Stepwise Success : Technology

Abort Retry Ignore

Scott Warner — Fri, 23 Oct 2009 10:07:00 GMT

MS-DOS (Microsoft Disk Operating System) debuted 28 years ago, quickly finding its way into labs on PCs in offices or attached to instruments. Programs such as BASIC promised much. We just knew , deep down, that computers meant less paper, effortless...(read more)

Back to BASIC

Scott Warner — Mon, 19 Oct 2009 10:17:00 GMT

I once read an article about a BASIC program used to temperature-correct arterial blood gas results. This was in the day when a program could be "keyed in" from a magazine. BASIC, which stands for Beginner's All-purpose Symbolic Instruction Code, was...(read more)

Calculations

Scott Warner — Tue, 08 Sep 2009 10:17:00 GMT

Most of us aren't mathematicians. Well, I'm not. I've known people who are just better at "seeing" math than myself. I've always struggled to add a column of figures in my head, forget solving Fermat's Last Theorem . Which has been solved already. Just...(read more)

Package Inserts

Scott Warner — Wed, 02 Sep 2009 10:14:00 GMT

In writing a procedure, I strive to make it the reference on the bench. Yet no matter how good a written procedure is, the package insert is always invaluable. There are two reasons for this. One, the package insert is the main reference for any procedure...(read more)

Misfiling

Scott Warner — Fri, 28 Aug 2009 10:06:00 GMT

If your lab uses a card file to track patient blood bank history, some cards are misfiled. Depending on where in the file they are placed, they may be good as gone. A blood banker won't be able to compare blood types or know that the patient has a positive...(read more)

Fast Bar Codes

Scott Warner — Mon, 27 Jul 2009 11:20:00 GMT

Let's suppose your information system test database prints at least one barcode specimen label for each test. This label contains the patient name, account number, test order number, a description of the test, and the barcode itself. Now suppose a new...(read more)

Making Sense of Results

Scott Warner — Wed, 22 Jul 2009 08:49:00 GMT

Whether reading a body fluid smear, a culture plate, or chemistry panel, we are paid to make sense of results. Decades of bench work teaches techs to know what is expected and to focus on the unexpected. Many of the techs working today make what is difficult...(read more)

Barcode Your QI Part 3

Scott Warner — Wed, 10 Jun 2009 09:49:00 GMT

With a handheld scanner attached to our terminal, here's a batch file to capture data: @ECHO OFF :LOOP SET /P ACCT=WAND TUBE ECHO %ACCT% %DATE% %TIME% >> SCANNED.LOG GOTO LOOP Saved as SCANNED.BAT in a place where you can run it – such as the Desktop...(read more)

Barcode Your QI Part 2

Scott Warner — Fri, 05 Jun 2009 10:25:00 GMT

A barcode is data that can be read by an optical scanner. A laboratory instrument, for example, may read a specimen label barcode to query a host computer for patient demographics and test information. The point is twofold: you don't have to, and the...(read more)

Barcode Your QI Part 1

Scott Warner — Mon, 01 Jun 2009 08:48:00 GMT

To reduce STAT turnaround time variation, you sometimes have to dig deeper. A chemistry specimen, for example, may have at least four stops before a result is sent from an analyzer to the information system to be verified: labeling, centrifugation, chemistry...(read more)

A New Marker

Scott Warner — Wed, 08 Apr 2009 08:26:00 GMT

When I spoke with the diaDexus rep the other day on the telephone, he told me the PLAC test , a new test that measures lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ), is being done in forty labs across the US, with another added every two weeks....(read more)

New Thinking

Scott Warner — Wed, 11 Mar 2009 14:27:00 GMT

When my son and I talked the other day about "green" technology, I suddenly realized the obvious: solar, wind and biofuel technologies are very old. (Think greenhouses, Don Quixote and wood heat). Is it possible to create new thinking with old technology?

The oft-repeated saying is "If you keep doing what you're doing, you'll keep getting what you're getting." (Never mind "If you do what you used to do, you'll get what you used to get").

This simple epiphany is so fundamental to success--beginner's luck excluded--that I wondered if all of the nagging, persistent problems that seem to evolve past our ability to solve them do so because we expect them to change on their own.

What does this mean for the lab?

It isn't paperless, it's how information technology can do what paper can't.
It isn't gadgets, it's how handheld devices can identify patients in ways we can't.
It isn't the information system, it's how data transformation can do what people can't.

In other words, new technology should suggest new thinking. It should enable a change in behavior, thus changing consequences.

For example, an office may use their information system for point-of-care order entry. These orders are printed, signed and faxed to the laboratory, which orders and runs the tests, prints results in the office and scans the requisition. The office staff then scans the paper reports into their system. All boast an "electronic" medical record, but it is in addition to paper. Providers wait longer for results--they call the lab more often--and the only "solution" is hiring more people to scan. It's for patient safety, after all.

Although it looks like an EMR, it's just a layer of technology. Because the process hasn't really changed, three things have happened: technology errors add to the old process errors (delays); expectations of the new technology fall short (hire more people); and new goals are invented (patient safety).

