Computer application to the laboratory management in hospital

A software has been developed on quality control, department economics, information supervise and personal administration. In this article, we discuss the part of quality control, from which we benefit most, on developing ideas, running principle, and application. This network will enable the implementation of total quality control, and possibly total computerised management.

[Development of retrieval system about clinical laboratory handbook "Kensa Koujien"]

Medical knowledge has been increasing and diversifying on a worldwide scale, while specialization of physicians has been extended vigorously. The knowledge has extended beyond the memory of human beings, there by causing the deterioration of service, called "Knowledge crisis". To tackle this problem, the electronic medical textbook(EMT) has been conceived and set up as a medical knowledge base for physician to optimize their specialties and activities in clinical practice. The doctors' diagnostic process is to be mentioned as the solution of backward problem, to speculate problem such as disease by the information observed from symptoms and findings. The EMT is more powerful tool for diagnosis than experiences or textbook that will aid for specifying the name of disease by arranging and combining information. Meanwhile, laboratory information systems are widely introduced. However, there are few systems which allow interpretation of the findings obtained. With this in mind, we have improved the utility of the EMT by enhancing its function with laboratory information follow-up, thesaurus back-up, Japanese language support, and on-line access. It made use of these experiences, we compiled an clinical laboratory handbook "Kensa Koujien", and developed retrieval system.

Laboratory results. Timeliness as a quality attribute and strategy

Although timeliness of results reporting has not been a major focus in clinical laboratories, there is increasing pressure from clinicians to report results rapidly. Even though there are only sparse data, timeliness in reporting of laboratory results undoubtedly affects clinician and patient satisfaction as well as length of hospital stay. Improving turnaround time (TAT) is a complex task involving education, equipment acquisition, and planning. All the steps from test ordering to results reporting should be monitored and steps taken to improve the processes. Various strategies to improve TAT at each step in the testing process are discussed.

Documentation of positive blood culture results in a London teaching hospital

OBJECTIVES

Our current practice is that initial (day 1) positive blood culture results are communicated to clinical teams; the task of recording those results in the notes is left to the clinical team. Microbiological information may be of crucial importance to an on-call doctor asked to review an unwell patient. We therefore sought to establish the extent to which day 1 positive blood culture information is available in patients' notes and its accuracy.

METHODS

There were 51 positive blood cultures over a 14-day period. Patient notes of 39 of these were available for examination for evidence of the day 1 culture report, the accuracy of that report and evidence of clinical interpretation.

RESULTS

The proportion of notes with a record was disappointingly low (54%), although the record was almost always accurate. Results reported at the weekend were as likely to be recorded in the notes as those given during the week.

CONCLUSION

On-call doctors, not previously acquainted with a patient, will find that important information about day 1 positive blood culture results is not available to them in patient notes in around half of all cases. This adds weight to the view that medical microbiologists should give greater priority to ward visits and documentation of significant results, thus ensuring continuity of care from the laboratory bench to the bedside.

Required steps for the validation of a Laboratory Information Management System

The task of managing laboratory data is not a new one. Over the past two decades, the use of Laboratory Information Management Systems (LIMS) has revolutionized how laboratories manage their data. A LIMS is more than software; it has become the workhorse of the laboratory, encompassing laboratory work-flow combined with user input, data collection, instrument integration, data analysis, user notification, and delivery of information and reporting. Types of organizations that utilize LIMS vary greatly from research laboratories to manufacturing laboratories to environmental testing laboratories. Commercially-available LIMS have been around since the 1980s. In addition, many laboratories have designed, implemented, and maintained in-house LIMS. The heart of any LIMS is the software. Like other laboratory systems, the LIMS software is subject to quality control and quality assurance checks. In regulatory environments this associated QA/QC is referred to as "system validation." The primary purpose of system validation is to ensure that the software is performing in a manner for which it was designed. For example, the system acceptance criteria should be established and tested against quantifiable tasks to determine if the desired outcome has been achieved. LIMS features, such as autoreporting, reproducibility, throughput, and accuracy must be quantifiable and verifiable. System validation ensures that the entire system has been properly tested, incorporates required controls, and maintains and will continue to maintain data integrity. Laboratories must establish protocols and standards for the validation process and associated documentation. Although vendors of commercial LIMS perform initial internal system validations, the system must be revalidated whenever the end user, vendor or third party adds modifications or customizations to the LIMS. Currently, detailed guidance regarding system validation of LIMS is not available to the user. The issue is addressed in Good Automated Laboratory Practices (GALP) and National Environmental Laboratory Accreditation Conference (NELAC) documents which indicate specific requirements or recommendations for operational checks and periodic testing; however, it is up to the laboratory to determine suitable methods to accomplish these tasks. Proper validation of a LIMS will allow a laboratory to comply with regulations and also provide comprehensive documentation on the system that is necessary to troubleshoot future problems.

