Professional Diagnostic Coordination

Clinical practice frequently requires diagnostic testing to confirm diagnoses, guide treatment, or monitor disease progression. Blood chemistry panels reveal metabolic disorders. Culture and sensitivity testing identifies specific pathogens and antimicrobial effectiveness. Histopathology examinations diagnose cancers or inflammatory conditions. Serology testing detects disease exposure.

Kora's laboratory workflow features support comprehensive diagnostic coordination. From initial test ordering through results receipt, professional review, and clinical decision-making. This systematic approach ensures diagnostic tests are ordered appropriately, results return to the right veterinarian, findings are professionally reviewed, and clinical outcomes inform ongoing case management.

When Laboratory Testing is Indicated

Professional judgement determines when diagnostic testing adds clinical value:

Diagnostic uncertainty - Symptoms suggesting multiple possible diagnoses benefit from specific testing to guide appropriate treatment.

Treatment failures - When initial treatment doesn't produce expected response, laboratory testing may reveal resistance, alternative diagnoses, or complicating factors.

Baseline assessment - Pre-anaesthetic evaluation, breeding soundness examinations, or health certifications often require laboratory confirmation of health status.

Monitoring chronic disease - Kidney disease, diabetes, liver dysfunction, and endocrine disorders require periodic testing to assess disease progression and treatment effectiveness.

Regulatory requirements - Disease surveillance, export certifications, or compliance testing may mandate specific laboratory procedures.

Evidence-based stewardship - Antimicrobial prescribing increasingly requires culture and sensitivity testing to identify appropriate drugs and support stewardship compliance (Chapter 19).

Public health protection - Suspected zoonotic diseases or reportable conditions require laboratory confirmation for appropriate public health response.

Laboratory workflows in Kora support these diverse testing scenarios while maintaining professional accountability, result tracking, and clinical documentation.

Laboratory Test Ordering

When creating or updating a veterinary observation, you can order laboratory tests through the integrated workflow:

Available Test Types

Blood Chemistry - Comprehensive metabolic panels, liver function, kidney function, electrolytes. Typical turnaround: 1 day.

Complete Blood Count (CBC) - Red blood cells, white blood cells, platelets, haematocrit, haemoglobin. Typical turnaround: 1 day.

Urinalysis - Urine chemistry, specific gravity, sediment examination. Typical turnaround: 1 day.

Faecal Examination - Parasite identification, faecal flotation, direct smears. Typical turnaround: 2 days.

Culture and Sensitivity - Bacterial identification and antimicrobial susceptibility testing. Typical turnaround: 7 days.

Cytology - Microscopic examination of cells from fluids, masses, or tissues. Typical turnaround: 3 days.

Histopathology - Tissue biopsy examination for cancer diagnosis, inflammation, or structural abnormalities. Typical turnaround: 7 days.

Serology - Antibody detection for disease exposure (brucellosis, leptospirosis, EIA, etc.). Typical turnaround: 5 days.

PCR (Polymerase Chain Reaction) - Molecular detection of specific pathogens. Typical turnaround: 3 days.

ELISA (Enzyme-Linked Immunosorbent Assay) - Antigen or antibody detection for specific diseases. Typical turnaround: 2 days.

Radiology - X-ray imaging for bone, chest, or abdominal assessment. Typical turnaround: 1 day.

Ultrasound - Real-time imaging for pregnancy diagnosis, organ assessment, or mass characterisation. Typical turnaround: 1 day.

Endoscopy - Internal visualisation of gastrointestinal, respiratory, or urogenital tracts. Typical turnaround: 1 day.

Biopsy - Surgical tissue sample collection for histopathologic examination. Typical turnaround: 10 days.

Test Ordering Workflow

Select tests - Choose one or more test types from the available options. Multiple tests can be ordered simultaneously (CBC + Chemistry + Urinalysis for comprehensive workup).

Set expected results date - Based on typical turnaround times, indicate when you expect results. System calculates recommended dates but allows adjustment for urgent testing or known laboratory delays.

Document clinical justification - Record why these tests are clinically indicated. This documentation supports laboratory requisitions, insurance claims, owner communication, and antimicrobial stewardship justification.

Submit order - Confirms tests ordered, marks observation as "Awaiting Lab Results," and creates laboratory workflow tracking.

Example test ordering:

Veterinary Observation for Cow #147:
Diagnosis: Suspected ketosis (pending laboratory confirmation)

Tests Ordered:
1. Blood Chemistry Panel (Glucose, BHB, calcium, phosphorus)
2. Urinalysis (Ketone bodies)

Expected Results Date: March 18, 2025 (3 days from ordering)

Clinical Justification:
7-day post-calving dairy cow with decreased appetite, reduced milk production,
and sweet acetone breath odour. Laboratory confirmation of ketosis severity
will guide treatment intensity (oral propylene glycol vs IV dextrose).