Has the failure of new technology changed your goals? Or does it suggest new thinking to help you reach your "unreachable" goals?

Paperless

Scott Warner — Fri, 09 Jan 2009 17:39:00 GMT

We should be paperless by now. We have computers, interfaces, scanners and nursing point-of-care software. It should be easy.

Yet we save instrument tapes of interfaced results, save work logs of microbiology specimens and print dozens of specimen labels that we discard. Administration sends e-mails that are printed and posted as wallpaper notices; they send a hard copy that gets posted, too. Patient charts have ballooned with reams of nurses' notes printed by the computer. Even IT isn't immune, their department heaped with printers, printer stands, paper manuals and newsletters.

True, these are hard-coded habits of professionals weaned on The Rifleman. But fact is, Boomers regard paper as work. Less has always been more, and "paper pusher" never a compliment. How ironic, then, that we are blamed as a generation for not being progressive enough to endorse a technology that wastes paper.

Since being named "Person of the Year" by Time in 1982, computers have helped generate enough paper to increase consumption fivefold. The average office worker prints a sheet every twelve and a half minutes, and the U.S. annually consumes over 180 million pounds of paper, equivalent to sixteen and a half billion sheets.

In our laboratory, computers automatically generate outstanding reports, turnaround time reports, specimen collection reports, specimen labels, aliquot labels, instrument printouts, quality control charts, patient reports, cumulative summary reports and whatever else needs to be printed.

That which isn't sent to providers fills a dozen recycle bins each day, adding cost to empty, store, shred, package, transport, store again, transport again and recycle (pulp, screen, clean, centrifuge, wash, bleach and other steps before actually making paper) into "post-consumer" product that is stored, sold, processed, printed, stored again, transported and sold again to be used before eventually making its way into a landfill. At least, jobs are created.

What remains in our laboratory takes more time and space to file than those quaint hand-written quarter-sheet carbons we were all too eager to trade for our current electronic efficiency.

If you ask me, we were much closer to "paperless" before computers.

Smear Art

Scott Warner — Mon, 11 Aug 2008 15:48:00 GMT

Little these days is not automated. The art of laboratory medicine is vanishing, from spectrophotometers to Folin-Wu filtrates to Lee-White clotting times. I'd wax poetic about the meditative lure of bench work, but I don't miss mouth pipetting, spit tubes (pg. 20), or Miller discs.

The wedge smear technique for making blood smears survives. Like handwriting, it is learned early and changed slowly. And while most colleagues make "acceptable" slides, others seem to use the heel of their shoe as the spreader.

Does it matter? This study concludes automated preparation methods show less variability with automated counts, particularly with monocyte populations. This makes sense, as cell size affects how cells are rolled along and eventually flattened by the edge, angle and force of a spreader slide. Sample hematocrit, room temperature and humidity, and slide cleanliness can all make a difference.

Two thoughts.

One, modern analyzers classify thousands of cells, not 100 cells from a few dozen fields. We don't need to match an automated count, just to scan a feathered edge long and wide enough to locate and identify abnormalities. How long and wide are disputable.

Two, if we reduce variability in smear preparation, does it significantly increase precision or accuracy? While difficult to get techs to agree what a smear should look like, it's even harder to get them to change. Experience teaches that day-to-day, tech-to-tech variation in identifying and counting cells is greater than, and not necessarily caused by, millimeters on feathered edges.

Maybe, that's just the artist in me talking. A well-made blood smear is a pretty thing, after all. How do you make your smears? And if you've switched, are automated methods really any better?

To PDF or Not PDF, Part 4

Scott Warner — Wed, 30 Jul 2008 19:24:00 GMT

At a previous position my manager ordered a replacement instrument exhaust fan. Since we didn't have the part, the instrument was useless. But a tech said with amazement, "I think I have one of those in my garage!" She went home and, sure enough, returned with a similar fan that worked.

It's all about accessibility. If you can't find it when you need it, it's gone.

And that is paper's fatal flaw. It is too easily damaged, misplaced, corrupted or thrown out. The only way to have it available at multiple locations is to make copies, creating a version control problem. It costs money to store and transport. Above all, paper is a physical device that consumes space.

Portable Document Format (PDF) manuals should solve the accessibility problem. Virtual storage is limitless, and a change once is a change everywhere. Finding what you need with a few mouse clicks is the raison d'être for online manuals.

But a PDF is slow. Were John Henry alive, he would grab the paper binder off the shelf and find the right page every time before all the Adobe Reader plug-ins even loaded.

The solution is using hyperlinks--just like that one--in policies and procedures to join them together. Imagine a map of links for your entire manual system that loads on startup at all terminals. Imagine any reference as a hyperlink to an electronic document. Paper can't be linked together so.

The full version of Adobe Acrobat is needed. Or (our administration vetoed this idea 2years ago) you can Save As a web page in Word. HTML-formatted documents are faster and just as secure as a PDF. HTML--the international standard--and hyperlinks already connect the internet. They can connect your policies and procedures, too.

Surf your manuals like the Web? Now, that would be something.