-Risk HPV DNA test can be used with Pap to adjunctively screen to assess the presence or absence of high-risk HPV types. This information, together with the physician’s assessment of cytology history, other risk factors, and professional guidelines, may be used to guide patient management.</blockquote>
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| :Some PIMS vendors allow users to manually add an adjunctive test to a primary pathology test, or in some cases this may be enabled as part of an automated reflex testing process.<ref name="TDHistoCyto">{{cite web |url=https://www.technidata-web.com/solutions-services/disciplines/anatomic-pathology |title=TD HistoCyto Livextens |publisher=Technidata SAS |accessdate=05 September 2020}}</ref> However, ensure that any such solution is capable of feeding any adjunctive test results into the final report, along with the results from the primary tests. Using adjunctive HPV test results as an example, the report should optimally include details such as assay name, manufacturer, the HPV types it covers, results, and any applicable educational notes and suggestions.<ref name="StolerAdjunctive15" />
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| * '''demand management''': Similar to test optimization or clinic decision support, demand management mechanisms help laboratories reduce the amount of unnecessary and duplicate testing they perform. The idea of using demand management to reduce unnecessary pathology testing has been around since at least the beginning of the twenty-first century, if not well before, in the form of decision support systems and order request menus of informatics systems.<ref name="RaoPath03">{{cite journal |title=Pathology tests: is the time for demand management ripe at last? |journal=Journal of Clinical Pathology |author=Rao, G.G.; Crook, M.; Tillyer, M.L. |volume=56 |issue=4 |pages=243–48 |year=2003 |doi=10.1136/jcp.56.4.243 |pmid=12663633 |pmc=PMC1769923}}</ref> Lang described what the process of demand management would look like in a system like a [[laboratory information management system]] (LIMS) in 2013<ref name="LangLab13">{{cite journal |title=Laboratory demand management of repetitive testing – time for harmonisation and an evidenced based approach |journal=Clinical Chemistry and Laboratory Medicine |author=Lang, T. |volume=51 |issue=6 |pages=1139–40 |year=2013 |doi=10.1515/cclm-2013-0063 |pmid=23420284}}</ref>:
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| <blockquote>When implementing a demand management tool it is important that the system used to manage a laboratory workload can correctly identify the patient and match requests with the patient’s medical record. Ideally there should be one unique identifier used (e.g., NHS number in the UK), which will allow the LIMS to interrogate the patient’s previous pathology result to allow identification of duplicate or inappropriate requests. If a subsequent request is blocked, then it is also important that there is real-time notification of a potential redundant test so that the requestor can make an informed choice on the clinical need of the test and if it is required to override the rule. It is important that there is a facility whereby the laboratory or requestor can record the reason for blocking a request or overriding the rule.</blockquote>
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| :Today, some PIMS are designed to allow configurable rules and parameters to check for duplicate and unnecessary test at various levels (e.g., by test ID or catalog type, activity type, or some other order level).<ref name="MorrisDemand18">{{cite journal |title=Demand management and optimization of clinical laboratory services in a tertiary referral center in Saudi Arabia |journal=Annals of Saudi Medicine |author=Morris, T.F.; Ellison, T.L.; Mutabbagani, M. et al. |volume=38 |issue=4 |pages=299–304 |year=2018 |doi=10.5144/0256-4947.2018.299 |pmid=30078029 |pmc=PMC6086671}}</ref><ref name="DXCLab">{{cite web |url=https://www.dxc.technology/healthcare/offerings/139499/139776-dxc_laboratory_information_management_lims |title=DXC Laboratory Information Management (LIMS) |publisher=DXC Technology Services, LLC |accessdate=05 September 2020}}</ref>
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| ==References==
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| {{Reflist|colwidth=30em}}
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