Sysmex WAM v4.1 Rule Overview Workshop

Sysmex WAM v4.1 Rule Overview Workshop Intermountain Health Care User Group Meeting April 22, 2014 Agenda Rule Overview Common Rule Types Rule Creation Procedures Intermountain Health Rule Examples 1

Sysmex WAM v4.1 RULE OVERVIEW Rule Engine Description 2

Rules Decision Support Variables Information to help Labs Work Smarter Rules on the Order level Location, Unit, Requestor, Age, Sex, Priority Rules on the Result level Present, outside/inside range, coded comment, flag Check previous results/orders - % or absolute Check result/absence/presence of another parameter Rules for reruns First run, all run, group/single tests for runs Action Rules Rules to create comments, operator alerts, add/delete tests 3

Examples of Rules Anatomy of a Rule IF Statement: Can have unlimited AND statements Each variable must be a test in database Instrument flags or errors must also be a test Then Statement: Multiple actions to include: Reflex: Add a different test Hold: One or more tests for user to review Add/Cancel: Add test(s) and Cancel test(s) Rerun: Add order again to rerun at instrument Operator Alert: Add display text If PLT ABN Distribution flag AND Retic order AND PLT < or > Then: REFLEX PLT-0 Then: RERUN - PLT Then: DISPLAY - PLT Abn Dist: If reflexed PLT-O acceptable, report. If not, add smear and scan for Abn morph. 4

Rule Actions Reflex: Add a different test Required if confirmation test Examples: Add manual diff, optical platelet, path review Cancel: Test Cancel a test from order NOTE: Only cancels in WAM. Not cancellation messages are sent to the LIS Hold: One or more tests for user to review Action required if require rerun AND/OR User review of results before release Perform manual test off-line Rerun: Add order again to rerun at instrument Automatic order addition by Sysmex WAM Rerun all tests or single tests by Rerun Group Operator Alert: Add display text Identification of condition Instructions to user in operator Alert Window Rule Condition Examples Critical Limits: Standard Values High Range - greater than ( e.g. > 7.0) Low Range - greater than ( e.g. < 3.0) Linearity: Based on instrument limits - Low to high range (e.g. 2.0-10.0) Delta Check: Customer Specific Based on last validated previous result. All results on the order must be validated. Site Specific e.g. Check back 7 days Absolute or relative (%) change Rule is only for one direction 5

Rule Definition Screen - Settings General - General User - Standard Rule Edits Expert - Sysmex TIS - Complex rules creation Rule Definition Screen: Standard Setting Customer Use Edit Standard Rules Copy Standard Rules 6

Rule Definition Screen: Expert Setting Sysmex Use Only Custom Rules Requires Change Request Rule Caveats Rules are ordered by priority (Order of Execution) Lowest number, highest priority Rules act only on test level, not profile level All instrument flags defined as a test Smear orders defined as a test Rules for locations & physicians A separate rule must be defined for each variable No OR statements e.g. location X or location Y Overlapping rules logic: Rule w/most criterion will be executed Priority rule actions override secondary rules Critical and Delta Rules Always trigger first in order sequence 7

Overlapping Rule - Example 1 Example 1: Overlapping Ranges Outcome: Rule 1 executes first, rule 2 executes second, therefore the ADIF will be reported if WBC is < 1 since priority is lower. Rule Type Rule Action Priority 1. WBC < 1 If WBC < 1 1 2. WBC <2 Hold ADIFF Do not report ADIFF to LIS If WBC <2 and >40 Rerun All 2 Overlapping Rule - Example 2 Example 1: Overlapping Ranges Outcome: Rule 2 executes first and reruns all, then rule 1 executes LAST so the ADIF results are not reported to the LIS if WBC < 1 Rule Type 1. WBC < 1 2. WBC <2 Rule Action Priority If WBC < 1 Hold ADIFF Do not report ADIFF to LIS If WBC <2 and >40 Rerun All 1 2 8

Overlapping Rule Notes - Priority does not affect the execution with overlapping Rules with identical criteria - IF two (2) Rules share the exact same test selection, they will be both executed in priority sequence. - Priority has no influence on rule execution if more than one rule has the same or less test selection or actions Rule Considerations Rerun Groups Consider selection of tests for rerun Recommendation: Do not use ALL, but enter in all tests Select tests based on rerun group Partial Validation Rules can hold back test results for manual validation Consider rerun and report group Smear Rules Smear test must be in ADIFF or MDIFF report group Smear cannot held independent of these groups 9

Critical Rule Definition Requires 2 rules per Critical 1 st Rule: CRIN Define each rule with CRIN pre-fix DEL controls color coding: Low (blue), High (red) Set range Outside of 2 nd Rule: Critical Rule for Actions Execute desired actions Set for all runs Delta Rules Requires 2 rules for each Delta 1 st Rule: DEL Define each rule with DEL pre-fix CRIN controls color coding: GREEN Enter in delta values (percentage/relative/days back) 2 nd Rule: Delta Rule for Actions Execute desired actions Set for all runs 10

