CCQLM Chemistry Working Group Report

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CCQLM Chemistry Working Group Report

• Hamilton, ON
• May 14, 2007

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CCQLM Chemistry Working Group

• Members Present
• AB
• SK
• MB
• ON
• CSCC
• PQ

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CCQLM Chemistry Working Group

• Issues discussed
• Serum Protein Electrophoresis Comment
  Standardization
• HbA1c Reporting Standardization
• eGFR
• Canada InfoWay - Nomenclature
• POC
• Budget

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CCQLM Chemistry Working Group

• New Initiatives Discussed
• Test Utilization
• TAT

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CCQLM Chemistry Working Group

• Serum Protein Electrophoresis Comment
  Standardization
• Resurrect the survey that was distributed over
  the last two years
• 88 laboratories had reported AB (5), NS (2),
  Ont (23), PQ (58)
• Dr. Francine Morin-Coutu (PQ) had developed the
  survey with responses returned to Dr. Ed Randell
  (NF) Francine

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CCQLM Chemistry Working Group

• Goal
• Update the database from Francine or Ed with
  responses from the missing provinces (BC, SK, MB)
• Analyze the database to identify the comments
  which are different and distribute to working
  group members for suggestions on a standardized
  approach
• Assigned to E. Serediak Dr. Naidoo

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CCQLM Chemistry Working Group

• HbA1c Reporting Standardization
• New guidelines are expected from ADA, CDA AACC
• There is no consensus at this time as to the name
  (A1c vs HbA1c), units ( vs non-), or
  standardization (IFCC vs NGPS)
• Last year there was a movement that mean plasma
  glucose (MPG) calculated from HbA1c be reported
  instead
• Consensus Stay where we are and wait until the
  other groups finalize their guidelines

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CCQLM Chemistry Working Group

• eGFR
• Ortho, Roche, Abbott Beckman will have IDMS
  traceable creatinine standardization by the fall
  of 2007
• A new IDMS traceable standard which will be
  available to manufacturers is due to be released
  in early 2008
• Provincial update BC routinely reporting with
  creatinine standardization from HeathMetrx

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CCQLM Chemistry Working Group

• Alberta is routinely reporting on inpatients
  outpatients with creatinine standardization from
  HealthMetx
• SK MB waiting for manufacturer IDMS traceable
  creatinine standardization and to report on
  outpatients in major centres this fall.
• ON reporting on outpatients in private labs with
  creatinine standardization from HealthMetrx

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CCQLM Chemistry Working Group

• In Quebec and further east it appears there is
  some reporting in outpatients
• Consensus Hang on for the ride as it is
  happening. As the manufacturers become IDMS
  traceable the need for creatinine standardization
  will diminish
• There is a recognized gap with education and
  understanding of the implications with clinicians

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CCQLM Chemistry Working Group

• CCQLM involvement guidelines have been coming
  from NKDA, CCSC, AACC and appears there is no
  need to further develop others
• It appears that progress is being made with
  creatinine standardization but a future area of
  concern in the same area of kidney function is
  microalbumin standardization

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CCQLM Chemistry Working Group

• Canada InfoWay Nomenclature
• A number of labs have participated in responding
  to surveys and information requests
• Appears that the issue is more of an IT one to
  allow portability of results to an electronic
  medical record
• Alberta is using an e-record with standardized
  codes for the northern half

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CCQLM Chemistry Working Group

• Only issue that seems to be coming forward with
  the nomenclature is standardization of units
• Majority of labs are reporting in SI however
  appears there are discrepancies in some units,
  ie. mU/L vs mIU/L
• Also issues with those tests who have not been
  standardized, ie HbA1c ( vs non-) and
  aminoglycosides (mg/L vs mmol/L)

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CCQLM Chemistry Working Group

• POC
• Consensus POC should be a committee on its own
• Diversity of testing and expanding of testing
  require a multi-disciplinary approach
• CCQLM role should be in standardization

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CCQLM Chemistry Working Group

• Budget
• Budget to date 0
• Future predicted budget 0
• Majority of correspondence and follow-up can be
  with e-mail and phone calls and see no financial
  commitments required

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CCQLM Chemistry Working Group

• Future Projects Test Utilization
• Discussion of tests that have served their time
  and should be discontinued
• An example is Folate with fortification of
  food, deficiency has been nearly eliminated
• Manitoba no longer offers folate and Ontario
  private labs would like to discontinue testing in
  light of the capping restrictions

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CCQLM Chemistry Working Group

• CKMB has been replaced by troponin
• Is there a role for CCQLM in recommending
  guidelines?
• Consensus - appears to be more of a provincial
  jurisdiction
• However the CCQLM forum is an excellent arena to
  discuss what other provinces have done and future
  directions

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CCQLM Chemistry Working Group

• Future Projects TAT
• TAT currently in accreditation requirements
• Defined in policies and audit requirements
• Is there a need for a standardized TAT and is
  this something CCQLM could provide guidelines?
• TAT appears to be customized for test and
  institution

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CCQLM Chemistry Working Group

• No benchmark exists as to what an appropriate TAT
  is for various tests as there are too many
  variables
• It would be interesting to do a survey of
  laboratories to see what they accept as their TAT
  for the commonly requested tests
• However, it was felt better to carry this forward
  in future years as it has a major time commitment

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CCQLM Chemistry Working Group

• Summary
• Resurrect Protein Electrophoresis Comment survey
  to standardize comments
• HbA1c Wait for further developments from the
  stakeholder groups
• eGFR implement as creatinine standardization
  occurs

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CCQLM Chemistry Working Group

• Recommend POC as a separate committee
• Chemistry Working Group Chair Manitoba

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Questions?