MedCom: laboratory test ordering--fully implemented nationwide in less than 3 years

Lab test result reporting has been fully implemented in Denmark since early 2000. Labtest ordering is much more complicated due to different handling and labeling procedures in more than 70 Danish labs. Until 2004 all orders were based on preprinted paper forms. A new electronic national lab test order solution based on national MedCom standards and codes was introduced in 2005 and it was fully implemented in all 2100 GP clinics and 1000 private specialist clinics in 3 years. It also included 42 biochemistry labs, 14 Microbiology labs and 16 histopathology and cytology labs. Implementation was organized by MedCom and planned in rough details. During the implementation period a set of planed and ad-hoc activities to reach 100 % implementation was successfully launched. Today more than 6.000.000 lab test orders (100%) are now handled electronically each year. The implementation process, the challenges: organizational and technically as well as outcome is described in the paper.

Laboratory and the art of enterprise integration

Many healthcare organizations are weighing the advantages of investing in a new laboratory information system (LIS) that promises greater accuracy and efficiency against the challenges of replacing the organization's existing LIS system. A recent KLAS survey considers the ROI of replacing an LIS with a next-generation solution, and whether providers are trending toward single-vendor integration or best-of-breed feature sets. Almost 70 percent of the 266 providers interviewed believe there is no "best" LIS.

Integration of scanned document management with the anatomic pathology laboratory information system: analysis of benefits

Electronic document management systems (EDMSs) have the potential to improve the efficiency of anatomic pathology laboratories. We implemented a novel but simple EDMS for scanned documents as part of our laboratory information system (AP-LIS) and collected cost-benefit data with the intention of discerning the value of such a system in general and whether integration with the AP-LIS is advantageous. We found that the direct financial benefits are modest but the indirect and intangible benefits are large. Benefits of time savings and access to data particularly accrued to pathologists and residents (3.8 h/d saved for 26 pathologists and residents). Integrating the scanned document management system (SDMS) into the AP-LIS has major advantages in terms of workflow and overall simplicity. This simple, integrated SDMS is an excellent value in a practice like ours, and many of the benefits likely apply in other practice settings.

Historical return on investment and improved quality resulting from development and mining of a hospital laboratory relational database

A hospital laboratory relational database, developed over eight years, has demonstrated significant cost savings and a substantial financial return on investment (ROI). In addition, the database has been used to measurably improve laboratory operations and the quality of patient care.

Impact of the New Beckman Coulter Cytomics FC 500 5-Color Flow Cytometer on a Regional Flow Cytometry Clinical Laboratory Service

Calgary Laboratory Services (CLS) in Alberta, Canada, is the regional reference laboratory providing flow cytometry services for southern Alberta and southeastern British Columbia. As a busy reference flow laboratory we provide flow cytometry immunophenotyping for investigation and diagnosis of acute and chronic leukemias, lymphomas, immunodeficiencies, neuroblastoma, platelet disorders, and interstitial lung disease (ILD). Because of increasing workload and the continual effort to improve the service to our health care providers, CLS invested in the new Beckman Coulter Cytomics FC 500 5-color flow cytometer. In addition to time and labor savings due to reduced maintenance and operating system design, this new flow cytometer automates many of the previous manual steps involved in quality control and flow cytometric analysis. It also incorporates 2 lasers and is capable of measuring 5-color antibody combinations in a single tube, enabling us to reduce the number of tubes and overall costs, giving us better gating options for minimal residual disease analysis. We present the first published evaluation, an assessment of the overall productivity and cost impact of the new state-of-the-art Cytomics FC 500 flow cytometer. Implementation of the Cytomics FC 500 has resulted in a 20% reduction in reagent costs and shorter turnaround time for analysis and diagnosis. This instrument has allowed us to reduce our acute leukemia panel from 17 to 13 tubes, our lymphoma panel from 13 to 7 tubes, and our ILD panel from 4 to 2 tubes. The availability of 2 lasers provides more flexibility in choosing antibodies and conjugates to customize immunophenotyping panels. It also allows us to use the DRAQ5 dye and simultaneously analyze the immunophenotype and DNA content of cells with very little compensation. Many of the arduous, time-consuming flow operator tasks often associated with previous generation flow cytometry instruments, such as color compensation, list mode analysis, sample repeats, and interpretations, have been substantially reduced with the Cytomics FC 500 5-color flow cytometer. In conclusion the Cytomics FC 500 5-color flow cytometer is a major advance in flow cytometry instrumentation and has reduced our overall reagent costs by 20%, provided better information and speedier turnaround time to our health care professionals. It is an ideal flow cytometer for any busy clinical or research flow cytometry service.

