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Design of a state of the art reporting system and process improvement for reporting of high complexity single antigen bead data for transplant patients to the electronic medical record
  1. Lupita I Geer1,
  2. Sonya Kagele2,
  3. Scot Townshend3,
  4. Brooke Watson3,
  5. Elaine F Reed1,
  6. Michelle J Hickey1
  1. 1 Pathology and Laboratory Medicine, Division of Immunogenetics, University of California, Los Angeles, California, USA
  2. 2 ISS Information Services & Solutions, University of California, Los Angeles, California, USA
  3. 3 SystemLink, Inc, Reston, Virginia, USA
  1. Correspondence to Dr Michelle J Hickey; mhickey{at}mednet.ucla.edu

Abstract

The UCLA Immunogenetics Center is an Immunogenetics and Histocompatibility laboratory that performs testing for multiple transplant programmes within and outside of UCLA. The single antigen bead (SAB) test is a high complexity luminex bead test used to assess pretransplant and post-transplant patients for the presence of pathogenic human leucocyte antigen donor-specific antibody associated with allograft rejection. Efficient reporting of the SAB test has been difficult as data analysis and reports are generated in the laboratory information system (LIS) and uploaded to the electronic medical record (EMR) as PDFs. To solve this, we recently developed a state of the art reporting workflow allowing discrete reporting of SAB data (antibody specificity, mean fluorescent intensity and interpretative comments) from the LIS HistoTrac to UCLA Health System’s EMR EPIC:CareConnect. However, a proportion of tests did not report to the EMR appropriately. Baseline system performance data evaluated over a 10-week period showed that ~4.5/100 tests resulted in EPIC as ‘preliminary result’ or ‘in process’ instead of ‘final result’ with only common cause variation. Quality improvement methods were employed to improve the process with the SMART Aim of reporting 100% of tests as ‘final result’. Pareto analysis identified two errors accounting for 79% of common system-level failures—status errors and interface errors. We hypothesised that addressing the status error would reduce or eliminate the interface errors. We used the Model For Improvement to test a reprogramming intervention. Status and interface errors were completely resolved through the process improvement. Continuous monitoring revealed a system-level shift with only ~1.9/100 tests resulting inappropriately. Through the audit process, the remaining common system-level failures were identified and resolved. Therefore, 100% of tests result to EPIC as ‘final result’. The study demonstrates that high complexity SAB bead data can be efficiently reported EPIC:CareConnect from HistoTrac as discrete data.

  • laboratory medicine
  • transplantation
  • electronic health records
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Footnotes

  • Contributors All coauthors made substantial contributions to the manuscript. MJH conceived and designed the quality improvement study, performed data analysis and drafted the manuscript. ST and BW contributed the programming intervention that lead to a sustainable system shift. SK and LIG gathered baseline and postintervention data. SK, LIG, BW, ST and EFR aided in data analysis and interpretation. All authors contributed to reviewing and revising the initial and revised submissions of the manuscript, and provided a final approval of the manuscript’s content, and are accountable for all aspects of the accuracy and integrity of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ST and BW are employees of SystemLink. SystemLink is a vendor that receives payment to perform database and interface development services for UCLA.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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