Automating Result Verification Autoverification Automating Result Verification

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Autoverification Overview Autoverification is functionality offered by the Cerner Millenium® PathNet General Laboratory system that allows the system to automatically verify results received from an interfaced instrument. Autoverification can be used to verify patient results, Q.C. results or both

Autoverification Overview Quality Control results can be used to govern Autoverification for patient results. By defining Controls, Q.C. Rules and a Q.C. Schedule, Cerner can turn A.V. off if the QC results indicate that the instrument is Out-Of-Control.

Autoverification Overview At LHSC we use Autoverification functionality for patient results on the following instruments. Clinitek DxH Roche ACL 10000 ACL Top And QC only; Centaur

Autoverification Overview In the past we used QC results being sent from the automated Hematology and Chemistry Instruments to govern Autoverification. We no longer send QC results into Cerner for; DxH Roche

Autoverification Overview The autoverification functionality is used to evaluate and autoverify the following result type assays; Numeric Calculations Alpha.

Autoverification Overview Each interfaced instrument result is evaluated based on assay level parameters identified for each assay and instrument combination. If the results meet the criteria defined, the results are verified by the system. If the results do not meet the criteria, the results remain in a performed status and a user must review and verify the results using a Accession Result Entry application.

Autoverification Overview Examples of Assay Level Parameters include; Reference Range ( not used to prevent AV at LHSC) Review Range Critical Range Linear Range ( not used to prevent AV at LHSC) Feasible Range Delta Check Consistency

Autoverification Overview Review Range At LHSC we use the Review Range to warn the Technologist that some action might be required. This could be a cue to repeat the result. Results that exceed the Review Range appear with a R in the Flags Column.

Autoverification Overview Delta Check At LHSC we Delta Checks are set to capture trending in patient Results. We can train the system to look forward from previous result and backwards from current results. This helps eliminate Delta Checks being missed from a set of results that are incrementally trending. Delta Checks at LHSC are set at either percent or absolute values. Results that fail the Delta Check appear with a D in the Flags Column.

Autoverification Overview Feasible Range At LHSC Feasible Ranges are generally set at the analytical range of the instrument. Results that exceed the Feasible Range will appear in red, and require a comment before the result is Verified. Results that exceed the Feasible Range appear with an F in the Flags column.

Autoverification Overview Consistency Check The consistency checking parameter provides the ability for the system to compare the current result with the previous result based on the result flag. If the system determines the current result to be consistent with the previous result, the system Autoverifies the current result even though a result flag is present.

Autoverification Overview Consistency Check The consistency check is only performed when both the current and previous result have the same result flag. For example if both results are flagged as R, the consistency check proceeds. The consistency checking parameters include the time interval allowed between the two specimens and the consistency check variance measure in percent or absolute values. Results that fail the Consistency Check do not appear with a flag in the Flags Column in ARE. There will be a message in Instrument Activity Monitor when the Check has either passed or failed.

Autoverification Overview Repeat all assays on the Orderable This option triggers a new download to the bi-directional and dynamic download instruments. If this setting is used, when a sample fails Autoverification the sample will qualify for a download. For Technologist using the Coulter instruments, this means repeat printouts from those instruments will include the patient demographics.

Autoverification Overview Additional criteria that can prevent Autoverification include; Instrument error codes Duplicate/equivalent assays Prevent Autoverification by Orderable Prevent Associated (Trigger/Associated)

Quality Control Schedule A QC Schedule must be identified when you have indicated that QC is required to autoverify patient results. The QC schedule identifies what controls must be run and when. You will have a tolerance time window to complete the task called the QC step time. • If QC has not been run and determined to be in control at the time patient results are received, the system fails the autoverification of patient results. • If a QC result has failed a QC rule and is determined to be out of control, the system stops autoverification of patient results until the out of control situation is resolved. Autoverification is never turned off for QC results Once the out of control situation is resolved the user must manually turn on autoverification for the affected assays.

Autoverification and Result Entry The Accession Result Entry application provides several options for managing the Autoverification process. These options include; the ability to prevent autoverification for a selected accession. turn autoverification off or on assign an operator to an instrument that requires operator assignment for autoverification.

Autoverification and Result Entry Prevent Autoverification for Accession Periodically there are situations where the specimen for a specific patient may require additional attention or preparation, such as a cold agglutinin, or a research sample, when a manual differential is required. The system provides the option to prevent autoverification for a selected accession number.  

Autoverification and Result Entry Prevent Autoverification for Accession The prevent option is available from; Pending Inquiry Specimen Log-in Accession Result Entry Multiple Accession Result Verification.

Autoverification and Result Entry Prevent Autoverification for Accession From the Menu; Select Task Click Select Button Enter Accession number and click on the OK Button Click on the Select Button to enter additional accession numbers or the OK Button to exit

Autoverification and Result Entry Prevent Autoverification for Accession From the Menu; Select Task Click Select Button Enter Accession number and click on the OK Button Click on the Select Button to enter additional accession numbers or the OK Button to exit

Autoverification and Result Entry Prevent Autoverification for Accession From the Menu; Select Task Click Select Button Enter Accession number and click on the OK Button Click on the Select Button to enter additional accession numbers or the OK Button to exit

Autoverification and Result Entry Autoverification Off/On Switch Autoverification can be turned off or on manually from; Pending Inquiry Accession Result Entry Batch Result Entry Multiple Accession Result Verification.   This option allows you to turn off autoverification for a selected instrument. If a problem is encountered with the instrument and the Technologist needs to turn off Autoverification they can quickly do so with this menu option.

Autoverification and Result Entry Autoverification Off/On Switch When the instrument problem is resolved they can turn autoverification back on with this menu option.

Autoverification and Result Entry Autoverification Off/On Switch Autoverification can be turned off for all Procedures for a specific Test Site or specific Procedures for a specific Test Site. By unchecking the All Procedures check box, the individual Procedures appear for selection. You can turn off Autoverifcation for one or multiple Procedures by placing a check mark against each in the Turn Off Column.

Autoverification and Result Entry Autoverification Off/On Switch If autoverification is turned off manually for one or more assays, then autoverification must be turned on manually for the same assays.

Autoverification and Result Entry Autoverification Off/On Switch If autoverification is turned off manually for one or more assays, then autoverification must be turned on manually for the same assays.

Autoverification and Result Entry Assign Operator to instrument The assign operator to instrument option provides the ability to associate a user with an Instrument to identify who is operating the instrument. When a user is assigned to an Instrument, that user is assigned as the performed personnel when the interfaced results are posted to the system. If an operator is not assigned to an instrument the performed personnel is set to zero, and autoverification will not occur. The instrument assignment is for the specific instrument. If you are running multiple instruments you can select each instrument separately

Autoverification and Result Entry or select the subsection with which the instruments are associated.

Autoverification and Result Entry If a Technologist is already assigned to either the desired instrument or subsection, an additional Assign Technologist to Instrument dialogue box will appear. This dialogue box allows the user to assign themselves by placing a checkmark against the desired instrument and clicking the OK button.

Autoverification and Result Entry When an assignment is overridden that user receives a notification that they are no longer assigned.

Autoverification and Result Entry Instrument Activity Monitor Use to view all activity for any General Lab test site during a defined time range. The application is used to validate that assays have been Autoverified and troubleshoot why assays did not autoverify.

Autoverification and Result Entry Instrument Activity Monitor Some examples of common AV Codes seen in IAM Autoverification Codes Instrument error Failed review range Failed critical range Failed feasible range Delta check failed Duplicate assay Previously performed result Assay within order is not verified Associated order failed