The use of clinical decision rules at clinical laboratories to rapidly release results, or auto-verify them without technologist intervention has been in use since the late 1990s. The benefits of auto-verification have an immediate impact on the laboratory by improving efficiency, increasing capacity, and reducing errors. Auto-verification eliminates those ‘time-wasting’ tasks that have no added value to the result qualification process so that every result is equally reviewed against a standard set of logic. Auto-verification can take your lab from 0 to 95% first-pass result release using LIS or middleware technology for many laboratory disciplines. Implementing auto-verification can effectively multiply your laboratory’s productivity and help you better manage the next cycle of healthcare change and disruption. Many believe that auto-verification is the one technology that labs can implement which is critical to lab survival.

So, why are only 50% of clinical labs using this super-power even after 20 years of availability? 

Many labs think that auto-verification is tied to automation. Only 50% of laboratories use automation or plan to use automation in the future. Yet auto-verification is readily available in most LIS’s or middleware software that provides connection capability. Access to auto-verification is something small and large labs alike can readily implement with just a little planning and prioritization.

Impact to you.

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Why Labs Don’t Implement Auto-Verification

The answer is complicated, but generally, the reasons that labs DO NOT implement or expand their auto-verification rule program fall into several key categories:

1) Time-consuming to implement and re-validate

The process of implementing auto-verification rules takes time, resources, and a team of people to not only identify clinical best practices but to write rules that represent these practices. It takes 100’s of hours to plan a rule verification project from identifying the verification methodology to writing the test cases and executing them. The documentation of rules testing is laborious and requires attention to detail to collate and format a final documentation report with screen capture evidence. The rule testing process is hard to complete and to keep up to date year after year to meet regulatory and quality requirements.

2) Shortage of IT and clinical subject matter experts

According to The American Society for Clinical Laboratory Science (ASCLS) in a 2018 position paper, the field is facing a critical shortage of trained technologists. Growing technological advances in instrumentation and IT requires new skills that are not necessarily available today. This combination of labor and skillset shortage impacts the lab’s ability to find the expertise that can translate clinical requirements into technical logic. This lack of rule construction knowledge and understanding of how to build a rule set limits many laboratories in their quest to deploy auto-verification.

3) Competing IT and instrument projects

Competing laboratory projects often derail and take a higher priority over auto-verification projects. Labs end up only implementing a single instrument series with auto-verification and never expand their auto-verification program beyond this initial release of rules. LIS and new instrument interface projects become the priority as technology is replaced or upgraded. The layering-in of rules to gain more efficiencies more often than not takes a back seat to time-sensitive and urgent organizational IT priorities.

4) Lack of rule testing and quality verification tools 

Laboratories resort to manually verifying their rules using old-school spreadsheet tracking and documentation. Rule performance confirmation using these manual tools is fraught with errors, not to mention it can be daunting for most first time testers. LIS and middleware vendors try to provide some level of testing capability to validate ‘singular’ rules but this assumes that rules only operate as individual operations and in isolation, an unrealistic assumption in today’s laboratory. What little capability the LIS and middleware vendors do provide falls short too because rule verification testing set up is difficult, testing outcomes are hard to interpret, and test-bed maintenance becomes a long-term commitment.

Auto-verification is your power tool 

Overcoming the obstacles of implementation and bringing an auto-verification program to your lab will dramatically improve your operation and the quality of patient care through standardized result handling – we can all agree on this. However, auto-verification can be challenging to implement without a strong team. The good news is that for labs that don’t quite have the right level of in-house expertise, services and solution providers are out there to assist you.

In the meantime, don’t give up! We urge all laboratories to pursue auto-verification as a key component of their strategic survival plan. Moving manual review to an automated process will free up technologist time so that other revenue-generating testing can be pursued. The use of auto-verification can increase testing capacity without hiring additional resources. The future of laboratories will depend on their ability to embrace this IT power tool called auto-verification, to reduce bottlenecks and change the trajectory of their lab’s operational efficiency.

Inspire you.

Want to learn about what to consider when evaluating outside services and solutions that help implement auto-verification? Check out this auto-verification checklist to encourage you to start taking the next step towards building your auto-verification strategy and plan.

References:

American Society for Clinical Laboratory Science. “Addressing the Clinical Laboratory Workforce Shortage. ASCLS, 2018, ascls.org/images/publications/Clinical_Laboratory_Workforce_FINAL_20180824.pdf. Accessed on March 24, 2020.