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Tomlinson E, Goodman J, Loftus M, Bitto S, Carpenter E, Oddo R, Judis L, Ali S, Robinson WE, Carver M, Ganea M, McDonnell K, O'Neill D, Starbuck J, Johnson E, Meister E, Pohl J, Spildener J, Shurtleff S, Sovie S, Melendez C, Krebs P, Riley JD, Wensel C, Astbury C, Azzato EM, Bosler DS, Brock JE, Cook JR, Cheng YW, Tu ZJ, Cruise M, Henricks WH, Farkas DH. A Model for Design and Implementation of a Laboratory Information-Management System Specific for Molecular Pathology Laboratory Operations. J Mol Diagn 2022; 24:503-514. [PMID: 35101595 DOI: 10.1016/j.jmoldx.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
The Molecular Pathology Section, Cleveland Clinic (Cleveland, OH), has undergone enhancement of its testing portfolio and processes. An Excel 2013- and paper-based data-management system was replaced with a commercially available laboratory information-management system (LIMS) software application, a separate bioinformatics platform, customized test-interpretation applications, a dedicated sample-accessioning service, and a results-releasing software application. The customized LIMS solution manages complex workflows, large-scale data packets, and process automation. A customized approach was required because, in a survey of commercially available off-the-shelf software products, none met the diverse and complex needs of this molecular diagnostics service. The project utilized the expertise of clinical laboratorians, pathologists, genetics counselors, bioinformaticians, and systems analysts in partnering with software-engineering consultants to design and implement a solution. Concurrently, Agile software-building best practices were formulated, which may be emulated for scalable and cost-effective laboratory-authored software.
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Affiliation(s)
| | - Jennifer Goodman
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margaret Loftus
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen Bitto
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Erica Carpenter
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard Oddo
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - LuAnn Judis
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shabab Ali
- Semaphore Solutions, Victoria, British Columbia, Canada
| | | | - Miranda Carver
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mariana Ganea
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kristen McDonnell
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Diane O'Neill
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Starbuck
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric Johnson
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Erik Meister
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan Pohl
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jessica Spildener
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheila Shurtleff
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sheryl Sovie
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Pamela Krebs
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacquelyn D Riley
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine Wensel
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Caroline Astbury
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth M Azzato
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - David S Bosler
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay E Brock
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - James R Cook
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yu-Wei Cheng
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zheng Jin Tu
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Cruise
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Walter H Henricks
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel H Farkas
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Keppens C, Van Royen Y, Brysse A, Cotteret S, Høgdall E, Kuhlmann TP, O'Sullivan B, Pauwels P, Pauwels S, Rot M, Vanderheyden N, Van Hee I, Dequeker EM. Incidents in Molecular Pathology: Frequency and Causes During Routine Testing. Arch Pathol Lab Med 2021; 145:1270-1279. [PMID: 33406246 DOI: 10.5858/arpa.2020-0152-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Errors in laboratory medicine could compromise patient safety. Good laboratory practice includes identifying and managing nonconformities in the total test process. Varying error percentages have been described in other fields but are lacking for molecular oncology. OBJECTIVES.— To gain insight into incident causes and frequency in the total test process from 8 European institutes routinely performing biomarker tests in non-small cell lung cancer and colorectal cancer. DESIGN.— All incidents documented in 2018 were collected from all hospital services for pre-preanalytical entries before the biomarker test, as well as specific incidents for biomarker tests. RESULTS.— There were 5185 incidents collected, of which 4363 (84.1%) occurred in the pre-preanalytical phase (all hospital services), 2796 of 4363 (64.1%) related to missing or incorrect request form information. From the other 822 specific incidents, 166 (20.2%) were recorded in the preanalytical phase, 275 (33.5%) in the analytical phase, and 194 (23.6%) in the postanalytical phase, mainly due to incorrect report content. Only 47 of 822 (5.7%) incidents were recorded in the post-postanalytical phase, and 123 (15.0%) in the complete total test process. For 17 of 822 (2.1%) incidents the time point was unknown. Pre-preanalytical incidents were resolved sooner than incidents on the complete process (mean 6 versus 60 days). For 1215 of 5168 (23.5%) incidents with known causes a specific action was undertaken besides documenting them, not limited to accredited institutes. CONCLUSIONS.— There was a large variety in the number and extent of documented incidents. Correct and complete information on the request forms and final reports are highly error prone and require additional focus.
