Spreadsheet or software for tracking client labs?

A spreadsheet is enough while you have a handful of clients, test the same markers each time, and enjoy keeping it tidy. It stops being enough when results arrive from several labs in different units, when you need to see one marker across years, or when you have to remember who is due for a retest. Below is a layout that works if you stay with a spreadsheet, and a list of things to check if you move to software.

I build Sera, a lab-review workspace for practitioners, so read the software half with that in mind. I've kept it to what to look for, not what to buy.

When a spreadsheet is enough

A spreadsheet is free, you already know how to use it, and the data is yours. For a small practice that's a lot.

It works well if:

• you have fewer than about a dozen clients with ongoing lab work
• most of their results come from one or two labs
• you track a short list of markers you know well
• you're the only person who opens the file

If that's you, there's no reason to change. Spend the time on the layout instead, because a messy sheet is where most of the problems below start.

A layout that holds up

Use one row per result, not one column per date. It feels backwards at first, but it's the only shape that survives new markers, new labs and repeat tests.

A few habits make the difference:

• Copy the unit exactly. Ferritin in ng/mL and µg/L is the same number, but a lot of markers change value when the unit changes. Vitamin D in nmol/L is about 2.5 times the ng/mL figure.
• Keep the lab's range on every row. The same marker can have a different interval at a different lab, and a result is only "in range" against the interval it came with.
• Write down where any target of your own comes from. In two years you won't remember why you used 50 for ferritin.
• Save the PDF and put its name on the row. Typing from a PDF is where mistakes get in, and you'll want to check.

Where it starts to break

These are the points where keeping the spreadsheet starts to feel like a second job.

Typing results in. A full panel can be 40 or 60 numbers. Every one of them is a chance to type 4.2 as 42 or put a value against the wrong marker. You can't tell which numbers you checked and which you didn't.

Units and labs. Once a client brings results from three labs, the same marker shows up in different units with different intervals. A chart of the raw numbers will jump around for reasons that have nothing to do with the client.

Seeing a marker over time. Charts in a spreadsheet are possible, but building one per marker per client, with the target band shaded behind it, is fiddly enough that most people stop doing it.

Other tests. Stool, urine, saliva and breath tests don't fit the rows. They end up in a folder somewhere else, away from the blood work they should be read with.

Retests. A spreadsheet doesn't tell you that a client's ferritin is due again in three months. You have to remember, or keep a second list.

Privacy. Client lab results are health information. Where the file is stored, who it's shared with and how it's protected all matter under laws like HIPAA in the US and GDPR in the UK and EU. A sheet in a personal cloud account emailed back and forth is hard to defend.

Showing the client. A spreadsheet is a working file. Turning it into something you can hand to a client takes another round of work every time.

What to check before you pay for software

Whatever you look at, these are the questions I'd ask. They come from the problems above.

1. Can it read the lab's PDF, and can you check every value before it's saved? Reading PDFs automatically helps, but you need to see each number next to the page it came from.
2. Does it keep the unit the lab reported? Be careful with tools that silently convert. You want to know when a marker arrives in two different units, not have it hidden.
3. Does it show which range a result is judged against, and where that range comes from? "Optimal" with no source isn't something you can check or explain to a client.
4. Can you see one marker across years, from different labs, on one chart? With the bands behind it, and more than one marker at a time.
5. Can you record what changed between tests? A diet change, a supplement, a medication. Without it, a trend is hard to read.
6. Does it keep the other tests in the same client record? Even if it can't score a stool test, the report should sit next to the blood work.
7. Does it help with retest dates?
8. Can you give the client a report without rebuilding it? Ideally with your own practice name on it.
9. Can you export everything and leave? Your clients' data shouldn't be stuck in someone else's system.
10. What does it decide for you? Some tools suggest supplements or protocols. If you want the clinical judgment to stay yours, check that it doesn't.
11. How is it priced? Per client, per report or flat. Work out what it costs at your caseload, not at the starter tier.

If you do switch

Don't move everything at once. Start with your next new client and one or two existing clients with the messiest history. Keep the spreadsheet until you trust the new tool's numbers against your own.

Where Sera fits

Sera is built around that list. It reads lab PDFs and shows each value next to its page in the report before anything is saved. It keeps every result in the unit the lab reported and flags a marker that arrives in two units. Every range it uses is published with its sources and an evidence grade. Trends run across years and labs, interventions show on the chart, stool, urine and hormone tests sit in the same client record, and Sera suggests a retest date for any result out of range and a yearly one for the usual check-up markers. Client reports carry your logo. It doesn't diagnose or suggest treatment.

It's free for three clients, so you can try it on your messiest one. 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.