Clinical Use of Eclair - Sysmex New Zealand

Clinical use of Éclair
A personal Journey
Stephen May

2 roles
• Provider of Laboratory Services
• Clinical Haematologist
– My own patients
– Advising GPs and other Specialists about
interpretation of Laboratory results

To get the full picture , you must have
a sense of history
• Pathlab Waikato has been going 20 years
• Use of Delphic from the outset
• ‘Borrowed ‘ Dave Scarrow from MedBOP to
set up the databases,
• Subsequently merged with MEDBOP and the
whole organisation was named Pathlab so as
to remove any confusion with Medlab
Hamilton.

Pathlab were early adopters of Éclair
in the pre-Y2K era

Dial-up era using the GPs dedicated
FAX line.
• I used Éclair to discuss cases with GPs as well
as to demonstrate the database as a useful
resource for their practices.
• Also it became the database that I used to
discuss results from GP queries
• Access by NHI # also by name

The original Pathlab Waikato website
• Had a link to Éclair that worked very well.

Website was not behind a firewall
• But the Éclair data was secure with personal
logins
• Everything auditable
• Hundreds of users (Hospital staff). Icon on the
desktop
• No GPs used it.
• Claudio Turilli used his own record in
demonstrations. (And could see who had
looked at his record.)

Tony Perdia
• I discussed his results with him. Éclair was a
very useful tool in the clinical context for
predicting when transfusions and other
therapy was required.
• He was so keen on this that he volunteered his
results to be used for demonstrations to GPs.

One day the Pathlab website looked
like this !
• We had been hacked

We took the éclair link off the website

Moved behind the DHB firewall

• Subsequently BOP DHB took over the Éclair
database.
• Data from the various Pathlab sites was
available.
– BOP (Tauranga and Whakatane Hospitals and
Community.)
– Rotorua Hospital and community (LSR)
– Waikato community (PLW)

I still remained optimistic that the
database should contain all the results
from the region

• Not everyone shared my views
Always seemed to be more complicated than I
could imagine to get all of the results from the
region into the one Éclair database

• I am pleased to say there really is some
progress now

How I use Éclair today, is little changed
• Why
from before
• Results were easily accessed
• Cumulated if required
• Categorised in the menu, and easily found

I take my netbook with me to all of
my clinics and use it as a tool to
look up results and discuss them
with patients

Mobile broadband is easily quick
enough

Citrix at WPH with link to ‘Pathlab’
Results, i.e. PLW PLBOP,PLWHK and LSR

On the PAL intranet, if the live éclair
goes down there is a Backup
• So I don’t keep a copy of any routine results in
my patients notes

Mapping of test codes
• E.g. protein C example

Cut and paste into emails
• E.g. Hennessey

Hi Stephen,
Many thanks for the CBC results. The mouth is
much better today so will resume the
Hydroxyurea tomorrow
as you suggest. Unfortunately I note that the
blast count is on the rise again, let's hope
there is an improvement
before my next test on Monday. I will see you
next Tuesday.
Kind regards,
Bryan
On Jun 5, 2012, at 20:46, Stephen May
wrote:
Platelets aren’t as low as we’d thought.
I think you should miss 2 days as planned and
then take 2 then 1 then nil. If the mouth
bleeding gets any worse, let me know.

Ref
Range
Units
07-May-12
13:55
14-May-12
13:48
21-May-12
13:31
28-May-12
08:00
05-Jun-12
13:22
STEPHEN
MAY
HM
STEPHEN
MAY
HM
12/2095165
STEPHEN
MAY
HM
12/2168902
STEPHEN
MAY
HM
12/2293530
STEPHEN MAY
HM
HAEMOGLO
BIN
130-175 g/L 156 156 149 149 157 157 155 155 153 153
PCV 0.40-0.52 L/L 0.49 0.49 0.47 0.47 0.50 0.50 0.49 0.49 0.48 0.48
MCV 80-99 fL 88 88 90 90 92 92 92 92 93 93
MCH 27-33 pg 28 28 29 29 29 29 29 29 29 29
WBC 4.0-11.0 x10E9/L 53.0 53.0 63.6 63.6 63.7 63.7 48.1 48.1 62.9 62.9
Blast x10E9/L 34.5 34.5 49.6 49.6 48.4 48.4 39.9 39.9 56.0 56.0
Neut Seg 1.9-7.5 x10E9/L 12.7 12.7 5.7 5.7 8.3 8.3 4.3 4.3 3.8 3.8
Lymphocyte 1.0-4.0 x10E9/L 2.1 2.1 3.8 3.8 1.9 1.9 1.9 1.9 1.3 1.3
Monocyte 0.2-1.0 x10E9/L 2.7 2.7 4.5 4.5 5.1 5.1 1.9 1.9 1.9 1.9
Eosinophil 0.0-0.5 x10E9/L 0.5 0.5 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1
Basophil 0-0.2 x10E9/L < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1
PLATELET
COUNT
150-400 x10E9/L 75 75 68 68 63 63 52 52 45 45
Haematolog
y Comment
Metamyeloc
yte
Nucleated
Red Cells
x10E9/L 0.5 0.5
/100wbc 1 1

Contrast with single result emailed
from USA
• PDF, non cumulative, lymphocytes labelled
‘critical’ though otherwise were not changed
• What I was really interested in was the
platelet count, as this lady had developed ITP
associated with the CLL.

Éclair repository just Path reports
initially
• Now lots of other reports
• Not currently used for images apart from
some Flow graphs and ECGs
• One surgeon in TGA scans letters in
• I have total access and that is the way we use
it

ps…….3 pitfalls to consider
• Don’t get too complicated
• Make sure your upgrades aren’t downgrades
• Keep your data safe but accessible

The New England Journal of Medicine
Perspective
Escaping the EHR Trap — The Future of Health
IT
Kenneth D. Mandl, M.D., M.P.H., and Isaac S.
Kohane, M.D., Ph.D.
N Engl J Med 2012; 366:2240-2242June 14,
2012DOI: 10.1056/NEJMp1203102

Medscape Medical
News © 2012 WebMD, LLC
• Physician's Stolen Laptop Leads to $1.5 Million
Settlement
– Robert Lowes
• (A patient database went missing)

stephen.may@
. .co.nz
That’s all folks