Workflow Improvement and Impact of the New Beckman Coulter LH 1500 High Throughput Automated Hematology Workcell

Our core laboratory at St. Joseph's Medical Center (SJMC) recently installed the new Beckman Coulter LH 1500 fully automated hematology workcell. Like many laboratories in North America and other parts of the world, we are under significant pressure to improve productivity, reduce costs, and improve service provision to our hospital and clinician bases. The difficulty of meeting this challenge is often further compounded by an increasing shortage of qualified technologist personnel. We recently reported on the significant productivity gains with the introduction of the LH 750 hematology system into the core laboratory, including a 23% reduction in slide review rate, automation of reticulocyte and nucleated red blood cell counts, and an 82% increase in the pass-through rate. Evolution to the next stage of automation has come much quicker than anticipated owing to a steep rise in workload and an ever increasing shortage of trained and experienced technologists to fill vacancies in the 24-hour core laboratory operation. We chose to upgrade our LH 750 analyzers to the newly introduced LH 1500 hematology workcell in order to cope with the increased workload and shortage of available experienced hematology technologists. The LH 1500 is a compact, high throughput, fully automated hematology workcell. It is designed to automate all manual process and handling steps associated with hematology analyses, including sample sorting, loading and unloading of cassettes, automatic rerun and reflex testing, sample storage, and tracking of samples. The LH 1500 is comprised of a minimum of 2, and up to 4, LH 750 instruments (with or without integrated slidemaker/stainers). The instruments are bidirectionally interfaced and linked to a fully automated conveyor track, specimen inlet and outlet stations, a sample stockyard, and a line controller. The configuration we chose at SJMC incorporates 1 LH 750 and 1 LH 755. We report that the upgrade to the LH 1500 was a relatively straightforward process and required no redesign of the core laboratory. Based on our evaluation, we estimate cost savings with the LH 1500 of between three quarters to 1 full-time equivalent, which eliminated or decreased many manual handling steps. In addition, this increase in efficiency has freed up our technologist resources to concentrate on the more difficult and clinically important samples. This is the first published report on the new LH 1500 hematology workcell. Our research indicates that the LH 1500 is the first hematology workcell to offer hematology laboratories the next level of automation and virtually eliminate preanalytical and postanalytical sample handling and sorting. For core laboratories and high-throughput hematology laboratories that face similar pressures to ours, the LH 1500 would appear as an attractive solution to maximize hematology productivity and improve service delivery.

The development of an intelligent laboratory information system for a community health promotion centre

This study aimed to develop an Intelligent Laboratory Information System (ILIS) for the community health promotion centre in Kwachun city to help process an increasing amount of laboratory test data in an efficient manner, and to support the clinical decision-making of public health doctors. A sample of 170 cases was used for validation of the system. Overall, the system correctly predicted 92.5% of the cases. This paper also analysed the economic feasibility of the ILIS based on the Information Economics approach. The results showed that the ILIS not only helps screen more people by increasing the capacity of a health promotion centre, but also brings in more revenue to the centre.

An inexpensive modification of the laboratory computer display changes emergency physicians' work habits and perceptions

STUDY OBJECTIVE

Little is known about how the availability of laboratory data affects emergency physicians' practice habits and satisfaction. We modified our clinical information system to display laboratory test status with continuous updates, similar to an airport arrival display. The objective of this study was to determine whether the laboratory test status display altered emergency physicians' work habits and increased satisfaction compared with the time period before implementation of laboratory test status.