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Affiliation(s)
- Cleo Keppens
- From the Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium (Keppens, Van Royen, Dequeker)
| | - Yann Van Royen
- From the Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium (Keppens, Van Royen, Dequeker)
| | - Anne Brysse
- Unilab, Service de Génétique Humaine, CHU de Liège, Liège, Belgium (Brysse)
| | - Sophie Cotteret
- Pathologie Moléculaire, Laboratoire de Cytogénétique, Institut Gustave Roussy, Villejuif Cedex, France (Cotteret)
| | - Estrid Høgdall
- Department of Pathology, Herlev Hospital, Herlev, Denmark (Høgdall, Kuhlmann)
| | - Tine Plato Kuhlmann
- Department of Pathology, Herlev Hospital, Herlev, Denmark (Høgdall, Kuhlmann)
| | - Brendan O'Sullivan
- Histopathology, Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom (O'Sullivan)
| | - Patrick Pauwels
- Centre for Oncological Research (CORE), University of Antwerp, Edegem, Belgium (P. Pauwels).,Pathologische Anatomie, University Hospital Antwerp, Edegem, Belgium (P. Pauwels, S. Pauwels)
| | - Siegrid Pauwels
- Pathologische Anatomie, University Hospital Antwerp, Edegem, Belgium (P. Pauwels, S. Pauwels)
| | - Mitja Rot
- Laboratory for Cytology and Pathology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia (Rot)
| | - Nancy Vanderheyden
- Pathologische Ontleedkunde, University Hospital Leuven, Leuven, Belgium (Vanderheyden)
| | - Ilse Van Hee
- Anatomo Pathologie, Imelda Ziekenhuis, Bonheiden, Belgium (Van Hee)
| | - Elisabeth Mc Dequeker
- From the Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium (Keppens, Van Royen, Dequeker)
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Myers C, Swadley M, Carter AB. Laboratory Information Systems and Instrument Software Lack Basic Functionality for Molecular Laboratories. J Mol Diagn 2018; 20:591-599. [PMID: 30146005 DOI: 10.1016/j.jmoldx.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/26/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022] Open
Abstract
Laboratory information systems (LISs) have some basic functionality necessary for molecular workflow that is glaringly absent. This study determined functionality gaps of LISs in molecular laboratories and the associated impact to workflow, efficiency, and security by collecting anonymous survey data from clinical laboratory professionals. A 34-question survey (30 required + 4 optional) was compiled using an online survey tool. Participants were recruited through several professional molecular society listservs and given 4 weeks to complete the survey. Data collected included participant demographics, scope of testing, software capabilities for the LIS and molecular instruments, and comments. Eighty respondents completed the entire survey. Many desired versus actual functionality gaps were identified. Prominent among these were bar coding, LIS interfacing, storage of preanalytical data, Health Insurance Portability and Accountability Act compliance/information security, and reporting. Much basic functionality is lacking in molecular LISs and molecular instrument software. Some of these results indicate that instruments and LISs are not compliant with the Health Insurance Portability and Accountability Act. Collaboration between molecular professionals and manufacturers of instruments and software is necessary to correct these deficits and is critically important to ensure the continued high quality and safety of molecular practice as the volume of testing skyrockets.
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Affiliation(s)
- Charles Myers
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Matthew Swadley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Alexis B Carter
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia; Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Tack V, Dufraing K, Deans ZC, van Krieken HJ, Dequeker EMC. The ins and outs of molecular pathology reporting. Virchows Arch 2017; 471:199-207. [PMID: 28343306 DOI: 10.1007/s00428-017-2108-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/07/2017] [Accepted: 03/12/2017] [Indexed: 01/15/2023]
Abstract
The raid evolution in molecular pathology resulting in an increasing complexity requires careful reporting. The need for standardisation is clearer than ever. While synoptic reporting was first used for reporting hereditary genetic diseases, it is becoming more frequent in pathology, especially molecular pathology reports too. The narrative approach is no longer feasible with the growing amount of essential data present on the report, although narrative components are still necessary for interpretation in molecular pathology. On the way towards standardisation of reports, guidelines can be a helpful tool. There are several guidelines that focus on reporting in the field of hereditary diseases, but it is not always feasible to extrapolate these to the reporting of somatic variants in molecular pathology. The rise of multi-gene testing causes challenges for the laboratories. In order to provide a continuous optimisation of the laboratory testing process, including reporting, external quality assessment is essential and has already proven to improve the quality of reports. In general, a clear and concise report for molecular pathology can be created by including elements deemed important by different guidelines, adapting the report to the process flows of the laboratory and integrating the report with the laboratory information management system and the patient record.
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Affiliation(s)
- Véronique Tack
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D, 3000, Leuven, Belgium
| | - Kelly Dufraing
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D, 3000, Leuven, Belgium
| | - Zandra C Deans
- Department of Laboratory Medicine, UK NEQAS for Molecular Genetics, UK NEQAS Edinburgh, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Han J van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth M C Dequeker
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok D, 3000, Leuven, Belgium.
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