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Standard processes fail to follow up half of Microcytic anaemia patients correctly

Dr Janne Cadamuro, from the University Hospital of Salzburg in Austria, reviewed the diagnostic process in Laboratory Information Systems and found that 50% of Microcytic anaemia patients were not followed up at all or followed up correctly.
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Photo by Seskan Mongkhonkhamsao/ Getty Images

Dr Cadamuro conducted a review to discover the underlying cost of microcytic anaemia. He looked back over Microcytic cases to find out where errors occurred in the diagnostic process using Abbott’s AlinIQ Clinical Decision Support. The next step is validating the clinical algorithm and rules to work with, using AlinIQ Clinical Decision Support solution, articulating an adequate follow up of the group of patients falling into a care gap.


There are many variables in the diagnostic process. If cases are not followed up correctly, or at all, this can lead to the wrong results, wrong interpretations, and inappropriate test requests. If laboratory information systems cannot fully explore decision trees and patient pathways, this can lead to patient harm and unnecessary costs.


“The goal in diagnostics is the medical tricorder from Star Trek, without even touching the patient you could see the diagnosis of the patient and ideal treatment. However, standard laboratory information systems are capable of only covering a small part of a complex algorithm.

"We evaluated this retrospectively, by looking at patients with Microcytic anaemia to evaluate how many of those were not followed up at all or followed up correctly, to see what the underlying cost of microcytic anaemia was. What we found with AlinIQ Clinical Decision Support was quite interesting, especially comparing with the literature on the topic, which flags a laboratory underuse of 50%.

"Fifty percent of cases with Microcytic anaemia were not followed up correctly, which might lead to patient harm. We also found in our study, when reviewing how the diagnoses were coded, that 76% of all iron deficiency anaemias were not ICD/DOCTOR coded, representing a direct loss of revenue,” said Dr Cadamuro.

The study showed that errors occurred in the interfaces between patient, doctor and lab physician, leading to incomplete anamnesis, wrong hypotheses, missed follow-up testing, incorrect interpretations of results and neglected results.

Dr Cadamuro added that most of the information was in the Hospital Information System and part of it was in the Laboratory Information System, and sometimes there was a connection between both systems for data transparency, but not for evaluation of the patient, to see the big picture. He compared this to having a European plug but an American outlet and said this issue would have to be resolved.

He argued that improving diagnostic processes could save costs: “Laboratory medicine could reduce secondary costs. If patients were followed up correctly, we would have about €10 of primary costs, however, if not followed up correctly, we would have: a longer hospital stay, more complications during operations, anaemia patients requiring more blood products in terms of patient blood management. The costs are basically incalculable, but they are by far more than €10.”

Commenting on the study, Abbot said their holistic informatics solution, combined with professional service experts, help to uncover intelligent insights from data and set the path to tackle care gaps, like in the case of University Hospital of Salzburg using the AlinIQ Clinical Decision Support solution.


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