Clinical Use of Eclair - Sysmex New Zealand
Clinical Use of Eclair - Sysmex New Zealand
Clinical Use of Eclair - Sysmex New Zealand
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<strong>Clinical</strong> use <strong>of</strong> Éclair<br />
A personal Journey<br />
Stephen May
2 roles<br />
• Provider <strong>of</strong> Laboratory Services<br />
• <strong>Clinical</strong> Haematologist<br />
– My own patients<br />
– Advising GPs and other Specialists about<br />
interpretation <strong>of</strong> Laboratory results
To get the full picture , you must have<br />
a sense <strong>of</strong> history<br />
• Pathlab Waikato has been going 20 years<br />
• <strong>Use</strong> <strong>of</strong> Delphic from the outset<br />
• ‘Borrowed ‘ Dave Scarrow from MedBOP to<br />
set up the databases,<br />
• Subsequently merged with MEDBOP and the<br />
whole organisation was named Pathlab so as<br />
to remove any confusion with Medlab<br />
Hamilton.
Pathlab were early adopters <strong>of</strong> Éclair<br />
in the pre-Y2K era
Dial-up era using the GPs dedicated<br />
FAX line.<br />
• I used Éclair to discuss cases with GPs as well<br />
as to demonstrate the database as a useful<br />
resource for their practices.<br />
• Also it became the database that I used to<br />
discuss results from GP queries<br />
• Access by NHI # also by name
The original Pathlab Waikato website<br />
• Had a link to Éclair that worked very well.
Website was not behind a firewall<br />
• But the Éclair data was secure with personal<br />
logins<br />
• Everything auditable<br />
• Hundreds <strong>of</strong> users (Hospital staff). Icon on the<br />
desktop<br />
• No GPs used it.<br />
• Claudio Turilli used his own record in<br />
demonstrations. (And could see who had<br />
looked at his record.)
Tony Perdia<br />
• I discussed his results with him. Éclair was a<br />
very useful tool in the clinical context for<br />
predicting when transfusions and other<br />
therapy was required.<br />
• He was so keen on this that he volunteered his<br />
results to be used for demonstrations to GPs.
One day the Pathlab website looked<br />
like this !<br />
• We had been hacked
We took the éclair link <strong>of</strong>f the website
Moved behind the DHB firewall
• Subsequently BOP DHB took over the Éclair<br />
database.<br />
• Data from the various Pathlab sites was<br />
available.<br />
– BOP (Tauranga and Whakatane Hospitals and<br />
Community.)<br />
– Rotorua Hospital and community (LSR)<br />
– Waikato community (PLW)
I still remained optimistic that the<br />
database should contain all the results<br />
from the region
• Not everyone shared my views<br />
Always seemed to be more complicated than I<br />
could imagine to get all <strong>of</strong> the results from the<br />
region into the one Éclair database
• I am pleased to say there really is some<br />
progress now
How I use Éclair today, is little changed<br />
• Why<br />
from before<br />
• Results were easily accessed<br />
• Cumulated if required<br />
• Categorised in the menu, and easily found
I take my netbook with me to all <strong>of</strong><br />
my clinics and use it as a tool to<br />
look up results and discuss them<br />
with patients
Mobile broadband is easily quick<br />
enough
Citrix at WPH with link to ‘Pathlab’<br />
Results, i.e. PLW PLBOP,PLWHK and LSR
On the PAL intranet, if the live éclair<br />
goes down there is a Backup<br />
• So I don’t keep a copy <strong>of</strong> any routine results in<br />
my patients notes
Mapping <strong>of</strong> test codes<br />
• E.g. protein C example
Cut and paste into emails<br />
• E.g. Hennessey
Hi Stephen,<br />
Many thanks for the CBC results. The mouth is<br />
much better today so will resume the<br />
Hydroxyurea tomorrow<br />
as you suggest. Unfortunately I note that the<br />
blast count is on the rise again, let's hope<br />
there is an improvement<br />
before my next test on Monday. I will see you<br />
next Tuesday.<br />
Kind regards,<br />
Bryan<br />
On Jun 5, 2012, at 20:46, Stephen May<br />
wrote:<br />
Platelets aren’t as low as we’d thought.<br />
I think you should miss 2 days as planned and<br />
then take 2 then 1 then nil. If the mouth<br />
bleeding gets any worse, let me know.
Ref<br />
Range<br />
Units<br />
07-May-12<br />
13:55<br />
14-May-12<br />
13:48<br />
21-May-12<br />
13:31<br />
28-May-12<br />
08:00<br />
05-Jun-12<br />
13:22<br />
STEPHEN<br />
MAY<br />
HM<br />
STEPHEN<br />
MAY<br />
HM<br />
12/2095165<br />
STEPHEN<br />
MAY<br />
HM<br />
12/2168902<br />
STEPHEN<br />
MAY<br />
HM<br />
12/2293530<br />
STEPHEN MAY<br />
HM<br />
HAEMOGLO<br />
BIN<br />
130-175 g/L 156 156 149 149 157 157 155 155 153 153<br />
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<br />
MCV 80-99 fL 88 88 90 90 92 92 92 92 93 93<br />
MCH 27-33 pg 28 28 29 29 29 29 29 29 29 29<br />
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<br />
Blast x10E9/L 34.5 34.5 49.6 49.6 48.4 48.4 39.9 39.9 56.0 56.0<br />
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<br />
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<br />
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<br />
Eosinophil 0.0-0.5 x10E9/L 0.5 0.5 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1<br />
Basophil 0-0.2 x10E9/L < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1<br />
PLATELET<br />
COUNT<br />
150-400 x10E9/L 75 75 68 68 63 63 52 52 45 45<br />
Haematolog<br />
y Comment<br />
Metamyeloc<br />
yte<br />
Nucleated<br />
Red Cells<br />
x10E9/L 0.5 0.5<br />
/100wbc 1 1
Contrast with single result emailed<br />
from USA<br />
• PDF, non cumulative, lymphocytes labelled<br />
‘critical’ though otherwise were not changed<br />
• What I was really interested in was the<br />
platelet count, as this lady had developed ITP<br />
associated with the CLL.
Éclair repository just Path reports<br />
initially<br />
• Now lots <strong>of</strong> other reports<br />
• Not currently used for images apart from<br />
some Flow graphs and ECGs<br />
• One surgeon in TGA scans letters in<br />
• I have total access and that is the way we use<br />
it
ps…….3 pitfalls to consider<br />
• Don’t get too complicated<br />
• Make sure your upgrades aren’t downgrades<br />
• Keep your data safe but accessible
The <strong>New</strong> England Journal <strong>of</strong> Medicine<br />
Perspective<br />
Escaping the EHR Trap — The Future <strong>of</strong> Health<br />
IT<br />
Kenneth D. Mandl, M.D., M.P.H., and Isaac S.<br />
Kohane, M.D., Ph.D.<br />
N Engl J Med 2012; 366:2240-2242June 14,<br />
2012DOI: 10.1056/NEJMp1203102
Medscape Medical<br />
<strong>New</strong>s © 2012 WebMD, LLC<br />
• Physician's Stolen Laptop Leads to $1.5 Million<br />
Settlement<br />
– Robert Lowes<br />
• (A patient database went missing)
stephen.may@<br />
. .co.nz<br />
That’s all folks