What is a paperless remote sign-out process for serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE)?
Making sure pathologists verify that these tests are completed through a sign-out system ensures clinical accuracy and allows qualified professional billing.
A paperless remote process digitizes the workflow, enabling electronic processing of all information, including protein fraction values (e.g., albumin, alpha-1, alpha-2, beta-1, beta-2, gamma), monoclonal (M) protein quantification, text-based interpretation comments, and the pathologist’s digital signature. This allows pathologists to review and finalize cases remotely, eliminating the need for them to be physically present in the laboratory as well as the need for printed records.
Why should labs adopt this process?
A paperless process improves efficiency by eliminating the need to access the full paper trail associated with a patient’s historical results, which technologists must spend substantial time retrieving, updating, and maintaining. By instead using a database that is integrated into the vendor’s electrophoresis software, labs can maintain a digital archive of patients’ results, preserving complete histories that support future research and artificial intelligence applications.
Paperless systems also reduce transcription errors by removing the need to do manual data entry. In labs where technologists, residents, or clinical chemists perform preliminary interpretations and pathologists complete final sign-out, this process facilitates collaboration through a shared digital environment.
How does the process work?
First, patient demographics, serum total protein levels, and test orders are downloaded from the laboratory information system (LIS) to the electrophoresis software, either directly or via middleware. The software controls the SPE instruments that perform the tests. Technologists analyze electrophoretograms, marking protein fractions and M protein peaks, and the software calculates their concentrations using peak-area percentages and total protein values.
If SPE results are abnormal, IFE or immunotyping is performed. IFE gel images are scanned and digitally linked to corresponding SPE results. Interpretive comments are added in the software or LIS, noting the presence or absence of M protein, its isotype, migration region, and comparisons to prior results for patients with existing histories. All results are then transmitted from the electrophoresis software to the LIS, where pathologists verify, digitally sign, and release them to the patient’s electronic medical record.
How can I implement this process?
Implementation requires collaboration among stakeholders. Laboratory IT specialists configure LIS interfaces and test setups. The vendor’s IT team installs electrophoresis software on local instruments and institutional servers. The server team works with the vendor and lab IT professionals to manage software installation and updates, and to secure remote access for pathologists. A medical or technical director oversees the project, ensuring it remains compliant with clinical and regulatory standards. Pathologists and technologists also contribute sign-out and operational insights.
A critical step is to standardize interpretative comments. Using a structured reporting format with consistent verbiage enables the creation of drop-down lists of standard comments in the electrophoresis software or mnemonic codes in the LIS, forming the basis for digital sign-out. Another key step is coding M proteins by isotype in the electrophoresis software and mapping them to standardized LIS entries for reporting.
Xiaochun Susan Zhang, MD, PhD, DABCC, DABMLI, FADLM, is the director of clinical immunology and special chemistry at the University Hospitals Cleveland Medical Center, Case Western Reserve University. +EMAIL: [email protected]
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