Showdown at the FLOW-K Corral Presented by Patti Chiurazzi Johns Hopkins Medical Institutions

FLOW CYTO METRY What is Flow Cytometry? Technology that measures characteristics of cells as they flow single-file through in a fluid stream through a beam of laser light

What is Flow Cytometry? Hematologic cells are characterized by antigen on their surface. Antibodies to these antigens can be compounded with a fluorescent dye which is excited by a laser. When these antibodies are added to cell solution, the presence of the antigen on a cell surface can be detected by the fluorescent signal. Due to differences in spectral emissions, different fluorescent dyes can be used in one tube…meaning multiple cell surface antigens can be measured in one tube.

JHMI Flow Cytometry Lab Becton Dickinson Instrumentation 3 FacsCantos SPA (Sample Prep Assistant) Analysis software Paint A Gate and Infinicyt Leukemia/ Lymphoma Phenotyping (~ 400 cases monthly) Lymphocyte Subsets (~650) PNH Quantitative CD34

Before Soft Flow Cytometry TEDIOUS paperwork

Before Soft Flow Cytometry Manual transcription of patient/testing information Raw data sheet with many initials Tube labels with hand written identification Transcription of all data into Access database Lost paperwork? Rework the sample!

Implementation of Soft Flow Cytometry Soft LAB 4.5.2 Soft FLW 3.1.13

Implementation of Soft Flow Cytometry Lots and Lots of Building Need the fence posts in order to build the fence

Implementation of Soft Flow Cytometry Antigen + Fluorochrome = Marker Marker + Marker+ Marker … = Panel tube

BUILDING SETUP FILES-SPECIMENS SETUP>>SETUP FILES>>SPECIMEN

BUILDING SETUP FILES-ANTIGENS SETUP>>SETUP FILES>>ANTIGEN 100+ files

BUILDING SETUP FILES- RESULT ELEMENTS SETUP>>SETUP FILES>>RESULT ELEMENTS 100+ files

BUILDING SETUP FILES- FLUOROCHROMES SETUP>>SETUP FILES >> FLUOROCHROME

BUILDING SETUP FILES SETUP>>SETUP FILES>>TESTS>>MARKERS

BUILDING SETUP FILES SETUP>>SETUP FILES>>TESTS>>PANELS

More building and dependent files BUILDING SETUP FILES More building and dependent files Actions- anything wanted to be documented in the system Protocols- actions grouped together for specific workflows for certain specimens (specimen protocols) or tests (test or panel protocols)

SETUP>>SETUP FILES>>ACTION !REV Test Review FLACQUIRE Acquire on Instrument

SETUP>>SETUP FILES>>PROTOCOL BMSPROC Bone Marrow Specimen Processing FLCLINICAL Leukemia/Lymphoma Panel Protocol

SETUP>>SETUP FILES>>PROTOCOL AB_ADD Antibodies Added FLACQUIRE Acquire on Instrument FLANALYZE Transfer FSC Files !PARV Panel Review

DMI>>INSTRUMENT SETUP>>DIVAS DIVAS Instrument looking for Order#_Panel Code_Tube#

DMI>>INSTRUMENT SETUP>>DIVAS DIVAS Instrument moves FSC File from FCS FILES folder to INFINICYT folder

DMI>>INSTRUMENT SETUP>>DIVAS FLANALYZE action is completed by DIVAS

DMI>>INSTRUMENT SETUP>>DIVAS Antibodies added and Acquire on Instrument are completed by a tech Transfer FSC files is completed by DIVAS

DMI>>INSTRUMENT SETUP>>INFINICYT Instrument Infinicyt looks for Order#_Panel Name_Run#

DMI>>INSTRUMENT SETUP>>INFINICYT Infinicyt is started by clicking Analysis Module button

DMI>>INSTRUMENT SETUP>>INFINICYT The panel name will dictate which analysis profile to use. MDS panel will use the MDS123.inp

DMI>>INSTRUMENT SETUP>>INFINICYT Populations from Infinicyt result page are mapped to SOFT result fields. From MDS tube 001- RE%MYELOID result field is populated.

DMI>>INSTRUMENT SETUP>>INFINICYT

DMI>>INSTRUMENT SETUP>>INFINICYT

DMI>>INSTRUMENT SETUP>>INFINICYT INFINICYT instrument moves XML file from INFINICYT_RESULTS to INFINICYT_ARCHIVE

Implementation of Soft Flow

Implementation of Soft Flow Tube labels print with patient and antibody information Label BARCODES (scan sample information directly into instruments)

Implementation of Soft Flow Previous history of patient in same system Automatic release of results into HIS

The Calm FLOW Frontier FLW 3.2.19.6

SOFT FLOW 3.2.19.6 SOFT LAB/MIC 4.5.4 SOFT MOLECULAR SOFT CYTOGENETICS SOFT TQC functionality with SOFT FLW

THE UPGRADE FLW 3.2.19.6

UPGRADE to 3.2.19.6.6 System slowness. Pathologists finding delays going from one screen to the other during the signout process.   Interpretation windows “freezing” SoftFlowcytometry.exe has stopped working. Doctor file not updating with roles- order cannot be saved in GENE Big Red X

BIG RED X

TQC in SOFT FLOWCYTOMETRY The concept of TQC for creating orders and saving results for statistical analysis is a good concept for LAB. TQC will not allow the ordering of panels which is the basis of the FLW module. TQC will only allow 1 tube to associate with each QC order. TQC is not setup to use result element reporting. TQC does not allow analysis of the order in the FLW module or automatic saving of documents.

TQC in SOFT FLOW CYTOMETRY X TQC in SOFT FLOW CYTOMETRY The concept of TQC for creating orders and saving results for statistical analysis is a good concept for LAB. TQC will not allow the ordering of panels which is the basis of the FLW module. TQC will only allow 1 tube to associate with each QC order. TQC is not setup to use result element reporting. TQC does not allow analysis of the order in the FLW module or automatic saving of documents.