The solution MUST be capable of supporting multiple user configurable request entry screens that support the addition of user defined demographic items.
Request entry screens are site configurable to support the addition of user defined demographic items. Previous positives are stored, and cross referenced through delta checks which will flag discrepancies. Delta checks are set up in system configuration (ULTRA Master) to check back a set number of days for any change in the susceptibility result for the organism/organism group and panel combination.
The solution MUST provide facilities to support a ‘paperless’ Microbiology Department.
ULTRA Microbiology facilitates a paperless Microbiology Department through its tab-based Microbiology form. Each tab allows the user to record results from a different step in the Microbiology workflow.
- The Initial Findings tab is used to enter and display results of initial tests that are routinely performed directly on the specimen such as Gram stain, India ink preps, urinalysis, etc. Results can be manually entered here or received from an instrument.
- The Work Card tab is used to record the amount of growth and description of colonies grown on various media. Entries are stored on tabs which correspond to the day the plate was read. The date, time and the user who entered the result are also displayed.
- The Procedure tab is used to enter and display results of identification procedures that have been reflexed based on the descriptors entered on the Work Card e.g. catalase, oxidase, step grouping, etc. Additional procedures can also be manually added and resulted if required. Organism ID can also be recorded on the procedure tab, a Primary and Final ID can both be recorded.
- The Susceptibility tab is used to enter the antibiotic susceptibility results for each isolate. Both minimum inhibitory concentration and Kirby Bauer can be entered and reported. These results can be manually entered or received from an instrument and entered. Reports can be viewed through the query function, this shows lab users the report as it would appear to the requesting doctor. The Report is not required to be printed to view as the requesting doctor will see it.
The solution MUST have the ability to alert specific system users under particular user-defined circumstances (e.g. sending an alert message or email to a Consultant Microbiologist and/or Infection Control Nurses whenever an MRSA or other flagged organism or serological result is confirmed).
Reports on notifiable diseases can be sent to Consultants or Infection Control Nurses. Which organisms are notifiable and to whom a report needs to be sent is user definable.
Organism abnormal levels can be classified as (0 = normal - black, 1 = abnormal - blue, 2 = warning - red, 3 = panic - pink). The organism code will then display in the corresponding colour. Expert rules are used to trigger reports to public health agencies and surveillance programs using a specific abnormal level that is limited to notifiable organisms. Separate, user-defined lists can also be used to define notifiable organisms
SYSTEM MUST be capable of Listing Samples with ALERTS with the Date the ALERT was generated and sholuld be able to sort and select on this.
The management report module in ULTRA uses Business intelligence reporting to create reports. A report listing samples which have caused notifiable disease reports to be sent can be created, containing the date the alert was created.
Above lists MUST be viewable on Screen, with Ability to Print or Export.
Reports can be viewed on screen and be printed or exported from Management Reports.
SYSTEM SHOULD have the ability to allow the use to select sample from the ALERT and branch into full Enquiry and notepad functions
Sample numbers from the reports can be copied and opened in enquiries where the user will have full access to all information on the patient and request. Including notepad functions.
There MUST to be an electronic mechanism by which microbiology clinicians can be alerted, and NHSMail for external parties of urgent interim results by lab staff by either;
a) bespoke ALERT List in system
b) Internal message box
C) Trust e-mail
Reports on notifiable diseases can be sent to Consultants or Infection Control Nurses. Which organisms are notifiable and to whom a report needs to be sent is user definable. ULTRA can be configured to send alerts by Email, SMS, Webhook, MS Teams, API call etc. For example alerts can be pushed into Microsoft Teams directly to a channel or to an individual as needed. Electronic delivery of final results would be complete by UAT.
The solution MUST be able to support the reporting via some means of presumptive positive results to infection prevention and consultant microbiologist NOT just when they are confirmed
A Preliminary ID can be entered when a positive organism is presumed and updated to a Final ID when this has been confirmed. Preliminary ID's can then be released as Preliminary reports and sent to infection prevention, Ante-Natal Co-ordinator and consultant microbiologist.
There SHOULD to be a mechanism by which microbiology clinicians can request additional follow up work from the laboratory (this should be permanently documented in the audit trail)
Validation add on test allows for additional follow up tests to be added by microbiology clinicians at the point of validation. Additional work may also be ordered from the Patient Record.
The solution MUST allow for multiple bar code formats and eye-readable label printing to label specimens/plates.
ULTRA allows for multiple barcode formats both 2D and 3D. Barcodes are configurable and so eye-readable labels can be created and printed for both specimens and plates
The solution MUST be able to group culture, non-culture tests, sensitivities and specimen comments all on the same screen together so that non-culture (specifically microscopy) results can be easily seen when entering culture results and so that culture and non-culture results on the same sample can be verified/validated simultaneously.
The Summary tab shows all results for the request on the same screen so that both culture results, non-culture results and sensitivities can all be viewed simultaneously. However, culture, non-culture and sensitivity results are all entered on different tabs within the one screen. For results of other panels or other requests the Test History Tab can be used. In validation the Culture report will be shown so culture and non-culture results on the same specimen or sample can be validated simultaneously.