Coverage of neonatal screening: failure of coverage or failure of information system

OBJECTIVES

To evaluate neonatal screening coverage using data routinely collected on the laboratory computer.

SUBJECTS

90 850 births in 14 North East Thames community provider districts over a 21 month period.

METHODS

Births notified to local child health computers are electronically copied to the neonatal laboratory computer system, and incoming Guthrie cards are matched against these birth records before testing. The computer records for the study period were processed to estimate the coverage of the screening programme.

RESULTS

Out of an estimated 90 850 births notified to child health computers, all but 746 (0.82%) appeared to have been screened or could be otherwise accounted for (0.14% in non-metropolitan districts, 0.39% in suburban districts, and 1.68% in inner city districts). A further 893 resident infants had been tested, but could not be matched to the list of notified resident births. The calculated programme coverage already exceeds the 99.5% National Audit Programme standard in 7/14 districts. Elsewhere it is not clear whether it is coverage or recording of coverage that is low.

CONCLUSION

Previous reports of low coverage may have been exaggerated. High coverage can be shown using routine information systems. Design of information systems that deliver accurate measures of coverage would be more useful than comparison of inadequately measured coverage with a national standard. The new NHS number project will create an opportunity to achieve this.

Automation and high through-put for a DNA database laboratory: development of a laboratory information management system

Automation and high through-put production of DNA profiles has become a necessity in every DNA database unit. In our laboratory we developed a Laboratory Information Management System (LIMS) controlled workflow architecture, which comprises a robotic DNA extraction- and pipetting-system and a capillary electrophoresis unit. This allows a through-put of 4,000 samples per person per year. Improved sample handling and data management, full sample- and batch-histories, and software-aided supervision of result data, with a consequent average turn-around time of 8 days, are the main features of our new system.

Making it work: planning and executing a successful LIS installation

This article relates how to plan and execute a successful laboratory information system (LIS) installation for those installing a first LIS, converting to a new LIS, or upgrading the current LIS. It covers the planning process, schedule adherence, vendor relationships, project team management, and system readiness, as well as post-installation issues.

Washington Clinical Laboratory Initiative: a vision for collaboration and strategic planning for an integrated laboratory system

This article addresses the importance of public health, hospital, and clinical laboratories in the role of patient care, disease prevention, and surveillance. It also focuses on the coordination and planning that needs to take place between these institutions in order to develop a more cost-effective and responsive laboratory delivery system. The Washington Clinical Laboratory Initiative is an innovative state initiative illustrating that coordinated and integrated strategic planning of public and private sector laboratories can be accomplished within a state. It also has increased interaction, collaboration, and communication between health practitioners, health plans, hospitals, laboratories, government agencies, and academicians. This accomplishment has enabled the establishment of public policy concerning laboratory reimbursement and development of standards of laboratory practice.

Disease reporting from an automated laboratory-based reporting system to a state health department via local county health departments

OBJECTIVE

The authors assessed the completeness of disease reporting from a managed care organization's automated laboratory-based reporting system to the California Department of Health Services (CDHS) via local public health departments.

METHODS

The authors identified all positive laboratory tests for 1997 from the computerized database of Kaiser Permanente Northern California for seven infections for which there are statutory reporting requirements: Campylobacter jejuni, Chlamydia trachomatis, Cryptosporidium parvum, hepatitis A, Neisseria meningitidis, Neisseria gonorrhoeae, and Salmonella (N = 7,331 reports). Cases were then matched by computer query to records of cases reported to CDHS. To determine why cases were not found in CDHS records, a sample of un-matched cases was searched at two county health departments.

