This topic covers the operation of the adjudication tools for a person with the Adjudication Lab Personnel role. Anyone with that role may perform the tasks described here, though it is good practice to designate a single person as the primary "monitor" of alerts and case progress. The dashboard, case summary statistics, and role-specific UI notifications are also visible to the Folder Admin, Infection Monitors, and Data Reviewers.

Adjudication lab personnel initiate an adjudication case when they determine one is necessary. Case data is uploaded and submitted to the adjudicators. Information about both active and completed cases is available on the dashboard. Once an agreed diagnosis is reached in a case, lab personnel verify the determination.

Note that the adjudication folder can be configured to support simultaneous diagnoses of multiple strains of HIV. If there is an agreed determination of diagnosis on one strain but not the other, the agreed diagnosis will be verified while the case remains active to follow up on the other strain.

Dashboard

When cases are active in the folder, the dashboard web part offers the ability to view current status of active and completed cases at a glance.

  • Click the Administrator Dashboard to find the Dashboard web part.
  • Select whether to view Active, Completed, or All Adjudications using the View dropdown.
  • In the Active Adjudication table:
    • Click the details link for more information on the CaseID for the listed participant ID.
    • The number of days since case creation are displayed here, as are any notes entered.
    • The Status column can contain the following:
      • "Not started": No adjudicator has made a determination
      • "# of # adjudicators made determinations"
      • "Resolution required": All adjudicators have made determinations, but need follow up because their answers disagree or because they have chosen an "inconclusive" status.
      • "Infection detected, resolution required": Adjudicators agreed that there is at least one strain present, but resolution is required on the other strain. See below.
      • "Further testing required": More testing was requested by one or more teams.
      • Note: The "closed" status is not displayed, because the case will just be moved to the "complete" table
  • In the Complete table:
    • The beginning and end dates of the adjudication are listed for each case.
    • The righthand column will record the date when the adjudication determination was recorded back in the lab.

Infection Detected

Particularly in HIV diagnosis, it is critical that action is taken when a positive diagnosis is reached. When the adjudication tools are configured to diagnose both HIV-1 and HIV-2 strains, notifications that an infection has been detected are raised independently for each strain.

In a case where there is agreement on only one strain, the status "Infection detected, resolution required" is shown on the dashboard. Hover text indicates which determinations matched, allowing quick patient followup when necessary, even while the overall case remains active.

Case Summary Report

Displays a summary of active/completed cases and how long cases have been taking to complete to assist lab personnel in planning and improving process efficiency.

  • Total Cases: Shows the aggregate count of the current cases in this container, as well as how many are active and how many completed.
  • Ave Comp Days (Average Completion Days): Tracks the average number of days it takes for cases in this container to be marked as completed. The case creation date is subtracted from the case completion date.
    • Min/Max Comp Days: The minimum/maximum number of days for a case in this container to go from creation to completion.
  • Ave Receipt Days (Average Receipt Days): The average number of days for completed cases in this container to be marked as verified as received by lab personnel. The case completion date is subtracted from the lab verified date.
    • Min/Max Receipt Days: The minimum/maximum number of days for a case in this container to go from completion to lab verification.
The query used to calculate these values can be found in the schema browser in the "adjudication.Case Summary Report" and reads as follows:

SELECT count(adj.CaseId) AS TotalCases,
sum(CASE WHEN adj.StatusId.Status = 'Active Adjudication' THEN 1 ELSE 0 END) AS ActiveCases,
sum(CASE WHEN adj.StatusId.Status = 'Complete' THEN 1 ELSE 0 END) AS CompleteCases,
round(avg(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Created, adj.Completed)),2) AS AveCompDays,
min(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Created, adj.Completed)) AS MinCompDays,
max(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Created, adj.Completed)) AS MaxCompDays,
round(avg(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Completed, adj.LabVerified)),2) AS AveReceiptDays,
min(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Completed, adj.LabVerified)) AS MinReceiptDays,
max(TIMESTAMPDIFF('SQL_TSI_DAY', adj.Completed, adj.LabVerified)) AS MaxReceiptDays
FROM AdjudicationCase adj
LEFT JOIN Status ON Status.RowId = adj.StatusId

Notifications

The Notifications web part displays active alerts that require the attention of the particular user viewing the web part. The user can click to dismiss the UI notification when action has been taken. If there are no UI notifications pending for this user, the web part will not be displayed. Each UI notification has a link to View details, and another to Dismiss the message from the web part.

The adjudication tools also send email notification messages to subscribed individuals, including lab personnel, data reviewers, infection monitors, and others identified as "to be notified." The email includes a direct link to the adjudication review page for the case.

Whether emails are sent, UI notifications are displayed, or both is governed by assigned roles.

UI Notification Types

For each type of UI notification, the rules for when it is added and dismissed vary somewhat.

