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Middleware and the Clinical Hematology Laboratory



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Verification of the Differential: Where?

Slide 7

February 2009

Let’s now look at the possible steps that may occur from when a differential count is done to when it is entered into the LIS or the electronic medical record.  First of all, the differential may auto-verify at the instrument and thus place the results directly into the electronic medical record or it may flag or trap that particular specimen; if it does, then the technologist may scan the slide, confirm the accuracy of the autodiff, and then release that differential without doing a full 100 cell manual differential count.  If not, then a full manual differential review should be done.  But it is important to think about the manual differential count in perhaps a different way.  A manual differential ends up in one of two separate categories: those cases with no or only minimal abnormalities versus those that have significant abnormalities with clinical implications.  Thus, in the laboratory the four green boxes identify the four key decision points; will the instrument auto-verify the results? Will the technologist scan and release this specimen? Will the manual differential count show only minimal or no abnormalities? Or will there be significant abnormalities on the manual differential?  This is the time when it is essential for a laboratory to model their practice so they can understand how their cases are distributed within these various categories.  This will help determine the potential value or not of the middleware product and its implementation.  For example, does your instrument currently auto-verify at a rate of 80% or 40%?  Clearly at an 80% level there is much less opportunity for a middleware product as opposed to 40%.  If the scan and release rate is a high number, like 30%, versus a very low number, it would offer more middleware auto-verification opportunities.  And finally, take a hard honest look at your manual differentials and understand how many really have contributed true clinical value by having a morphologic review.  Again if it’s a low percentage, middleware can clearly add value.  The scan & release and the minimal or no abnormality boxes are the key areas that a laboratory needs to focus on as they will provide the most opportunities for using middleware within a clinical hematology laboratory. 

Verification of the Differential: Where?

 


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