Is It Time To Overhaul Biochemistry Reporting Format?

Let me start with an anecdote a patient named X comes to my chamber and thumps on the table claiming that his blood sugar reports are all wrong. The basis of this challenge is minimal internet search and knowledge gathered from his technician friend and thinks it prudent to alert the management against the wrong reporting by biochemists. His complaint is that his PPBS is lower than his FBS and as per him it can never happen. I do not feel like teaching him about reactive hypoglycemia and sort it out with the treating physician.
With increasing awareness and demand of patients, evolving evidence-based laboratory medicine, and dependence of diagnosis and treatment on laboratory tests, it is now time to think and overhaul how we can provide a concise and informative biochemical report to the patient and the treating physician which can aid in diagnosis and reduce such altercations.

70 percent of all healthcare decisions involve a laboratory investigation and 80 percent of the lab requisition funnels to the biochemistry division, owing to its large range of parameters. Yet, most of the labs retain the old pattern of reporting them with the result with the reference range mentioned on the side.
At present, in around 2500+ NABL accredited labs it is mandatory that reporting or at least countersigning by MCI recognized pathologists/microbiologists/biochemists of all the reports should be there. But in contrast to pathology and microbiology divisions, a biochemist’s clinical prophecy is least utilized while releasing a biochemistry report. With every advancing day and accumulated experience, the biochemist can render his/her expertise in aiding in diagnosis. This can come as a conclusive statement at the bottom of the report like impression provided as in radiological or histopathological reports.

Apart from this, repetition of biochemical tests tops the chart among all tests in any standard lab. However, the requisition of tests can be over-ordered by physicians or self-ordered by the patient. Hence, a mention of frequency of repetition of the desirable tests should be there that would guide the patient and also serves as a track record for the physicians.

Owing to a huge load of biochemical reports in the lab usually this additional inference part may sound like enhancing the burden manifold. Where lies the solution? Here comes the role of artificial intelligence and further automation in the labs. Customizing the reports with an inference, advice on the frequency of tests, and auto verification of reports will not just improve the quality of the report but it may actually improve the TAT and quality check.

Auto-verification is the process of releasing the reports to hospital interface or to the patient directly without human intervention. To implement the same, the verification rules are inserted in auto-verification software and/or the LIS as per the criteria set by the laboratory. AV algorithms are designed as per the need and three metrics – TAT, technology use, and error rates are kept in track. Instrument flags, evaluation of sample integrity, test linearity, delta check, and critical values are to be used to construct the verification algorithms.

Simultaneously with the help of software the inference customization of 70-80 percent reports can be done. For example, in the case of reactive hypoglycemia mentioned above, apart from the inference as reactive hypoglycemia, the possible causes of it should be mentioned, which will help the physician to look for any missed points for differential diagnosis. This will also increase the interaction between the treating physicians and laboratory physicians.

Albeit the initial hitches and resistance from different levels to initiate these changes in a standard biochemistry report and doubts over proper implementation and cost-effectiveness, this would definitely be a step further in improvising the report quality, TAT reduction, and proper utilization of resources.