RESULTS

Overall, 84.5% (95% CI 83.4, 85.6) of the laboratory reports submitted with accompanying demographic information were successfully matched with cases in the CDHS disease surveillance database. Frequency of matching for specific diseases ranged from 79.4% (95% CI 75.6, 83.3) for N. gonorrhoeae to 88.4% (95% CI 85.3, 91.6) for C. jejuni. Reports were more likely to be matched when the county of residence was the same as the county of the health care facility. At the county level, reasons for failure of cases to be forwarded to CDHS included: errors due to manual data entry, failure to forward information from the county of diagnosis to the county of residence, and incorrect disease coding.

CONCLUSION

Automated laboratory-based reporting is highly effective, but some data are lost with off-line transfer of information. To optimize surveillance accuracy and completeness, reporting at all levels should be done via direct electronic data transfer.

How to maintain blood supply during computer network breakdown: a manual backup system

Electronic data management systems using computer network systems and client/server architecture are increasingly used in laboratories and transfusion services. Severe problems arise if there is no network access to the database server and critical functions are not available. We describe a manual backup system (MBS) developed to maintain the delivery of blood products to patients in a hospital transfusion service in case of a computer network breakdown. All data are kept on a central SQL database connected to peripheral workstations in a local area network (LAN). Request entry from wards is performed via machine-readable request forms containing self-adhesive specimen labels with barcodes for test tubes. Data entry occurs on-line by bidirectional automated systems or off-line manually. One of the workstations in the laboratory contains a second SQL database which is frequently and incrementally updated. This workstation is run as a stand-alone, read-only database if the central SQL database is not available. In case of a network breakdown, the time-graded MBS is launched. Patient data, requesting ward and ordered tests/requests, are photocopied through a template from the request forms on special MBS worksheets serving as laboratory journal for manual processing and result report (a copy is left in the laboratory). As soon as the network is running again the data from the off-line period are entered into the primary SQL server. The MBS was successfully used at several occasions. The documentation of a 90-min breakdown period is presented in detail. Additional work resulted from the copy work and the belated manual data entry after restoration of the system. There was no delay in issue of blood products or result reporting. The backup system described has been proven to be simple, quick and safe to maintain urgent blood supply and distribution of laboratory results in case of unexpected network breakdown.

Implementation of data security and data privacy provisions will bring sweeping changes to laboratory service providers

The Health Insurance Portability and Accountability Act included substantial changes involving handling of health information by establishing national standards for electronic transactions, data privacy, and data security. The first final rule for electronic transaction standards was published August 17, 2000. The remaining final rules are expected to be published in Winter 2000. Providers, such as clinical laboratories, will have 26 months from the data of publication to comply. The civil monetary fines for noncompliance are substantial. This article will review the key provisions of the data security and data privacy proposed rules. These provisions will touch virtually every aspect of electronic claims submissions, electronic data transactions, and the electronic storage of medical information. The proposed rules will require a coordinated approach by providers to develop the policies and procedures, and the technical and physical infrastructure to protect health information. Moreover, providers will need to identify a privacy officer, to review existing privacy policies to compare the proposed rule with any existing state laws to determine which may be more stringent, and to develop new policies to address the particular requirements of the final rule.

Automated mapping of observation codes using extensional definitions

OBJECTIVE

To create "extensional definitions" of laboratory codes from derived characteristics of coded values in a clinical database and then use these definitions in the automated mapping of codes between disparate facilities.

DESIGN

Repository data for two laboratory facilities in the Intermountain Health Care system were analyzed to create extensional definitions for the local codes of each facility. These definitions were then matched using automated matching software to create mappings between the shared local codes. The results were compared with the mappings of the vocabulary developers.

MEASUREMENTS

The number of correct matches and the size of the match group were recorded. A match was considered correct if the corresponding codes from each facility were included in the group. The group size was defined as the total number of codes in the match group (e.g., a one-to-one mapping is a group size of two).