Laboratory Status Tracking

Once tests are ordered, Kora tracks their status through the diagnostic process:

Laboratory Workflow States

Ordered - Tests have been ordered but not yet received by laboratory. This initial state indicates requisition is complete and awaiting sample submission.

In Progress - Laboratory has received samples and testing is underway. This state confirms samples arrived safely and analysis has begun.

Completed - Laboratory testing finished and results available. This state triggers notifications to the ordering veterinarian.

Failed - Testing could not be completed due to sample quality issues, insufficient sample volume, or technical failures. Requires sample re-collection and test re-ordering.

State transitions:

Test Ordering → Ordered → In Progress → Completed
                   ↓
                Failed (requires re-ordering)

Viewing Test Status

From the veterinary observation or animal health record, laboratory test status is always visible:

Laboratory Tests:
Blood Chemistry - Completed (March 18)
Urinalysis - Completed (March 18)

Results Available: View Results
Results Reviewed: No (pending your review)

Status visibility helps you track which tests are outstanding, when results are expected, and which cases require follow-up once results arrive.

Recording Laboratory Results

When laboratory results arrive (via email, fax, online portal, or courier), you record them in Kora to complete the diagnostic workflow:

Access test record - From the veterinary observation or laboratory workflow page, select the completed test.

Enter results - Record findings in structured or free-text format depending on test type:

Structured results (Blood Chemistry):

Glucose: 45 mg/dL (Low - normal range 60-100)
BHB (Beta-hydroxybutyrate): 2.8 mmol/L (High - normal <1.4)
Calcium: 8.2 mg/dL (Normal range 8.0-10.0)
Phosphorus: 4.5 mg/dL (Normal range 4.0-6.0)

Narrative results (Histopathology):

Tissue: Mammary mass biopsy
Diagnosis: Mammary adenocarcinoma, grade II
Histologic description: Infiltrative neoplastic epithelial cells arranged
in cords and solid nests. Moderate nuclear pleomorphism. Mitotic index
12 per 10 HPF. Margins not completely excised.
Recommendation: Wide surgical excision recommended. Metastatic workup
(chest radiographs, regional lymph node assessment) advised.

Attach reports - Upload PDF laboratory reports, images, or diagnostic images to create complete documentation.

Interpretation notes - Add your professional interpretation of results explaining clinical significance and how findings inform diagnosis or treatment.

Reviewing and Approving Results

Professional review distinguishes raw laboratory data from clinically interpreted findings:

Results Reviewed Flag - Mark results as professionally reviewed once you've assessed clinical significance. This flag indicates results have received professional attention (not just data upload), triggers owner notification that results are available with interpretation, completes the diagnostic cycle from test ordering to clinical decision-making, creates accountability for professional review of all diagnostic testing.

Review workflow:

Laboratory Results Received
    ↓
Professional Review (assess clinical significance)
    ↓
Clinical Interpretation Documented
    ↓
Results Reviewed Flag Set
    ↓
Owner Notification (results available with interpretation)
    ↓
Treatment Plan Updated (if needed)

Example reviewed results:

Blood Chemistry Results - Reviewed March 18 by Dr. Martinez

Results:
Glucose: 45 mg/dL (LOW - ketosis confirmed)
BHB: 2.8 mmol/L (HIGH - moderate ketosis)

Professional Interpretation:
Results confirm moderate ketosis as suspected. Glucose depression and
elevated BHB consistent with negative energy balance post-calving.
Current findings indicate IV dextrose therapy warranted rather than oral
propylene glycol alone.

Treatment Plan Updated:
- IV 50% dextrose 500mL slow IV infusion
- Oral propylene glycol 300mL PO q12h for 5 days
- Recheck blood glucose in 48 hours
- Dietary consultation to optimise energy intake

Expected Results Dates and Turnaround Tracking

When ordering tests, Kora calculates expected results dates based on typical laboratory turnaround times:

Turnaround time defaults:

• Same-day tests (Radiology, Ultrasound, Endoscopy): 1 day
• Routine tests (CBC, Chemistry, Urinalysis, ELISA): 1-2 days
• Moderate complexity (Faecal Exam, Cytology, PCR): 2-3 days
• Extended tests (Serology, Culture and Sensitivity): 5-7 days
• Complex analysis (Histopathology, Biopsy): 7-10 days

Overdue result tracking:

If expected results date passes without results being recorded, the observation appears in your "Pending Laboratory Results" queue:

Pending Laboratory Results (3 observations):

Cow #147 - Blood Chemistry
Expected: March 18 (TODAY)
Status: In Progress
Action: Contact laboratory to confirm status

Horse "Thunder" - Culture and Sensitivity
Expected: March 15 (3 days overdue)
Status: Ordered
Action: URGENT - Follow up with laboratory

Cat "Whiskers" - Histopathology
Expected: March 20 (Expected in 2 days)
Status: In Progress
Action: Results on track

This tracking prevents diagnostic results from being overlooked. Ensures clinical decisions aren't delayed by unreceived laboratory reports.