Standard Calculations Overview Standard in WAM/no need to define ANC/ALC must be defined test codes Display in Manual Diff window Manual Diff Report Group Manual WBC Cell Type Calculation Cell Type % x WBC/100 = Absolute cell count ANC Absolute Neutrophil Cell Count ANC = (NEUT% x WBC/100)+(BANDS % x WBC/100) ALC Absolute Lymphocyte Cell Count ALC = (LYMPH% x WBC/100)+(ALYMP % x WBC/100) Citrate Platelet CPLT = PLT x 1.10 COMMON RULE TYPES 11

Standard Rule Origin Basis: Standards rules based on composite of single and multi-site customer accounts (>200) Sysmex TIS recommendations Technical operation of instrumentation ISLH Consensus Rules for Hematology Standard Rule Template Rule ID Selection of Rule Flag Test Code Rule Name Rule Definition Selection of Rule Action Operator Alert Text 12

Common Rule Types All instrument flags Linearity ranges Range rules Critical rules most common analytes Delta rules most common analytes Cross parameter rules - Retic & PLT Instrument Function & Asterisk flags Rule Creation Conventions 1 Demographic Rules can ONLY be created for data received from the LIS. 2 Check for overlapping rules especially for actions and priority. The most specific rule will trigger. 3 A separate rule is required for each location & physician. The rule is based on the code or ID. 4 For Result type rules requires 2 rules a) first and b) second run actions. 5 Each test must be listed in the rerun field for the specific rerun group. The rerun is always set at status 0 and not status 1. 13

Delta Rule Conventions 1 Default Delta rule based on the LAST validated previous numerical result in comparison with current result. All results must be validated on the order. 2 Delta Rules DO NOT check back on a range of values, coded comments or critical results 3 Delta rules must have a trigger limit [increase or decrease] of either absolute (whole number) or percentage change. 4 Each change in direction for delta must be defined as a separate rule. 5 No OR statements are allowed. Getting Started Determine Rule Outcome Identify rule parts: Demographic variables from LIS Test(s) Action(s) Operator Alert text Confirm no current duplicate rule 14

Rule Review & Build Tips Consider rule priority: Prioritize only important rules Default: Critical & Delta priority 1 Linearity priority 2 Consider overlapping rules in regard to: Priority Range rules higher range rule will execute Consider rule action on runs: First run, subsequent run, all runs Define a second rule for subsequent run Recommendation: 1 st run for all rules Rule Testing Guidelines Dry Testing: Use the Emulator Software program Test each rule independently Create a sample ID orders for each rule with appropriate demographics in LIS or Sysmex WAM Do not re-use sample IDs to test rules Retest: Use new sample ID Wet Testing: Test Samples Use Lab samples; Do not re-use same sample IDs Place orders in LIS test to Sysmex WAM test Use varied samples that will trigger multiple rules 15

RULE CREATION PROCEDURES Sysmex WAM Rule Screens Rule Selection Screen Rule list all, active, inactive Summary of each rule Ability to select rule to edit or copy Rule Definition Screen Detail display of rule components Ability to define or edit rule Ability to copy rule 16

Rule Selection Screen Search by active/inactive rules Double click on rule to view rule Copy Function Rule Selection Screen Display Rules Select ACTIVE, INACTIVE or BOTH toggle button OR enter in Rule ID Press the SEARCH key Rules will display Select rule to edit or copy Current rule Double click in row Rule definitions will display in INFO window Rule Definition screen will display 17

Rule Definition Screen - Zones Rule Definition Zone 1 18

Demographic Rule Selection Zone 2 Rule Type Selection Zone 3 19

Test/WP Selection Zone 4 Previous/Delta Check Zone 5 20

Action on Rules Zone 6 Operator Alert Text Look Up Functions 21

Steps to Define a Rule Rule Definition Next Steps 22

Rule Definition Next Steps Copy Rule Function 23

V4.1 INTERMOUNTAIN HEALTH CARE RULE EXAMPLES 47 Rule Example: NEUTAB Critical 48 24

Rule Example: WBC Critical 49 Rule Example: MCV Delta 50 25

Rule Example: Flag Rule 2012 Sysmex America, Inc. All rights reserved. 51 V4.1 KNOWLEDGE CHECK 52 26

Check Your Knowledge! WAM can trigger a rule for demographics (location, physician etc) if it not received with the order? True False Critical and Delta rules have priority over all other rules in triggering sequence? True False Check Your Knowledge! Delta rules trigger based on the following: Last validated result + MRN match Last unvalidated result + MRN match Last validated result + all results validated on order + MRN match Previous result 27

Check Your Knowledge A subsequent rule is? Previous to another rule A secondary rule to a primary rule with a different action Occurs later on Note: A subsequent rule is used to set the color for critical color coding and if a different action e.g. hold for review 55 Questions 28