Electronic Crossmatch

[bmarotto]

My hospital lab has been a Misys (formerly Sunquest) site since the mid 1980's (Blood Bank went live in 1990). We worked out a way to do electronic crossmatching and received FDA approval in 1995. Misys now offers an Electronic Crossmatch option and I was excited to test it out. After playing with it in our test area, I am concerned that it is overly restrictive. Any QA failure, even if legitimately overridden, will block units from being electronically crossmatched. For example, if it becomes necessary to switch an Rh negative patient to Rh positive blood due to massive transfusion, units can not be electronically crossmatched even though the patient has the required two blood types and negative antibody screen/history. My understanding of the electronic crossmatch is that it is used to determine ABO incompatibility when a patient has a negative antibody screen & history. True, the system must alert the user if there is a patient/donor Rh discrepancy but should it BLOCK the electronic crossmatch? It also blocks electronic XM if a patient requires irradiated blood and the units are not irradiated. It will, however, allow these units to be serologically crossmatched. Where is the logic here?

It is the Rh pos unit to Rh neg recipient scenario that poses the biggest problem. Often, this occurs when massive units of blood are needed emergently. Going back to tube immediate spin xm in these cases is going to cause a delay in getting blood to the patient.

Does anyone know how/if other software vendors are handling electronic crossmatching?

[donellda]

We use Sunquest/Misys at our institution but we have not tried to implement the electronic crossmatch yet. Your LIS department should be able to alter the database in your system to avoid the QA failure. I used Meditech at my former place of employ, and the system had a problem issuing Rh positive to Rh negative individuals but there was a way to temporarily alter the patients Rh type to allow the issue of Rh positive units. I think that the LIS department needs to be involved. They may need to contact Sunquest/Misys to find out how to change it in the database.

[bmarotto]

The problem is with the electronic crossmatch feature, which is a new option in GUI Blood Bank. Rh positive units can be issued as long as a serological crossmatch is done. Misys acknowledges this is how the program was designed to work, i.e. to block electronic crossmatching anytime there is any kind of QA failure. It is not just limited to the Rh pos blood to Rh neg recipient scenario. My issue is that it sometimes blocks electronic crossmatching on qualifying patients for reasons other than ABO incompatability.

[adiescast]

My suggestion would be if the electronic crossmatch "fails" and research proves it to be one of these scenarios (Rh positive to Rh negative), use your current FDA-approved work around instead. We are not yet on GUI, so I can't be sure this will work, but I think that it could.

The problem would come if someone doesn't do the research and works around the failure inappropriately. You would need adequate fail-safes built into the current method to prevent that.

[Linda Fatolitis]

I am not a billing expert but, I attended the AABB Annual Meeting in October where they announced that the electronic crossmatch had been given a CPT code and was now approved. The code they announced was 86923. You may want to verify this, but it's a start.

[bmarotto]

My current FDA workaround involves having a blood type repeat and a history check included in the crossmatch battery. If there is a type on file, the tech results the history check and retype with the historical blood type (without reaction results for the retype as they are not performing a second blood type...no charge to the patient for this). If there is no historical type on file, the tech results the history check with NOF (none on file). A second tech then performs and results the second blood type.

With the electronic xm package, I planned on removing the retype and history check from the crossmatch battery since the computer would be determining if the patient has had the required two blood types performed. If I have to use my workaround for the cases Misys considers "electronic crossmatch failures" (Rh pos to Rh neg), then I have to keep things the way they are. I would then have two methods for performing electronic crossmatch. Software upgrades should make things easier, not more complex. I am hesitant to go on a version that has an FDA approved electronic crossmatch feature and choose to reject it in favor of our workaround. On the other hand, I have a problem paying Misys for their electronic crossmatch feature (it is an optional feature you have to purchase) if it means I need a workaround to achieve the level of functionality I have now.

We have decided to look at other BB software products before making a decision to proceed with the Misys upgrade.