Mobile Phones in Haematology

Introduction

Pathology tests have a relatively small presence in terms of visibility in healthcare but the impact is nonetheless undeniable. It is estimated that 70% of healthcare decisions affecting diagnosis or treatment involve a pathology investigation, often initiated as a test request from a clinician to a laboratory to analyse specimens and await the return of results to form a balanced decision, Carter (2006). The haematology laboratory often located on a hospital site provides an important service to clinical areas in terms of analysing blood samples for disease diagnosis, monitoring and screening. Quantitative and qualitative results are produced from frequently requested tests such as the full blood count (FBC) and blood film morphology. The FBC test provides valuable information on the number and type of white cells, red cells and platelets in a patient. This is of particular importance when diagnosing and monitoring infection, leukaemia and anaemia. The blood film is often requested as a reflex test in response to a FBC report or clinical indication. The blood film report can validate the FBC report with a visual representation of the numerical data and it can also highlight significant abnormalities that could go undetected if the FBC report is considered in isolation such as various types of lymphoma, myelodysplastic syndromes and pathogens (e.g. malaria). Due to the subjective nature of interpreting a blood film it is recommended that its review is performed by an experienced laboratory scientist or a medically trained haematologist or pathologist, Bain (2005). The Royal College of Pathologists draw attention to the relationship between the laboratory and the clinician by emphasising the need for an onsite 24/7 consultant haematologist in hospitals that service acute medicine, surgery, orthopaedic, trauma, obstetrics and paediatrics. The prompt communication of urgent results is of paramount importance for effective healthcare management. In a modern healthcare environment this is facilitated by transmission of results from a laboratory information management system (LIMS) to a hospital information system (HIS) or a remote location e.g. GP surgery. Communicating results via secure electronic networks is the preferred method of delivery, Dacie & Lewis (2012). Prior to this system and still widely in use is the delivery of results as paper reports.

Despite the assurances these pathways provide in the delivery of information, there are situations where verbal communication of results is required to relay urgent information or life threatening results to a clinician. Verbal communication of results is considered a risk management issue due to the possibility of mishearing, misinterpretation or transcription errors, IBMS (2011).

Challenges to the haematology laboratory may present in low income healthcare environments or rural areas where limited resources have an impact on the quality of service, Dacie & Lewis (2012). Tests may be carried out by non-laboratory staff with basic training or the equipment in use may require technical support and finally interpretation of results. A key component of improving the quality of under resourced laboratories is establishing effective connectivity with centres able to provide support in terms of diagnosis and problem solving. A 2012 World Bank Report suggests three quarters of the world inhabitants have access to a mobile phone, the developing world has seen a rapid rise in the uptake of mobile phones which appear to have a higher penetration than traditional fixed landlines.

Telehaematology is the transmission of haematological images and data for the purpose of diagnosis or teaching. As mobile phones have progressed beyond the capability of voice transmission to now incorporate cameras, multimedia messaging and email, the possibility to expand its use in haematology has diversified.