Why practice software doesn't handle lab work well, and what to add

Most practice software is built around appointments, notes and payments, so it tends to treat a lab report as a document: a PDF attached to a client or a visit. Lab review needs the results as values, each with its unit, date, lab and a range you can name, so you can follow a marker across years. If your practice software doesn't do that, the usual answer is to keep it for running the practice and add a lab tool beside it, with a clear rule for which one holds what.

I build Sera, which is one of those lab tools, so read the last section with that in mind. The rest applies whatever you use.

What practice software is good at

General practice software earns its place. Depending on the product, it can handle booking and reminders, intake forms and consent, session notes, client messaging, invoicing and payments, and programs or meal plans. Those are the parts of the work that happen every day, for every client, and having them in one place is worth a lot.

None of that is a reason to replace it. The question is narrower: whether it does what lab review needs.

Where lab work falls through

Many practice tools store lab results as attached files, sometimes linked to an order or a session. A file is fine for keeping the report. It's not enough for reviewing it.

A file isn't a value. You can't chart a number that sits inside a PDF. To see a client's ferritin over three years, someone has to open each report and copy the number out, which is how a spreadsheet ends up running next to the practice software. There's more on that route in spreadsheet or software for tracking client labs.

Units and labs get lost. Once values are typed into a general notes field, the unit and the lab often go missing. That matters: vitamin D in nmol/L is about 2.5 times the ng/mL figure (vitamin D range page), and for some markers results aren't comparable between labs at all. The TPO antibody note says to read a result against the cut-off on its own report. Comparing results across labs and units goes through this in detail.

Ranges have no source. If a tool flags results at all, it's worth asking whose range it uses. Functional targets vary between practitioners, and a flag with no source is hard to defend to a client or a colleague. A TSH result of 3 sits inside the American Thyroid Association's 0.5 to 4.5 range and above a functional target ending at 2, which the TSH range note says has no guideline behind it. You need to know which of those a flag reflects.

Trends aren't the default view. A client record is usually organized by session. Lab work is read by marker, across sessions and labs. Those are different shapes, and a notes timeline doesn't easily become a chart.

Retests aren't tracked by marker. Where a tool has reminders, check whether they can follow a marker that's due again, or only an appointment.

Other tests sit somewhere else. Stool, urine and breath reports are often in yet another folder, away from the blood work they're read with.

None of this is a failing of the software. It was built for a different job.

What to add

Lab review needs a few specific things. Whatever you add, check for these:

• results stored as values, with unit, draw date and lab on each
• a way to read lab PDFs, with each value checked against the page it came from
• the unit kept as the lab reported it, and a warning when one marker arrives in two units
• ranges that say where they come from
• one marker charted across years and labs, with what changed between tests marked on the chart
• retest dates per marker, not per appointment
• other test reports in the same client record as the blood work
• a client report you can hand over
• a full export, so the data isn't stuck

The checklist in the spreadsheet article goes through each of these as questions to ask.

Running two tools without keeping two records

Two tools only work if each has a clear job. Decide it once and write it down for anyone else in the practice.

Give each tool its own records. The practice software holds appointments, session notes, messages and billing. The lab tool holds the lab reports and the values read from them. Don't copy every value into session notes as well: that's the second record you were trying to avoid, and the two will drift apart.

Link them with a summary. After a review, put a short note in the session record: the date of the panel, the markers you discussed, and what you referred or planned to retest. If the lab tool produces a client report, attach that PDF to the client in your practice software, so the record of what the client received sits with the rest of their file.

Use the same client name in both. It sounds obvious, but a "Jen Smith" in one tool and a "Jennifer Smith-Lee" in the other is how reports get filed under the wrong person.

Check where the data goes. Every tool that holds client health information needs to be covered by your privacy notice and your agreements. Under GDPR, a processor's work has to be governed by a contract (Article 28). In the US, a HIPAA covered entity needs a written contract with a business associate that handles protected health information for it (45 CFR 164.502(e)). Adding a tool adds one to the list.

Keep a way out. Make sure you can export everything from both tools. If you later find one that does both jobs well, or stop using one, the data should come with you.

When one tool is enough

If you rarely review labs, or you review one panel per client and never look back, attachments in your practice software may be all you need. The case for a lab tool grows with the number of clients whose results you follow over time, and the number of labs those results come from.

Where Sera fits

Sera is a lab layer that sits next to your practice software. It's not a practice management system or an EHR: it has no booking, billing or integrations, so it doesn't replace what you already use. It has client notes and dated notes on the timeline, for context next to the results.

What it does is the lab side. It reads lab PDFs and shows each value next to its page in the report so you can check it before saving. It keeps every result in the unit the lab reported and flags a marker that arrives in two units. Every range is published with its sources and an evidence grade. Trends run across years and labs, interventions are marked on the charts, and DUTCH, stool, urine and breath reports are kept in the same client record, stored, not scored. Sera suggests a retest date for any result out of range and a yearly one for the usual check-up markers. Client reports are PDFs with your logo, ready to attach in your practice software. Your data can be exported and deleted at any time. It doesn't diagnose or recommend treatment.

It's free for three clients with no card. There's a 3-minute tour if you'd rather watch first.

Alina Radu is the founder of Sera and a software engineer. The idea started with her own Hashimoto's tests, scattered across years without the big picture.