Mariann Amador, marketing manager, Arkray USA: When I first started working in the lab, the criteria that were positive in the urine chemistry would get reflexed to a urine sediment. Then I started working outside the U.S. market, first in Latin America, and my question to lab directors there was, “What’s your reflex rate?” The question surprised them because for them a urinalysis consists of a urine chemistry and a urine sediment, regardless of whether the chemistry is negative. I think it is good practice for labs to do almost 100 percent urine chemistry and sediment.
I agree with Matt about the urine culture because there are devices now that can identify the bacteria, for example, and do a quick susceptibility so you don’t have to give a broad-spectrum antibiotic from just the urinalysis result. It would be great in the future if we could, based on the bacteria or WBC count, gauge whether it’s a pure culture or a contaminant and then incorporate susceptibility testing into the urinalysis process.
Meagan Seeger, what are your thoughts on what you’ve heard so far?
Meagan Seeger, MLS(ASCP)CM, hematology and coagulation supervisor, Wisconsin Diagnostic Laboratories, and member, CAP Hematology/Clinical Microscopy Committee: We recently transitioned to a similar process and changed many of our reflex orders. Clinicians used to be able to order the macroscopic, microscopic, everything separately or together, and now we have initiatives with our CAUTI [catheter-associated urinary tract infection] group, especially inpatients, to make sure they get the correct order for the proper reflex testing to determine if an associated UTI was from the patient’s hospital stay. We’ve reduced our urinalysis orders by using reflex testing with what we offer to people because we’re doing extra testing that doesn’t seem helpful.
We’ve been utilizing AI and reflexing to help with staffing metrics. For example, “I don’t have to look at that urine; it’s going to go through and will autoverify.” Or, “I have to spin this down and look at the sediment to determine what I’m looking at.” It’s been useful for us to do the reflexing so we’re not spinning down every urine we look at to look at the sediment.
When you say you’re using AI, is this an algorithm your laboratory developed based on certain values?
Meagan Seeger (WDL): Yes. We are using the Arkray Iris system, so we use the pictures from what it determines to also decide if we need to look at it under the scope.
Rob Fratino, tell us your thoughts on what you’ve heard so far and where Siemens Healthineers is with AI and the efficiency of testing urinalysis.
Rob Fratino, global product manager, centralized urinalysis, Siemens Healthineers: I agree with what was said about reflex rules. Today reflex testing still depends on site-specific and population-based-specific implementation of rules. On a global level, many of our customers had been performing 100 percent microscopy for a long time, but because of the changing headwinds they’re facing, whether it be reimbursement or resources within the lab to perform site microscopy, there has been a stronger desire to cut down on review rates. We’ve been working hand in hand with customers on validation studies to get them to a point where they’re comfortable with what they’re seeing from the chemistry side and what is ultimately going to the microscopic side.
There’s always interest in AI. My focus today would be on the underutilization of urinalysis in the marketplace. A number of existing analytes have significant value, whether it be kidney disease or cardiovascular, and are not applied at the same level of urinalysis tests being performed today. A disproportionate amount of information is being left on the table.
Urinalysis is such a high-volume test, but it doesn’t always get the respect for the clinical value it can yield. Meagan Seeger, are we maximizing the value of our urinalysis efforts?