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8
| 4 | 2007
Klinisk Biokemi i Norden
Are laboratory reports too
simple?
It is not rare to hear complaints
about usability of laboratory
reporting systems. Be it LIS, HIS
or paper, clinicians may encoun-
ter problems in following time
series of patient related results
or when they try to put together
related findings from different
laboratories. So, the reports appear not be too
simple. They are too complicated! Or are they?
Decades of work has been invested in standar-
dising the reporting of laboratory findings. The
nordic innovation of reference intervals and it´s
incarnation in NORIP and numerous smaller pro-
jects give clinicians a compressed and standardised
consultation concerning normality or abnormality
of the result compared to the reference population.
Similarly, coding systems like C-NPU, LOINC or the
somewhat older national system of Finland give
names and content to examinations available.
Standardisation of nomenclature and interpre-
tation guidelines have helped us automatise the
analytical process and today laboratories have
unique position as data factories for healthcare.
Attempts to refine this data into information are
rarely made by the laboratories. Furthermore, sci-
entific literature shows that usefulness of interpre-
tative comments is sometimes questionable. Does
this mean, that mass production of raw data is our
only lot?
Being in charge of a clinical data factory is chal-
lenging – you need to know clinical medicine, mana-
gement of processes and personnel as well as bio-
chemical principles and their application. However,
young medical professionals are not tempted by the
challenge of laboratory work. Recruitment problems
exist all over the Nordic area.
In Finland we see the tendency of young pro-
fessionals to aim towards the most interpretative
subdisciplines of clinical chemistry, i.e. labora-
Nytt från NFKK
Jarkko Ihalainen
tory hematology (cytomorphology) and genetics.
We have also several central hospitals (secondary
to tertiary level hospital centers) without medically
trained clinical chemists and they are generally
coping well. The challenge of producing metrologi-
cally reliable hight quality measurement results can
be met with many kinds of education.
Other diagnostic disciplines like anatomic patho-
logy, radiology, clinical physiology or neurophysio-
logy provide more information in their multidimen-
sional descriptive interpretations Most of the time
they also receive a substantial amount of clinical
background infromation in the request for analysis.
To a certain extent this holds true also concerning
microbiology. The professionals in charge of trea-
ting the patients can identify ”their” pathologist or
radiologist but the person in charge of the labora-
tory may remain anonymous if they do not actively
pursue a role in clinical interaction.
At the same time the clinical process not rarely
suffers from the incomplete understanding by
the treating professionals that measuring complex
analytes still is challenging and the number sent
from the laboratory with a simple interpretation
guideline -reference range or decision limit - car-
ries with it many hidden data dimensions like
measurement uncertainty, calibration curve, epitope
specificity etc. These background factors have been
reduced to self-evident ”hygiene factors” by our
standardisation of requesting and reporting. Only at
special instances like the forthcoming HbA1c recali-
bration initiative are these hidden depths of simple
numbers recognised by clinicians. Maybe we have
overcompressed the data flow we send out?
It would be irrealistic to suggest returning to
a situation where all analysis requests would be
accompagnied with a clinical anamnesis and con-
sultation request to the laboratory. Only in some
special situations (e.g. coagulation, serum protein
electrophoresis) this should be the case.
More generally we could look at the opportu-
nities provided to us by the emerging electronic
