Implementing digital blood cell analysis technology in a distributed laboratory network
The recent introduction of the CellaVision DC-1 makes it possible for small labs to implement the same digital methodology for performing blood cell differentials that is commonly used by large laboratory organizations. CellaVision recently teamed up with Alberta Public Laboratories (APL) to conduct an in-situ product evaluation assessing the utility and impact of CellaVision DC-1 in a distributed laboratory network. APL is a leading medical diagnostic laboratory serving a large catchment of Southern Alberta, Canada. CLI talked to Dr Etienne Mahe, consultant pathologist at APL, who shares here his experience of this technology.
1. Could you briefly describe your laboratory setting and specific requirements regarding hematology testing ?
Laboratory testing in Southern Alberta (and in many other jurisdictions elsewhere in the world) can easily be summarized as a “hub-and-spoke” model. We have a large central high-throughput laboratory to which geographically dispersed small referral laboratories or collection sites send specimens.
Since many of these smaller sites are at substantial distances from the central referral laboratory, the strategy in hematology has been to situate low-complexity low-throughput analysers at the spoke sites and reserve the high-throughput high-complexity infrastructure for the hub labs. In the case of peripheral smear review, CBC data are generated at the peripheral sites on low-complexity low-throughput analysers, but slides (as required) are referred to the hub for additional review and interpretation. In cases requiring pathologist review, delays of up to several days are possible, with the significant itinerant potential for delayed patient care.
2. In your view, what are the most interesting characteristics of the Cellavision DC-1 analyser and the main advantages of its technology ?
The Cellavision suite has provided our hub labs in Southern Alberta with league improvements in efficiency for high-throughput hematology testing. We employ Cellavision integrated analysers in our hub labs to perform nearly all peripheral smear manual differential and morphology review activities. We also use the Cellavision body fluid analysis features to assist with review and interpretation of most fluid specimens. The networking capabilities of the Cellavision suite have allowed for seamless data exchange between our network of hospital-based hub labs. The Cellavision suite has also allowed for improved training and quality control workflows.
The Cellavision DC-1, designed to better address the digital hematology and pathology needs of lower throughput laboratories, raised significant interest for us as a means to better improve our spoke-to-hub workflows. In particular, while our performance parameters for basic CBC resulting are reasonable, we currently experience heavy delays in the morphological review of peripheral smears by hub technologists and pathologists by virtue of transportation delays from spoke centers. The Cellavision DC-1 presents the opportunity for real-time digital interpretation of peripheral smears originating from spoke sites by expert hub lab staff, entirely negating the need for slide transport.
3. What was the aim of the product evaluation carried out by your laboratory network ? Could you briefly explain the methodology employed ?
When presented with the opportunity to test the Cellavision DC-1 instrument, we immediately wanted to prove the theoretical turn-around time benefit could be realized in our lab system. We obtained research ethics and institutional approval to perform a prospective study of turn-around times (from specimen collection at spoke sites to expert review by the hub lab), comparing a Cellavision DC-1 assisted workflow with the current standard-of-care. We assessed in comparison the reported results from morphology review using the Cellavision DC-1 assisted workflow relative to the standard-of-care workflow. We also undertook a comparison to historical turn-around time data in order to estimate the volume of cases (and hence the length of the study) required for a reasonable comparison.
4. What were the results of the evaluation and did they meet your expectations ?
Since we hope to publish our results in the future, I won’t divulge them in their totality as yet, except to say that we identified statistically significant improvements in all parameters assessed, including turn-around times, without evidence of any discordance in the quality of morphologic assessment. While we were not at all surprised to see a statistically significant difference between the workflows, we were impressed by the degree to which these improvements in turn-around time were realized, which we anticipate will mean a clinically significant improvement for labs facing similar workflow hurdles.
5. Can you tell us anything more about your experience of this technology and do you have any particular advice or recommendation for labs interested in its implementation ?
We have been working with the Cellavision suite of technologies for several years and have incorporated it into the vast majority of our routine hematology workflows. Several years ago, as part of a small implementation project, I asked a number of our technologist super users to provide their feedback on instrument usage and software usability. By far and away, the feedback was positive.
As part of our current work, we are also hoping to provide more tangible data relating to Cellavision software useability. More specifically, we have undertaken several exercises across a broad cadre of technical staff, to identify how much more time-efficient the process of technologist classification using Cellavision software is compared with manual morphology assessment. As with our turn-around time results, we will soon be reporting a significant advantage to a Cellavision based workflow.
For laboratories and laboratory networks thinking of implementing Cellavision enabled technologies, it is important to first understand the nature of your laboratory structure and its hematology workflows. For single lab sites with high-throughput, Cellavision offers a number of solutions geared to high-volume needs. Now, as we have seen, Cellavision also offers solutions for smaller low-throughput labs, especially labs frequently faced with the challenges of material referrals.
6. What do you see as the next step for your organization ?
While our data support improvements in time-based metrics using the Cellavision DC-1 in our distributed laboratory network, we are hoping next to make an economic argument to support the integration of the Cellavision suite of technologies across our hub-and-spoke network. More specifically, we are hoping to liaise with local health economics experts to prove that improvements in turn-around times (and the commensurate assumed cost reductions if materials transportation is not required) support the necessary investments in infrastructure required, as well as where such investments should be made across our network.
Dr Etienne Mahe is Clinical Assistant Professor, Department of Pathology & Laboratory Medicine, University of Calgary, and Consultant Pathologist, Division of Hematology, South Sector, Alberta Public Laboratories