Under schedule 5 of the ATCSA, Trusts are required to keep records of destruction for organisms and culture materials of those that are of potential terrorist use. It SHOULD be possible to use The solution to keep these records.
For low numbers of samples a non-reportable panel can be added which prompts for specific destruction information to be recorded. This can be viewed and added to the management report. Specimen tracking can also be used to manually add a message that the specimen has been destroyed or by storing and then discarding the sample.
The solution SHOULD have a Specimen Storage application that can be used to store and record disposal / destruction of samples.
ULTRA has a manual storage system that will display location on specimen tracking and any additional comments, as needed. Stored specimens could then be retrospectively tested. The Core Lab module provides specimen tracking to follow the life of a specimen for events that occur including disposal, regardless of the sample having been processed.
The solution MUST provide the ability to abandon any work stream at any stage but keep the record of the work in an audit trail.
Work can be saved at any stage and not released by clicking the 'No Report' save option. ULTRA has 4 different types of tracking - Patient, Request, Specimen and Report tracking. This will keep track of all activities carried out at the request, specimen, panel and report level. Details of all results entered and changed are stored automatically in an on-line audit trail.
There MUST be a facility to report at different levels of report designation including interim, final, additional, amended and multiple reports per specimen need to consider how to incorporate different reports on different organisms.
When closing and saving work from the Microbiology screen the user can select which report type they want to release a Preliminary (Interim), Final, Supplementary, Amended report or No report.
The solution MUST have a facility for secondary, non-reportable tests (and groups of such tests) which can be allocated workload units for statistical purposes.
In ULTRA Master, Panitems can be set up as non-reportable when defining a panel, so that they may still be viewed within ULTRA but will not show up on reports. These Panitems can be found on the Procedure tab and are secondary tests that are carried out within a panel to identify an organism. The results of these tests are not on the final culture report but are recorded in the procedure tab. Alternatively, the panel itself can be marked as non-reportable within panel set up in ULTRA Master.
The contractor MUST provide a solution for the upload of but not limited to the National Catalogue (or user-definable files) onto their system of coded text comments, organisms and antibiotics etc to populate The solutiondata base.
The National Catalogue or user-definable files can be uploaded to ULTRA to populate the ULTRA database.
There MUST be a facility to enter clinical details and details of antibiotic/antiviral therapy in coded and free text form.
Clinical details are recorded at the point of request entry, library codes can be used to enter clinical details. Antibiotic/antiviral therapy can also be entered here in coded and free text forms.
It MUST be possible to request a standard set of Microbiology tests from all patients at any location or group of patients at the same time.
A standard set of Microbiology tests can be ordered using a profile. Multiple panels can be attached to a profile code and ordered together.
It MUST be possible to request more than one culture type and type of test on the same sample and when required allocate separate laboratory accession numbers to each test.
It is possible to order more than one culture or test type on the same sample/specimen in request entry. When required, separate specimen numbers will be allocated to each test and labels printed out.
The solution MUST also support reflex/cascade tests following an initial test request.
Procedure tests to identify a particular organism are reflexed based on the results recorded in the Work Card Tab of ULTRA Microbiology (e.g. a catalase test will be reflexed if ‘apparent staph’ is entered as an isolate descriptor).
It MUST be possible to allocate a user definable code to all specimens associated with an outbreak or incident to allow related samples and patients to be “linked” and display these at all stages.
ULTRA has user defined fields which can be set up in patient details, order details or can be added to panels which can be used for linking events such as incidents and outbreaks. These fields can be used to collate information so the linked details can be used to generate reports or dashboards and export to excel or pdf.
SYSTEM MUST allow Outbrreak/Inicdent codes to have additional fields and notepads associated
Lab Notes can be used to add additional information about Outbreak codes to a request.
Outbreak Incidents codes - should automatically generate new codes/numbers in an agreed sequence
Outbreak codes are not automatically generated.
Outbreak Incidents codes should be searcable by Date (ranges)
Business Intelligence Reporting can be used to create reports listing Outbreak codes, these reports can be generated for a defined date period.
SYSTEM SHOULD be able to generate SUMMARY reports on each incident - viewable on screen, printable and exportable (CSV,XML)
Business Intelligence Reporting can be used to create reports detailing each outbreak code incident. Information required in these reports is user definable, they can be printed and exportable as CSV, XML.
This facility for the outbreak management MUST be available to those requiring bacteriology or virology investigations.
Outbreak management fields will be available to those requiring bacteriology or virology investigation.
It MUST be possible to search by this outbreak code.
Specific outbreak codes can be searched for in Management Reports where the reports created by BIRT can be viewed.
It SHOULD be possible to copy (or duplicate) electronic request information to separate accession numbers if multiple accession numbers are required for a single request
Within request entry there is a duplicate action for manual entry where details for a previous request can be copied. Multiple accession numbers can be added against a single request if required, all of which will retain the original request information.
