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Easier data entry for blood sample test results:
Collecting a blood sample for diagnostic purposes is a common procedure in veterinary medicine. The expected results for blood tests are usually well established for domestic species, but interpreting these laboratory test results can pose more difficulty when dealing with the species that are typically examined by a zoo clinician. The MedARKS hematology, chemistry and serology module is designed to provide the zoo clinician with diagnostic assistance by providing a context for the interpretation of laboratory results for blood samples obtained from wildlife species.
Entering the laboratory results into MedARKS may seem like a difficult process, but with some initial preparation to customize the module to your needs, and some data entry practice, it is possible to enter all the test results from a typical laboratory analysis in 3 to 4 minutes. This amount of effort is comparable to that expended by locating the normal reference range for a species and then manually comparing every test result to those reference values. Blood sample records retrieved from MedARKS are automatically compared to reference ranges for the appropriate species and values outside of the normal range are flagged for your attention. Of course, once the records have been entered into MedARKS, the computerized blood sample records provide further advantages in terms of developing in-house reference values, ease of information retrieval and data transfer. In addition, MedARKS blood sample records can be submitted to ISIS for inclusion in the worldwide database, helping to refine the MedARKS reference ranges for everyone (see Helpful Hint #10). The remainder of this document discusses the steps needed to customize this module to make the task of data entry as simple as possible, so that you can gain the benefits of computerized records with the minimal data entry effort.
1. Defining the default laboratories and the default units for blood sample results:
Go to the utilities menu of the hematology, chemistry and serology module and choose to edit/update the module parameters. While it is important to set all the module parameters, the parameters that have the largest impact on data entry are the ‘default laboratories’ and the ‘units for data entry’.
List of default laboratories: One of the data entry problems that MedARKS has to overcome is that the reports from every laboratory have a different output format. To make data entry easiest, MedARKS must accept test results in the same order that those tests are presented on the laboratory report. This means that you must be able to specify a different order for data entry for each laboratory that you use on a routine basis. The first step in this process is to define the list of laboratories that you use on a routine basis. The number of laboratories that you can define in this list will depend on the version of MedARKS that you are using, but with version 5.30L, it is possible to define up to 20 different laboratories. Make the description of each laboratory as complete as possible in the allocated space (see Helpful Hint #40).
Units for data entry: While test results may be reported in virtually any units, there are 2 broad sets of units in routine use. The units used by most laboratories in the U.S.A. are termed ‘American’ units while the most common set of units used by laboratories in the rest of the world are the ‘International’ units. Make the appropriate choice for the laboratories that you use on a routine basis.
2. Define the test order for data entry screens:
Return to the hematology, chemistry and serology utilities menu and choose the ‘Set Order of Tests for Data Entry’ option. Now select a laboratory from the list of default laboratories.
Laboratories typically report the results in sections and MedARKS data entry in this module is divided into the same groupings. Choose hematology, cell morphology or chemistry/serology to set the data entry test order for that section of the MedARKS record.
The final step is to create the actual list of tests in the same order that they appear on the laboratory report. You can add and remove tests from the list and move the position of tests within the list. The MedARKS data entry screen will present the tests in the same order as the tests appear on the list for this laboratory. Do not add calculated test results to the list (e.g., MCV, MCHC, Ca:Phos ratio, etc.) as MedARKS will calculate these results from the appropriate test results (there is no need to waste data entry effort on a value that MedARKS will calculate anyway). During data entry, you specify which laboratory analyzed the sample and MedARKS uses this laboratory information and the test order list to build a data entry screen that has the appropriate tests in the correct order, making data entry much easier (and therefore much faster).
Conversion factor: Some laboratories do not report their results in the units that are expected by MedARKS. When creating the test list for data entry, you will be given the opportunity to specify a conversion factor for each test on the list. As you add a test to the list, check to ensure that the units expected by MedARKS are the same as those being reported by the laboratory. If the laboratory units differ from the standard units expected by MedARKS, then you will need to enter a conversion factor for that test (see below). When the MedARKS units match the laboratory units, leave the conversion factor blank (no conversion needed).
If you request a special (non-routine) test for a particular sample (e.g., you request a reticulocyte count in addition to the routine hematology tests), it is always possible to enter extra tests at the end of the regular data entry screen. In other words, you can always enter a result for a test that does appear on the routine test list for that laboratory. At the end of the routine tests, you simply specify the additional test and then the result obtained.
You definitely do not want a data entry test list that includes every possible test that a laboratory may perform. The purpose of the laboratory test list is to make it easy to enter the results for the routine tests performed by that laboratory. If you have a data entry screen that contains many tests that are not run routinely, then you will expend too much effort skipping past the tests that have not been performed and you will actually decrease your data entry efficiency. Remember that you may always change the test list for a laboratory, so start with just the routine tests and then if you find that you are adding a particular extra test on a regular basis, you can add that test to the routine test list for that laboratory.
What about a laboratory that reports their results in units that differ from those specified by MedARKS?
Results that are entered into MedARKS must be in the units that are specified by MedARKS. When you get results in units that are different from what MedARKS expects, the results must be converted to the appropriate units. With non-routine laboratories or non-routine tests from a routine laboratory, you must manually convert the result and enter the converted value. This is clearly not convenient but results must either be converted to the appropriate units or simply not entered into MedARKS (see the warning below).
However, MedARKS can make data entry easy when dealing with the conversion of results for a routine test from a default laboratory. When one of the default laboratories is reporting a test result in non-standard units, you have the ability to allow the program to automatically convert the result to the appropriate units. During the process of defining the data entry order of the tests for a laboratory, you are asked whether you want to specify a conversion factor. When a conversion factor is present for a test, any value that you enter will be multiplied by this conversion factor and the converted value is then stored (only for results from that laboratory). This allows you to enter the result as the laboratory reports it, but have that result converted to the appropriate units for storage (so you do not invalidate your data files). The only remaining difficulty can be determining the appropriate conversion factor.
A word of caution: Adding results to your data files that are not in the correct units will make it impossible for you to compare results for that test between laboratories. Should you attempt to calculate reference values for that test, those values with incorrect units will cause inaccuracies in the final results. Should you add those invalid test values to the centralized ISIS database, they will also tend to cause inaccuracies in the reference values calculated from the worldwide data set.
written by J. Andrew Teare, DVM
Last update: 13.Sep.1998
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