Second Opinion and Consulting Veterinarian Collaboration

Complex cases or uncertain diagnoses may warrant consulting veterinarian input. Laboratory workflow supports professional collaboration:

Requires Second Opinion Flag - Mark observations requiring consultation from specialist veterinarians or experienced colleagues.

Consulting Veterinarian Assignment - Assign specific consulting veterinarian by name or speciality. They receive notification of consultation request.

Consultation Access - Assigned consulting veterinarian gains access to complete animal health history, your veterinary observation including clinical findings, laboratory test results, diagnostic images or reports, your preliminary assessment and specific questions.

Consulting Veterinarian Notes - Consultant records their assessment, recommendations, alternative diagnoses considered, or additional testing suggested:

Primary Veterinarian: Dr. Martinez (General Practice)
Consulting Veterinarian: Dr. Okonkwo (Equine Internal Medicine Specialist)

Consultation Request:
"4-year-old Thoroughbred mare with chronic weight loss despite normal appetite.
Blood chemistry shows hypoalbuminaemia (2.1 g/dL), mild anaemia (PCV 28%).
Normal faecal examination. Seeking guidance on differential diagnoses and
diagnostic workup recommendations."

Consultant Response:
"Thank you for this interesting case. Differential diagnoses to consider include:
1. Protein-losing enteropathy (most likely given hypoalbuminaemia + weight loss)
2. Hepatic insufficiency (less likely - liver enzymes normal)
3. Protein-losing nephropathy (unlikely - urinalysis normal)
4. Malabsorption syndrome

Recommended diagnostic workup:
- Abdominal ultrasound (assess intestinal wall thickness, mesenteric lymph nodes)
- Oral glucose absorption test (assess intestinal function)
- Consider rectal biopsy if ultrasound suggests inflammatory bowel disease

Treatment considerations:
- Low-dose corticosteroids may help if inflammatory component
- Dietary management: high-quality protein, easily digestible feeds
- Monitor albumin levels weekly to assess response

Happy to discuss further or see in referral if diagnostics suggest specialist
intervention needed."

Consultation Reviewed: March 20 by Dr. Martinez
Follow-up Plan: Schedule abdominal ultrasound, proceed with recommended workup

This collaborative workflow supports evidence-based practice, professional learning, and optimal patient outcomes when cases exceed primary veterinarian expertise or experience.

Clinical Workflow Status Metadata

For complex cases involving multiple diagnostic phases, clinical workflow status tracking helps coordinate care:

Workflow status options:

• Pending Review - Initial observation created, awaiting veterinarian review
• In Review - Active case under veterinarian management
• Awaiting Lab Results - Tests ordered, waiting for diagnostic findings
• Requires Follow-Up - Results received, follow-up examination needed
• Completed - Case resolved, no further diagnostic work planned
• Closed - Case archived (animal died, euthanised, or transferred to other care)

These statuses appear in your veterinary case dashboard. Helping you triage which animals need urgent attention, which are awaiting results, and which require follow-up scheduling.

Integration with Antimicrobial Stewardship

Laboratory testing directly supports responsible antimicrobial use (Chapter 19):

Culture and sensitivity testing - Identifies specific bacterial pathogens and their antimicrobial susceptibility. Enabling targeted therapy rather than broad-spectrum empirical treatment.

Treatment modification tracking - When culture results indicate resistance to initial antimicrobial choice, documenting the switch demonstrates evidence-based stewardship.

Clinical justification - Laboratory confirmation of bacterial infections provides clinical justification for antimicrobial prescriptions. Supporting stewardship compliance.

Outcome monitoring - Follow-up testing (repeat cultures, resolution confirmation) documents treatment effectiveness. Informing future antimicrobial selection.

This integration means your laboratory workflows contribute to broader antimicrobial stewardship goals beyond individual case management.

Integration with Other Kora Features

Laboratory workflows connect throughout professional veterinary features:

Veterinary Observations (Chapter 20.3) - Test ordering, results recording, and professional review all link directly to clinical observations documenting diagnostic decision-making.

Biosecurity Integration (Chapter 20.5) - Laboratory-confirmed infectious diseases trigger automatic contact tracing and quarantine recommendations once results are reviewed.

Animal Health Records (Chapter 10) - Laboratory results become permanent parts of animals' lifetime medical histories. Accessible to future caregivers.

Traceability (Chapter 12) - Laboratory testing creates traceability events documenting diagnostic procedures and professional veterinary involvement.

Owner Communication - When results are reviewed and interpreted, owners receive notifications with professional assessment of findings and updated treatment recommendations.