  • Adjudication Case Created
    • Added on new case creation (i.e. upload by lab personnel)
    • Dismissed via clicking "dismiss" or viewing the details or determination page for the given case
  • Adjudication Case Assay Data Updated
    • Added on upload of appended assay data to an existing case
    • Dismissed via clicking "dismiss" or viewing the details or determination page for the given case
  • Adjudication Case Completed
    • Added on case completion (i.e. agreement among all adjudication team determinations on all strains)
    • Dismissed via clicking "dismiss" or viewing the details or determination page for the given case
  • Adjudication Case Ready For Verification
    • Added on case completion for lab personnel only
    • Dismissed for all lab personnel on click of the "Verify Receipt of Determination" button on the details page for a given case
  • Adjudication Case Resolution Required
    • Added when case status changes to "Resolution required" or "Infection detected, resolution required". (i.e. adjudication determinations disagree on at least one strain).
    • Dismissed for all adjudicators when the case has an updated determination made (note: if updated determinations still disagree, this would then activate a new set of "resolution required" notifications)
  • Adjudication Case Infection Detected
    • Added when the case status changes to "Infection detected, resolution required" indicating a case with agreement about one positive diagnosis, but disagreement about the other. This case remains Active until both diagnoses are agreed.
    • The "view" link included for lab personnel, infection monitors, and folder admins will be to the admin review page. For adjudicators the will go to the non-admin review page.
    • Dismissed when the case is closed (i.e. agreement is reached on the other diagnosis).
This table summarizes which roles see UI notifications for each type of action:

Notification TypeLab PersonnelAdjudicatorsFolder AdminInfection MonitorData Reviewer"To Be Notified" users
Case Createdyesyesyesnonono
Case Assay Data Updatedyesyesyesnonono
Case Completednonoyesyes - if infection presentnono
Case Ready for Verificationyesnonononono
Case Resolution Requirednoyesnononono
Case Infection Detectedyesyesyesyesnono

Notifications Sent Via Email

This table shows which roles receive email notifications for each type:

Notification TypeLab PersonnelAdjudicatorsAFolder AdminInfection MonitorData Reviewer"To Be Notified" users
Case Createdyesyesyesnoyesyes
Case Assay Data Updatedyesyesyesnoyesyes
Case Completedyesyesyesnonoyes
Case Determination Updatedyesnoyesyes - if infection presentyesyes
Case Resolution RequirednoyesBnononono
Case Infection DetectedCyesyesyesyesnoyes

Notes:

A. Email notifications for adjudicators can be enabled or disabled by the adjudication administrator.

B. The "Case Resolution Required" email is sent to all adjudicators in one email with multiple addresses on the To: line.

C. The "Infection Detected" email notification is sent while the case is not completed in order to allow prompt follow-up on the agreed diagnosis, while a process outside these tools is required to resolve the disagreement on diagnosis of the other strain.

Verify Determination

When all adjudicators have made determinations and are in agreement, a notification goes to the lab personnel. The final step in the process is for them to verify the determination.

  • Click the Administrator Dashboard tab and click View next to the "Case Ready for Verification" notification.
    • If the notification has been dismissed, you can also click Details next to the row in the "Completed Cases" table. Note that there is no date in the "Adj Recorded at Lab" column for the two cases awaiting verification in this screencap:
  • On the details page, scroll to the bottom, review the determinations, and click Verify Receipt of Determination.

Update Case Data

When an update to a case is required, perhaps because additional assay data is provided in response to any adjudicator indicating additional testing is required, a member of Lab Personnel can reupload the case. When re-uploading, the case filename is case-insensitive (i.e. vtn703_123456782_01Aug2015.txt will be an update for VTN703_123456782_01Aug2015.txt).

Any time a case has multiple uploads for the same date, the user will be prompted whether to merge (append) the new data, or replace the existing data and create a new case.

  • Merge: Add the assay results from the uploaded TXT file to the existing case. This does not remove any previously uploaded assay results, case details, or determinations. Note that if the updated TXT file is cumulative, i.e. includes everything previously uploaded, you will have two copies of the previously uploaded assay results.
  • Replace: This option will delete the current case including the previously uploaded assay results, the case details, and any determinations. A new case will then be created with the new TXT file data.
  • Cancel: Cancel this upload and exit the wizard.

When you upload additional data, all assigned adjudicators will receive notification that there is new data to review.

Case data can also be updated by lab personnel after the case determination is made. When that happens, the case data is flagged with an explanatory message and the case remains closed.

Send Email Reminders

On the Manage page, under Adjudication Email Reminders, click Cases.

You will see a Send Email Reminder button for each case without completed determination. Click to send email to all assigned adjudicator team members for that case.

Automatic daily email reminders can be configured at the site, project, or folder level using the module property, "Automatic Reminders". Daily reminders will be sent when other system maintenance tasks are performed.

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