Technology is becoming an integral part of health care and has the capacity to augment diagnostic capabilities at both the point of care (Point of Care Testing [PoCT]) and in the laboratory/hospital setting. Quality assurance (QA) issues are paramount to ensure new technology will produce reliable results, especially in the emerging areas of PoCT and genetics. Ensuring technology also has the capacity to deliver quality outcomes into the future before an investment is made is also an ongoing issue in health care.
The Quality Use of Pathology Program (QUPP) enabled projects to develop, define and educate stakeholders about the quality assurance and capacity of new technology. Eight projects (Table 4) covered areas from genetics to PoCT, with a major issue arising being QA issues associated with PoCT.
The emerging area of genetics was also targeted with projects that sought to define and inform stakeholders about best practice and QA issues in this area. PoCT and genetics are also dynamic areas with information and capability increasing rapidly, sometimes from month to month. These areas underpin the areas for future consideration including:
Further possible work by the Genetics Working Party set up under the Pathology Funding Agreement.
Investigate the framework for PoCT in General Practice recommended by the Point-of-Care Testing in General Practice Trial (http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pathology-poctt-index.htm).
Investigate and define QA issues for PoCT.
Project Name
Grant Recipient/s
1
Virtual Microscope (2005)
Royal College of Pathologists of Australasia (RCPA)
2
High Resolution Scanning Microscopy for Quality Assurance and Educational Applications (2009)
Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP)
3
Development of a Quality Assurance Module for Human Papilloma Virus Testing (2008)
RCPA QAP
4
Preparing for Genomic Medicine: National Audit and Development of a Best Practice Approach (2009)
RCPA
5
Policies, Procedures and Guidelines for Point-of-Care Testing (2011)
RCPA QAP
6
PoCT Training, Certification, Support and Skill Maintenance Program (Australian PoCT Practitioners Network – APPN) (Current)
Australasian Association of Clinical Biochemists (AACB)
7
Establishment of a Molecular Genetics Quality Assurance Program (Current)
RCPA QAP
8
MAWSON – An Online Repository of Genetic Data to Aid Reporting of Medical Genetic Tests (Current)
University of South Australia
Table 4: Reports summarised for Quality Assurance and Capacity – New Technology
Virtual Microscope (2005)
Description
The Virtual Microscope (VM) is a computer system consisting of both software and hardware for scanning microscopic images of cells, tissues and body fluids and converting them into a digital image. The technology allows the images to be transferred to a CD and to the Internet, and is particularly beneficial for quality assurance, training and educational purposes.
The Australian Government Department of Health and Ageing (DoHA) provided funding to the Royal College of Pathologists of Australasia (RCPA) for this project and the VM was installed on 2 August 2004. The project timeframe was 1 March 2004 to 31 January 2005, with regular updates submitted for the life of the asset until 2009.
Grant Recipient
RCPA
Aims and Objectives
to introduce virtual microscope technology as a means of delivering high quality images to laboratories in the Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP) and other quality assurance programs
to use virtual microscopy technology to develop education packages for Trainees and Fellows
to collaborate with University Medical Schools and other pathology organisations to provide digital images for educational programs to benefit registrars, medical practitioners and medical scientists
to coordinate the use of the virtual microscopy technology for other pathology related organisations with quality assurance programs.
These aims and objectives were achieved by this project.
Outcomes
Pilot surveys were undertaken in 2007 and 2009, with CD delivery of images rated higher than online delivery.
Survey results were presented as a poster at the International Society for Laboratory Hematology (ISLH) conference in May 2009.
A scanning service was established by the RCPA Haematology Quality Assurance Program (QAP) for clients within and outside the RCPA.
Candidates for the RCPA Haematology Fellowship participated in mock examination sessions for the preparation of their rigorous morphology examination.
Slide scanning has been provided to the University of Tasmania for their education materials.
Findings
Virtual microscopy cannot yet completely replace glass slide surveys because some laboratories have difficulties with downloading due to restrictive policies for software installation or slow Internet connection. However, it is a useful adjunct to the current RCPA QAP glass slide haematology morphology program with participants choosing to receive the digital images online or on CDs.
High resolution virtual slides of blood and bone marrow smears are practical alternatives to glass slide sets for education and training in haematology morphology.
Key Project Learning
One challenge was ongoing technical problems with the original system. It was completely replaced by the manufacturer in March 2006 under the warranty agreement.
Follow on Initiatives and Projects
High Resolution Scanning Microscopy for Quality Assurance and Educational Applications (2009).
