January 2026 Development Of Pathology AutoReview Rules

We’ve had some helpful feedback, which has led us to refine some of our pathology rules and there may be a few patients you want to review.

Low HbA1cs

A practice has reported a patient with a very low HbA1c of 10mmol/mol where the result was autoreviewed and not picked up for review in our clinical reports (a diabetic with HbA1c<20 and on diabetic medication would have appeared in our HbA1c reports to review).

We’ve amended our HbA1c rules to no longer file any HbA1c <20, and have published some reports you can use if you want to check whether any patients of yours have had low HbA1cs autoreviewed:

We think the number of patients is likely to be in single figures for most practices. We’ve also published a report output called “Review HbA1c” that will display age, diabetic diagnosis (if any), latest BMI and the last 5 HbA1cs.

Increases in Creatinine

Our UE rules already don’t file if the lab AKI, if eGFR<30 or if eGFR 30-75 and there’s a drop of >10% from the highest in the last 18m verses the most recent. One practice has raised the possibility of a significant increase in Creatinine where eGFR is still normal, and the lab doesn’t report on AKI. We can see this is something that could potentially occur and so we’ve added an exclusion to our filing rules that compares the latest Creatinine with the lowest 12m to 7d ago, as per NICE guidance (Diagnosis | Diagnosis | Acute kidney injury | CKS | NICE) or a Creatinine >300. The data suggests this may block less than one result per week from being autoreviewed. We’ve also built reports that identify patients where the result wouldn’t now be autoreviewed. This is the report:

After reviewing some patients, it appears they are appearing in the report because results were autoreviewed after a previous significant increase in creatinine. i.e., the point at which AKI occurred, the result wasn’t autoreviewed. We’re not currently aware of any example of a result being autoreviewed inappropriately for this reason.

FBC and LFT rules

When we first built these rules, there wasn’t an option to use the lab ranges. Now that this is possible, the best approach is to have different combinations of investigations and comments to reflect all the labs we work with. In the next couple of weeks, we plan to make this change. Please let us know if there are any issues or if anything stops filing.

More generally, please do let us know if there are results that aren’t filing that you would like to have autoreviewed. The most helpful thing is to send us a screenshot of the result to support@welbyinnovate.co.uk – e.g.