To the Editor.—Question GEN 20375 of the College of American Pathologists (CAP) Laboratory Accreditation Checklist requires that all laboratories have a document control policy in place “to manage policies, procedures, and forms that are subject to CAP accreditation.”1 The document control system must “ensure that only current policies, procedures (including derivative documents, such as card files and summary charts), and forms are in use and that records for approval, review, and discontinuance are available. Discontinued documents must be appropriately archived and removed from general access. It is recommended that the laboratory maintain a control log listing all current policies, procedures, and forms.”1 Although there are commercial document control products to manage a laboratory's policies and procedures, these can be expensive. As a result, many laboratories use a locally developed system of Microsoft Word or similar documents for their policies and perform document control using a combination of spreadsheets and manual updating and version control. Very often this is managed by the laboratory itself, without any significant technical or administrative support from the institution. Because these products have only limited access and version controls, the medical director may not always know if a document has been altered.
Git is an open-source product for version control that is widely used in the computer software industry. Github (github.com; accessed March 20, 2020) is an online site where many software engineers store and maintain their content using Git. Although Git was originally designed as a free command line tool, recently several versions of Git (sublimeMerge [sublimeMerge.com; accessed March 20, 2020] and Fork [git-fork.com; accessed March 20, 2020]) have been offered as a graphical user interface; these versions are more user friendly and make it possible for a less experienced user to successfully use them (Figure). These products offer a time-unlimited free trial period, and a license can be purchased for a one-time fee of less than USD $100 for an individual or per individual license within a business. Unlike most document control products, Git is simply a program that can be downloaded to one or more computers and does not need a dedicated server, Web access (other than for download), integrated security, or significant network administrative support. All it does is keep track of different versions of documents, and this may be helpful for laboratories that are managing their policies themselves without a dedicated document control product.
In brief, the medical director should stage all of the policy documents in a folder as a repository. The policies then show up as a list or “log” within the program. When the documents are staged the director applies a comment or “commit” that describes what this version is (for example, “Policy XYZ, changed staining procedure”). Once staged, that version of the policy is saved by the program and can be accessed at any time. It is no longer possible for someone to alter a document without the director's notice because all changes are now being tracked. All previous versions and retired polices are tracked and can easily be accessed if necessary. There is no need to maintain a separate folder of “retired” policies. Only the most current version is available for the laboratory staff to see. If a problem arises, it is possible to revert the current status back to the point of any previous commit.
However, the product is not perfect because it is a version control product rather than a document control product. It does not have an internal clock or any way to set reminders that specific documents need to be signed by a particular date. While the program can show the differences between many types of files, including text (.txt) and Markdown files, Microsoft Word and Excel files are saved as binaries, and the changes between the documents cannot be shown directly in the program. As a result, the commit message becomes the primary means of navigating between versions. Correlation of policies with specific checklist questions must still be performed manually, but a spreadsheet of these results can be included in the repository. Most importantly, the product has many advanced features that are not necessary for most laboratories but can be confusing. Most online tutorials concentrate on these more advanced features rather than the basic features. A good online tutorial for someone just starting out is “Version Control for Everyone” by Joe Chellman on Lynda.com/Linked In Learning.2
Are there other open-source solutions available? The answer is yes. Pydio (pydio.com), Mayan EDMS (mayan-edms.com), and NextCloud (nextcloud.com) all offer open-source document control software that, to various degrees, allow document storage, version control, authentication and security, signature of documents, dedicated workflows, and Web access. The functionality of these products is much more extensive than that of Git; however, it comes at a price. These products need a dedicated server, a network administrator, and active support from your administration. Most pathologists will not have the technical knowledge or time to install and manage such a program. Many laboratories that do not yet have a true document control program and instead rely on Microsoft Office products do so because that is what is available to them and what they know how to use. In addition, none of these programs are designed to work with Microsoft Office products (although a plug-in is available from OnlyOffice [onlyoffice.com]), but instead were designed to treat all documents as images rather than text or spreadsheets. Without this plug-in all documents will have to be converted to yet another format.
If you can afford a true document control program (both in cost as well as technical and administrative support), you should use it. If you cannot, these Git-based products allow you to more fully maintain control over all your documents and can save you time, effort, and money.
The authors have no relevant financial interest in the products or companies described in this article.