RESULTS

Of the matches generated by the automated matching software, 81 percent were correct. The average group size was 2.4. There were a total of 328 possible matches in the data set, and 75 percent of these were correctly identified.

CONCLUSIONS

Extensional definitions for local codes created from repository data can be utilized to automatically map codes from disparate systems. This approach, if generalized to other systems, can reduce the effort required to map one system to another while increasing mapping consistency.

[Communications among components of automated clinical laboratory systems]

Laboratory Automation Systems has been developed with original specifications from each vender. To construct a system in a multi-vender environment, remodeling of the interface and software had to be done by the user. The standard concerning automated laboratory systems was made by NCCLS in 1997. This standard provides a protocol for communications among Laboratory Automation Systems(LAS), Laboratory Information Systems(LIS), automated instruments (analyzers), and pre- and post-analytical automated devices. This document explains the current details and the overall content of the communication standards for automated laboratory systems developed by the NCCLS Subcommittee on Communications between Automation Systems.

[Results of a questionnaire survey about "standardization" of connection methods in Laboratory Automation System or Laboratory Information System by the National University Hospital Clinical Laboratory Divisions]

"Standardization" is very important in the field of clinical laboratory medicine. Enzyme reference materials(ERM) and standard plasma proteins(CRM470) have already been developed. Reference methods for some clinical chemical tests have also been developed. We are studying "standardization" of electric communication methods between computers and automatic analyzers in Laboratory Automation System(LAS) or Laboratory Information System(LIS). We present the results of a questionnaire survey of 73 LAS or LIS making Companies in this paper. Although "standardization" of electric communications or local area network in LAS or LIS has been done in only 22 companies(34.9%), we are planning more functional standard electric communication methods such as Health Level 7(HL7) or American Society for Testing and Materials(ASTM).

[Can we rely on electronic reporting of laboratory results?]

BACKGROUND

Electronic result reporting from two laboratories to physicians in primary health care through electronic data interchange (EDI) has been used as a supplement to the printed reports. The aim of the study was to see if the quality of the electronic reporting could be improved so that the printed reporting could be cut out without any loss of data.

MATERIAL AND METHODS

Staff members in 20 selected offices were interviewed and error messages on file in the computer systems were studied.

RESULTS

During a period of four months, the laboratories sent 10,740 electronic messages to the selected offices. Error messages arose from 71 of these messages (0.7%). 49 of the errors were discovered and corrected by the staff, but 22 errors were not noticed, and the result reports were lost.

INTERPRETATION

If electronic result reporting should become the only reporting routine, it would be necessary to change several routines both in the laboratories and in the physician's offices. Patients must be identified by using official identifiers. The physicians must control in the computer system that all requested results are received, and the programs used for controlling the messages before they are entered into the electronic patient journal, must be improved.

Electronic laboratory-based reporting for public health

This article describes the role of laboratory-based reporting for public health in the United States and outlines a vision for electronic laboratory-based reporting (ELR). It emphasizes the importance of adoption and implementation of standards to the successful development of ELR. In particular, it describes the role of Health Level 7 as a standard for electronic message formats and the roles of LOINC (Logical Observation Identifiers, Names, and Codes) and SNOMED (Systematized Nomenclature for Human and Veterinary Medicine) as standards for test names and results, respectively. In addition, the article describes ongoing and planned ELR projects

Planning for the future: the Department of Defense Laboratory Joint Working Group and Global Laboratory Information Transfer

The Department of Defense (DoD) Laboratory Joint Working Group plans unified laboratory strategy under the auspices of the Armed Forces Institute of Pathology Board of Governors. One goal of the Laboratory Joint Working Group is to advocate clinical integration through automation of data transfer between medical treatment facilities using the DoD standard platform, Composite Health Care System (CHCS). A working group project team is implementing global laboratory information transfer, which enables CHCS-to-CHCS communication throughout the DoD. A prerequisite to global laboratory information transfer is the standardization of laboratory test nomenclature across all CHCS systems using LOINC (Logical Observation Identifiers, Names and Codes). This makes possible easier access to information among caregivers and therapeutic and public health disease managers and enhances global surveillance of disease outbreaks and continuity of care. The end result is the first-ever electronic transfer of laboratory results between all DoD facilities.