Feature

Teletronic Doctoring

Automated analysis and electronic communications speed up medical test results.

Janine Griffin

A new laboratory system is cutting days off the time it takes to receive test results, days that for patients can mean faster treatment and a faster cure.

The Cardinal Care system provides rapid test results by minimising the amount of time it takes to get samples to the lab, the time it takes to run the required tests and the time it takes for the laboratory to return the test results to the patient's doctor.

The system is run by Christchurch-based Cardinal Community Laboratories, a subsidiary of the Aoraki Corporation. Aoraki is also the parent organisation of Cardinal Network, which provides the electronic mail (e-mail) facilities used by the system. Since it was established in 1992, 85 surgeries throughout the country have been connected to Cardinal Care.

The aim of the system is to make the turnaround time as rapid as possible, says Dr Peter George, head of pathology at Cardinal Community Laboratories.

It's difficult to predict when test results will be required rapidly.

"Our philosophy", says George, "is to treat everything as something that should have a bit of priority on the basis that you can't really tell exactly when it's going to be needed."

This rapid turnaround time is particularly important with the management of acutely ill people and those with infectious diseases. Infections can suddenly get worse in a way that cannot always be predicted, says George. In other situations, though, faster results might not necessarily lead to a significant improvement in the care of the patient.

"Simply having the information in the doctor's hands quicker will allow them to benefit," he says.

A personal computer in the doctor's surgery provides direct access to the system. Samples taken at surgeries around New Zealand are delivered by courier to Cardinal's Christchurch lab twice daily. There, state-of-the-art analysers perform the required tests and once these are completed, the results are e-mailed directly to the patient's doctor. The use of such equipment can considerably reduce the amount of time it takes to get test results.

For example, Cardinal uses a Micro Scan Walkaway system to identify bacteria. Traditional techniques require an overnight culture to establish that an infection exists, a further day to identify the culprit and a third to determine which antibiotic will provide the most effective treatment. The Walkaway only requires the initial overnight culture and a further eight or so hours before the appropriate treatment can be identified. This cuts up to two days off the time to a test result.

Another analyser, the Roche Cobas Argos blood cell testing system, can accurately count and identify red blood cells, five types of white blood cells, any abnormal white blood cells and platelets at the rate of tens of thousands per second, which means more rapid diagnosis of problems ranging from anaemia to cancer or leukaemia. This analyser, the first of its kind in Australasia, also mixes samples efficiently and consistently, which makes test results more accurate.

Software provides an interface between the analysers and Cardinal Network so that once the results are available they are automatically e-mailed to the surgery, preventing further delay in posting results or phoning them to a doctor who might not be available. This, together with the rapid test time, ensures that delays in diagnosing a patient are kept to a minimum. It also provides a permanent record of the test result and saves that record with the patient's other test results through the system's database, which contains the results of all tests carried out by the laboratory and can provide summary reports on individual patients. Doctors also have access to the National Poisons and Hazardous Chemicals Information Centre, which is also on the network.

The e-mail facility also makes it easier for doctors to establish a dialogue with a pathologist without having to place numerous phone calls. This is particularly important in today's working climate where a pathologist might spend part of the day at a hospital and another at the laboratory. A doctor can also forward the results to another doctor for a second opinion.

The software for the Cardinal Care system was developed by Hawdon Technologies, another Aoraki subsidiary. Because Cardinal owns its own software, the software can be changed to meet a surgery's individual needs, which makes the system very user friendly. Several overseas medical organisations have expressed interest in the system and its software.

Communication

Better communication is the main feature of the system. Although the state-of-the-art analysers are instrumental in providing doctors with more rapid results, better communication allows those results to be delivered more rapidly. Connection to the network makes communication between doctors and pathologists easier, and provides a forum for discussion that is much more accessible than the telephone system. The system is also unobtrusive. A doctor might be seeing a patient when test results become available -- rather than interrupting the doctor with a phone call, the result is e-mailed and the doctor can read it between patients. The network is at present only used for sending results and making enquiries. But the possibilities are limitless, says Mike White, chairman of Cardinal Community Laboratories.

There's potential for the network in the field of radiology. Because the system can send x-rays, an x-ray taken in a remote town can be sent to a specialist in a major centre without using the post or couriers. This already happens overseas, says White, but isn't yet very common in New Zealand. Another possible use is providing statistics to Regional Health Authorities. RHAs will soon be required to provide details on the number, type and cost of tests referred to a laboratory, and Cardinal Community Laboratories could act as a central repository for such statistics.

Interactive video could provide a further dimension, and a doctor could examine a patient remotely, order a particular test, get the results and recommend treatment without ever seeing the patient, who could be hundreds of kilometres away. A patient in a remote area can get the same quality medical services as someone in a major centre.

At present, better communication, combined with the latest in medical technology, is providing better treatment for patients through faster, more accurate results.

"This is clearly the way of the future in the development of laboratory technology", says Peter George. In the future there will be fewer, larger laboratories outside their traditional geographic boundaries providing high technology medical services that won't depend on a patient's proximity to those services. "Technology is really an important edge."

Janine Griffin is a freelance journalist specialising in science issues.