Using next generation electronic medical records for laboratory quality monitoring

Posted On 2017-08-30 01:53:30

Using next generation electronic medical records for laboratory quality monitoring

Tze Ping Loh1,2, Tony Badrick3

1Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore; 2Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore 119077, Singapore; 3Royal College of Pathologists of Australia Quality Assurance Programs, St Leonards, NSW, Australia

Correspondence to: Tze Ping Loh. Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Email:

Abstract: The increasing commoditization of laboratory practice risked favouring speed and cost at the expense of quality. Recent retroactive reagent recalls and literature reports of failure to detect significant analytical deviation suggest that the practice of traditional quality control measures is increasingly insufficient to maintain the quality required for resource restricted, high throughput and complex laboratory testing environment. Newer, patient result-based quality techniques have shown good capability in detecting analytical errors. However, a limitation of such techniques is the difficulty in determining whether a breach in control limit is due to an analytical error or a shift in underlying population being monitored. The next generation electronic medical record is an information technology system that brings together different silos of healthcare databases. It has the potential to significantly alter the way laboratory practices quality control by matching patient result-based laboratory observations with clinical practice and findings. This way, any significantly abnormal laboratory findings can be quickly verified with clinical information. It is possible that the traditional internal quality control practice will be replaced by these techniques, although more research is required before this becomes commonplace.

Keywords: Quality control; laboratory management; electronic medical records; statistics; quality assurance

Received: 15 July 2017; Accepted: 07 August 2017; Published: 21 August 2017.

doi: 10.21037/jlpm.2017.08.06

There is a saying that one can only have two of the following three features when it comes to a service or product: cheap, fast or good. The increasing commoditization of laboratory services often emphasizes on the former two, at the expense of quality.

Clinical laboratories produce results that physicians rely upon to make diagnostic and management decisions. The results generated by the laboratories should meet certain quality specifications to be clinically fit for purpose. At present, this is monitored through a combination of internal quality control and external quality assurance systems. These complimentary quality systems rely upon periodic testing of a sample that has a known value, and looking for significant deviation from the known/target value, when compared to certain control limits.

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