At our academic health system laboratory, we have formulated a urine drug testing ordering and interpretation workflow which incorporates an ordering strategy based on the assessed patient’s risk of non-compliance. The urine drug test includes immunoassay testing along with one or more liquid-chromatography mass-spectrometry confirmatory tests when indicated. Because integrating and interpreting the results from multiple assays and methods can pose a challenge for clinicians who may not be familiar with the biochemistry and testing methods, our pathologists provide a written clinical interpretive report. While this service provides the highest level of diagnostic accuracy for our clinicians, integrating a large number of results and additional clinical information posed a challenge that had required multiple related spreadsheets generated and maintained by labor-intensive workflows.
The aim of this project was to design and implement of a web-based software application that centralizes test results for pathologist review, performs the quality control calculations for the complex LC-MS/MS analysis of opioids and their metabolites, functions as a user input form for pathologist interpretation entry, and auto-files results into the LIS.
The initial step before designing the application was to understand the entire workflow including how clinicians ordered the different drug monitoring tests, how results were generated, and what information was necessary for pathologist review when writing the interpretation. This information helped design the architecture and layout of the application. Finally, to assess the performance of the application, we surveyed stakeholders on the spent time reviewing and handling cases before and after implementation of the application.
The application is a web-based application that can be launched from any web browser for active users. Tabular views were created based on the different roles and steps in the workflow, helping staff and faculty prioritize cases. The application provides data entry fields for information that does not readily fit into the LIS, such as summaries of recent prescriptions or internal comments, in addition to the interpretation that is resulted to the patient’s chart. Auto-filing of results and interpretation from the opiate confirmation testing using Data Innovations software replaced prior manual data entry or copy and paste. On average, users reported to have gained roughly 3 hours per batch since incorporating the application into the workflow. Additionally, staff no longer spent time managing spreadsheets or manually entering results into the laboratory information system, adding to the time gained back.
We have developed an application that centralizes urine drug testing data. The automatic aggregation of this data provides an efficient and convenient method for pathologists to review the data to generate an interpretation of the results for clinicians and providers to review with their patient's undergoing opioid therapy. We demonstrated that the primary benefit to implementing a custom application has been a profound improvement in workflow and staff efficiency.