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The UCLA Immunogenetics Center is an Immunogenetics and Histocompatibility laboratory that performs testing for multiple transplant programmes within and outside of UCLA. The single antigen bead (SAB) test is a high complexity luminex bead test used to assess pretransplant and post-transplant patients for the presence of pathogenic human leucocyte antigen donor-specific antibody associated with allograft rejection. Efficient reporting of the SAB test has been difficult as data analysis and reports are generated in the laboratory information system (LIS) and uploaded to the electronic medical record (EMR) as PDFs. To solve this, we recently developed a state of the art reporting workflow allowing discrete reporting of SAB data (antibody specificity, mean fluorescent intensity and interpretative comments) from the LIS HistoTrac to UCLA Health System’s EMR EPIC:CareConnect. However, a proportion of tests did not report to the EMR appropriately. Baseline system performance data evaluated over a 10-week period showed that ~4.5/100 tests resulted in EPIC as ‘preliminary result’ or ‘in process’ instead of ‘final result’ with only common cause variation. Quality improvement methods were employed to improve the process with the SMART Aim of reporting 100% of tests as ‘final result’. Pareto analysis identified two errors accounting for 79% of common system-level failures—status errors and interface errors. We hypothesised that addressing the status error would reduce or eliminate the interface errors. We used the Model For Improvement to test a reprogramming intervention. Status and interface errors were completely resolved through the process improvement. Continuous monitoring revealed a system-level shift with only ~1.9/100 tests resulting inappropriately. Through the audit process, the remaining common system-level failures were identified and resolved. Therefore, 100% of tests result to EPIC as ‘final result’. The study demonstrates that high complexity SAB bead data can be efficiently reported EPIC:CareConnect from HistoTrac as discrete data.

Aim The UCLA Immunogenetics Center (UIC) uses HistoTrac for transplant patient data storage, analysis and reporting to UCLA Health System’s EMR EPIC:CareConnect. Currently, paper reports are uploaded from UIC to EPIC as a scanned PDF. To improve reporting workflows from HistoTrac to the EMR, we developed and mapped components in EPIC:CareConnect to allow numeric reporting of Single Antigen Bead (SAB) reports from HistoTrac. Methods A new State of the Art reporting workflow (Figure 1a) was designed and validated in the test environments. The build was completed for multiple orderables: SAB Class I, Class II or Class I/II combo, and modifications- titration and C1q (specificity, strength/MFI’s and interpretative comments). Results After migration of the reporting workflow to the live environment, baseline system performance data evaluated over a 9 week period showed that ∼4.5/100 tests were resulting in EPIC as “Preliminary” or “In Process” instead of “Final Result” with only common cause variation (Figure 1b). Classic quality improvement methods were employed to improve the process with the aim of reporting 100% of tests as “Final Result”. An audit system was developed and a Pareto Analysis identified two errors accounting for 79% of common system level failures- Status/Timing Errors, and HL-7 Warning Errors. We used the Model For Improvement for system transformation. Status/Timing and HL-7 Warning Errors were completely resolved through the process improvement. Through the audit process, the remaining common system level failures due to technical errors in ordering/reporting, result delays, and HL-7 Fatal errors are identified and resolved. Continuous monitoring reviled a system level shift with only ∼1.9/100 tests resulting in EPIC as “Preliminary” or “In Process” instead of “Final Result” (Figure 1b). Conclusions The study demonstrates that high complexity SAB bead data can be numerically reported to the EPIC EMR from HistoTrac. Through the process improvement, 100% of tests result to EPIC as “Final Result”. Download : Download high-res image (226KB) Download : Download full-size image