The solution MUST provide facilities to derive plate requirements from request details using a rules base.
Plates are allocated to a specimen according to the panels that are ordered in the request. The rules for plate allocation are predefined by the user and will be automatically assigned when panels are ordered.
The solution MUST enable the addition or subtraction of plates from the standard set.
Plates can be added to or removed from a panel on a request in the set up section of Microbiology Specimen Receipt.
The solution MUST support the issue of labels for containers for splitting of samples.
Labels are user defined, multiple labels will be printed if a sample/specimen needs to be split.
The solution MUST provide the facillity to enter both coded, date time stamp and free text data regarding travel history and date of onset into dedicated fields at request entry.
Instant result items can be added to panels that you wish to record travel history and date of onset for. A 'travel' item could be used to capture this information.
There MUST be an option of retrospective testing of stored specimens
ULTRA has a manual storage system that will display location on specimen tracking and any additional comments, as needed. Stored specimens could then be retrospectively tested.
Must be possible to request sample without full patient ID demographics. Full patient information must be added before the result is released.
First stage entry allows a request to be entered into ULTRA without full patient ID demographics being required. Full patient information can then be entered in second stage entry before results are released.
The solution MUST allow the processing of paired samples.
The same panel can be ordered twice (tiebreaker) or a serial format can be used for multiple requests with the same panel.
The solution MUST provide a “notepad” functionality for the storage of clinical information related to a patient.
The Lab Notes functionality functions as a notepad where clinical information related to a patient can be stored. This functionality also allows for information to be stored against a specific request for a patient.
The presence of clinical information in the notepad MUST be flagged on screens at testing, authorisation etc. This must be privilege level associated.
The presence of information in lab notes is highlighted by icons throughout the application. Access to Lab Notes is controlled at a user group and individual level in ULTRA Security.
The solution MUST flag discrepant results (i.e. discrepant with previous results) according to user defined rules.
Susceptibility results for cultures have delta checking. This is set up in master to check back a set number of days for any change in susceptibility results for this organism and panel combination. If a susceptibility result fails delta check the system will display the number of days back it looked to find that delta check. Any numeric items can also have delta checks but will have to be entered in Vertical result entry to receive a delta check warning.
The solution SHOULD have the ability to produce a searchable address / phone list
ULTRA Notifications displays a phone list and contains patient demographic information, request details, and the ability to enter a phoned message containing information on who was phoned, by whom, and the date and time of phoning. The required phone number is displayed on screen. Samples can be sent to the phone list from clinical validation or can be set-up to be telephoned during request entry.
The solution MUST be able to include images and authorised logos in reports. E.g reports from reference laboratories
Management and Culture reports are user definable and can include images and logos
The solution MUSTbe able to prevent a further request being made depending on the previous test result.
ULTRA can prevent users from ordering additional duplicate or like tests by providing a warning that a duplicate test has been ordered. However, this is not based on previous test results.
There MUST be a robust full audit trail for every sample entered onto the system
ULTRA has 4 different types of tracking: Patient, Request, Specimen and Report tracking. This will keep track of all activities carried out at the request, specimen, panel and report level. Details of all results entered and changed are stored automatically in an on-line audit trail.
The report designation MUST be visible on all reports
Reports are configurable and can be set up to show the status of the report/test, if required.
The solution MUST have the ability to record that the result has been telephoned
From the Microbiology screen, pressing the phone icon opens the Phone Call Notes form where users can enter that results where phoned, to whom and the date and time.
The system SHOULD have an internal messaging system to allow laboratory users to contact users at any site
The Microbiology screen has an internal free text button where users can leave internal messages to each other in the Workcard tab. Users can also leave Temporary or Permanent department comments using Panel free text option.
There MUST be a suitable alert provided when an interface times out
A suitable alert is provided in the microbiology module if an interface times out, or there is an issue with the sending/receiving of results.
There MUST be ability to interrogate the system using multiple demographics
Enquiries allows users to interrogate the system using multiple demographics to view requests and reports.
The system should be capable of generating Multiple Alerts i.e. MRSA/C.difficile/CPE. These may be permanent or for defined periods per alert
Patient alerts allows users to create alerts against a patient. A review date can be set for these alerts to be reviewed after a defined period or they can be permanent. User can also mark if they want this alert to display on Request and Result entry. Warning/Alert messages may also be configured when entering susceptibility results for antibiotics as part of cascade rule configuration. For example, if antibiotics Flucloxacillin and Penicillin are marked with conflicting susceptibilities (e.g. Resistant and Sensitive), the user will receive the message "Flu and Pen conflict, please check zones again". These messages are configurable in ULTRA Master.
The system should record time of drug administration and dose for theraputic drug monitoring
Drug administration and dose can be recorded, as an item against a panel. Or the notepad functionality can be used to record clinical details against a patient or a specific request for that patient. Such as time of drug administration and dose for therapeutic drug monitoring.