Autoverification in a core clinical chemistry laboratory at an academic medical center

Matthew D Krasowski1, Scott R Davis1, Denny Drees1, Cory Morris1, Jeff Kulhavy1, Cheri Crone1, Tami Bebber1, Iwa Clark1, David L Nelson1, Sharon Teul1, Dena Voss1, Dean Aman2, Julie Fahnle2, John L Blau3
1 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
2 Department of Pathology, Hospital Computing Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
3 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA

J Pathol Inform 2014, 5:13

Abstract
Background: Autoverification is a process of using computer-based rules to verify clinical laboratory test results without manual intervention. To date, there is little published data on the use of autoverification over the course of years in a clinical laboratory. We describe the evolution and application of autoverification in an academic medical center clinical chemistry core laboratory. Subjects and Methods: At the institution of the study, autoverification developed from rudimentary rules in the laboratory information system (LIS) to extensive and sophisticated rules mostly in middleware software. Rules incorporated decisions based on instrument error flags, interference indices, analytical measurement ranges (AMRs), delta checks, dilution protocols, results suggestive of compromised or contaminated specimens, and 'absurd' (physiologically improbable) values. Results: The autoverification rate for tests performed in the core clinical chemistry laboratory has increased over the course of 13 years from 40% to the current overall rate of 99.5%. A high percentage of critical values now autoverify. The highest rates of autoverification occurred with the most frequently ordered tests such as the basic metabolic panel (sodium, potassium, chloride, carbon dioxide, creatinine, blood urea nitrogen, calcium, glucose; 99.6%), albumin (99.8%), and alanine aminotransferase (99.7%). The lowest rates of autoverification occurred with some therapeutic drug levels (gentamicin, lithium, and methotrexate) and with serum free light chains (kappa/lambda), mostly due to need for offline dilution and manual filing of results. Rules also caught very rare occurrences such as plasma albumin exceeding total protein (usually indicative of an error such as short sample or bubble that evaded detection) and marked discrepancy between total bilirubin and the spectrophotometric icteric index (usually due to interference of the bilirubin assay by immunoglobulin (Ig) M monoclonal gammopathy). Conclusions: Our results suggest that a high rate of autoverification is possible with modern clinical chemistry analyzers. The ability to autoverify a high percentage of results increases productivity and allows clinical laboratory staff to focus attention on the small number of specimens and results that require manual review and investigation.

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