APIII - Advancing Practice, Instruction & Innovation Through Informatics

Electronic PCR Request System for Alpha Thalassemia – An OnlineMiddleware Powered by Visual Basic

Richard Yu, MD (ryu@mdsmetro.com); Jan Palaty, PhD; Ekram Zayed, MD; Monika Hudoba, MD; Suseela Reddy, MBBS. Department of Hematopathology; MDS Metro, Burnaby, British Columbia, Canada

Context: Our laboratory performs approximately 3500 Hb investigations including molecular PCR analysis for alpha-globin gene deletional mutations (3.7, 4.2, Southeast Asian, Filipino, Thai, Mediterranean, 20.5, Hb constant spring and Quong Sze).  We routinely screen for hemoglobinopathy/thalassemia using high performance liquid chromatography.  A negative screen may necessitate PCR analysis.  Using this approach for diagnosis results in generation of multiple worksheets requiring convoluted manual data tracking and management.  Pathologist interpretation of result at a distant reference lab adds further complexity to the workflow resulting in further delay in TAT.

Technology:  Informatics analysis of data arrangement in worksheet batch and application of Visual Basic programming language for the extraction of patient information to Excel worksheet with a built-in PCR request system.

Design:  Our system is designed to electronically transfer PCR requests online to the molecular diagnostic lab using Visual Basic.  The e-worksheet is feature enhanced to facilitate entry of interpretation codes and comments.  It is archived in the access restricted network drive which can be retrieved by pathologists and technologists for the purpose of data tracking.

Results:  Post implementation, at least 50% of the paperwork was eliminated.  Retrospective analysis of 124 data points for pre- and post-implementation TAT analysis showed a 29% improvement (88.7 hrs vs 63.1 hrs; p < 0.016).  TAT for the distant reference lab (n=49) showed 43% improvement (118 hrs vs 67.4 hrs; p < 0.0006).

Conclusion:  By applying informatics, we have successfully designed and implemented a middleware with e-worksheet and a built-in PCR request system that enables pathologist to result interpretations and transfer PCR requests resulting in improved TAT.  Further development is underway to enable technologist to enter molecular diagnostic results into PDA pre-loaded with e-worksheet thereby creating a paperless electronic system.  Our approach is best applied to tests with low to moderate volume for which the testing platform has not been interfaced into the mainstream LIS.  Finally, pathologist should take opportunities to learn and participate in informatics management.  In our case, the informatic tools were designed by the lead author who has interest in the field.