Autoverification has become an accepted feature of modern laboratories. Along with instrument flagging, delta checking and reflex rules, computer verification of laboratory reports is a logical extension of information technology.
Pros (Why Not?)
Turnaround time and payroll reduction are two good reasons to autoverify. Augmenting technologist skills that are in short supply makes good sense. Most significantly, your staff has more time to troubleshoot abnormal results.
John H. Stroger, Jr. Hospital in Chicago saw a reduction in turnaround time (TAT) after implementing autoverification. Routine testing TAT was reduced 22%; stat high-volume testing decreased 19%. Staff needed for result-review functions was reduced by 5.5 FTEs (full time equivalents). Many results are now reviewed using consistent criteria, eliminating human variation, improving productivity and reducing error rates.1
Another hospital echoes these findings, estimating a reduction of 3.5 FTEs and a dramatic reduction in turnaround time. The greatest benefit, the authors suggest, is consistency of review by eliminating variability. Time saved is used to focus on manual verification.2
Dale Duca, MT, systems analyst at the Cleveland Clinic Foundation, summarized the pros nicely: "Turnaround time may be reduced. 'Normal' samples can be released and processed at the speed of the instrument, workflow efficiency can be improved, and personnel may become available for other duties."3
Cons (Not So Fast!)
Autoverification sounds great, but if you haven't tried it or tried it and failed, you aren't alone. Bruce Friedman, an Active Emeritus Professor of Pathology at the University of Michigan Medical School in Ann Arbor, reports early suspicion about autoverification and a concern to protect FTEs.4 Other reasons may include:
- Cost. Implementation costs money, not just in payroll hours but in software expenses if middleware solutions are needed. It may look good on paper to compare an initial expense to future savings, but your bean counters may want hard and not soft dollars.
- People. Autoverification, from developing criteria to implementation to testing, takes time and FTEs. Forget this if your laboratory is already stretched to the limit or subsisting on travelers just to get the day to day work done.
- Buy-in. Intuitively, your staff will worry about being replaced. It can be difficult to sell a reduction in turnaround time without a change in report distribution. And there may be little enthusiasm in testing and maintaining the system, an ongoing responsibility.
A consistent strategy to implement autoverification is sustainable. Since technology is constantly changing, requiring periodic adjustments to your test menu, you should design an implementation process rather than a one-time event. Part of your winning strategy includes promoting what autoverification is as well as its benefits to techs working the bench. Here are tips:
- Be realistic. Autoverification may or may not save time. Your vendors can provide some guidance (Siemens has an online estimator5). A literature search can suggest expected savings (one laboratory in New York reduced their workforce by 3.1%6). Estimate the impact on your lab before presenting it to your staff as a plan.
- Involve staff. Autoverification, like instrument flagging and delta checking, is another system quality check. Work with your staff to directly address their concerns and invite them to be part of the verification process. Their buy-in is your most valuable asset.
- Choose high impact tests. It may seem logical to start small with a urine dipstick analyzer or a specific test, e.g., PSA, but you need a big win. Brainstorm with your staff to choose tests that have the highest impact, such as high volume, variable turnaround time tests.
- Be creative. To reduce expenses, consider different ways to test using real patients, such as retransmitting test patient results using different reference ranges so the information system sequesters the results. Work with your IT department to avoid using reagents and instrument time.
- Write it down. Writing down plans ensures success. Use tools like truth tables to map expectations of what will happen and include testing as part of written action plans.
Finally, it's important to celebrate your success along the way. If your entire staff is involved as an ongoing process of improving laboratory productivity, they can all take credit.
Scott Warner is lab manager at Penobscot Valley Hospital, Lincoln, Maine.
- Torke N et al. Process improvement and operational efficiency through test result autoverification. Available at: http://www.clinchem.org/content/51/12/2406.full#F1. Last accessed: 11/26/12.
- Shih M et al. Building and validating an autoverification system in the clinical chemistry laboratory. Available at: http://labmed.ascpjournals.org/content/42/11/668.full. Last accessed: 11/26/12.
- Duca D. Autoverification in a laboratory information system. Available at: http://labmed.ascpjournals.org/content/33/1/21.full.pdf. Last accessed: 11/26/12.
- Friedman B. Upcoming AACC audioconference on autoverification of lab test results. Available at: http://labsoftnews.typepad.com/lab_soft_news/2009/04/aacc-audioconference-on-autoverification-.html. Last accessed: 11/26/12.
- Siemens. Autoverification savings estimator. Available at: http://healthcare.siemens.com/diagnostics-it/diag-it-resources/autoverification-savings-estimator. Last accessed: 11/28/12.
- Pearlman ES et al. Implications of autoverification for the clinical laboratory (abstract). Available at: http://www.ncbi.nlm.nih.gov/pubmed/12168427. Last accessed: 11/28/12.