METHODS

A retrospective analysis was performed of emergency physicians' actual use of the clinical information system before and after implementation of the laboratory test status display. Emergency physicians were retrospectively surveyed regarding the effect of laboratory test status display on their practice habits and clinical information system use. Survey responses were matched with actual use of the clinical information system. Data were analyzed by using dependent t tests and Pearson correlation coefficients. The study was conducted at a university hospital.

RESULTS

Clinical information system use by 46 emergency physicians was analyzed. Twenty-five surveys were returned (71.4% of available emergency physicians). All emergency physicians perceived fewer clinical information system log ons per day after laboratory test status display. The actual average decrease was 19%. Emergency physicians who reported the greatest decrease in log ons per day tended to have the greatest actual decrease (r =-0.36). There was no significant correlation between actual and perceived total time logged on (r =0.08). In regard to effect on emergency physicians' practice habits, 95% reported increased efficiency, 80% reported improved satisfaction with data access, and 65% reported improved communication with patients.

CONCLUSION

An inexpensive computer modification, laboratory test status display, significantly increased subjective efficiency, changed work habits, and improved satisfaction regarding data access and patient communication among emergency physicians. Knowledge of the test queue changed emergency physician behavior and improved satisfaction.

E-health, phase two: the imperative to integrate process automation with communication automation for large clinical reference laboratories

The initial efforts of e-health have fallen far short of expectations. They were buoyed by the hype and excitement of the Internet craze but limited by their lack of understanding of important market and environmental factors. E-health now recognizes that legacy systems and processes are important, that there is a technology adoption process that needs to be followed, and that demonstrable value drives adoption. Initial e-health transaction solutions have targeted mostly low-cost problems. These solutions invariably are difficult to integrate into existing systems, typically requiring manual interfacing to supported processes. This limitation in particular makes them unworkable for large volume providers. To meet the needs of these providers, e-health companies must rethink their approaches, appropriately applying technology to seamlessly integrate all steps into existing business functions. E-automation is a transaction technology that automates steps, integration of steps, and information communication demands, resulting in comprehensive automation of entire business functions. We applied e-automation to create a billing management solution for clinical reference laboratories. Large volume, onerous regulations, small margins, and only indirect access to patients challenge large laboratories' billing departments. Couple these problems with outmoded, largely manual systems and it becomes apparent why most laboratory billing departments are in crisis. Our approach has been to focus on the most significant and costly problems in billing: errors, compliance, and system maintenance and management. The core of the design relies on conditional processing, a "universal" communications interface, and ASP technologies. The result is comprehensive automation of all routine processes, driving out errors and costs. Additionally, compliance management and billing system support and management costs are dramatically reduced. The implications of e-automated processes can extend beyond the specific transaction problems they are designed to solve. The ready access and communication of process details required by e-automation can apply to many other business functions.

Enhancing the financial performance of a health system laboratory network using an information system

We describe the improvements created by successful implementation of a laboratory information system for a multi-institutional integrated delivery system, including an analysis of the financial results. Conditions at the outset of the project, methods of management and project design, selected aspects of services redesign and consolidation, integration of services among the sites and their effects on laboratory staff and productivity are illustrated. A method for and example of measuring the financial outcomes in the sense of quantifiable improvements in operating expenses and new revenue for a whole health system clinical laboratory computer system are discussed. In this health system, the measurable financial improvements facilitated by an information system were the ability to control operating expenses and to grow the hospital laboratory network through the development of an outreach program. With organizational commitment to process innovation and improvement, using team processes and customer-driven decision-making criteria, the financial performance of our consolidated laboratory network was enhanced substantially. A fully implemented laboratory information system is considered the major enabler of positive change when combined with a genuine commitment from all levels of staff and leadership. Over time, this system's financial return is several times that of the information system investment.

Intranets: virtual procedure manuals for the pathology lab

A novel system exists for replacing standard written operation manuals using a computerized PC-based peer-to-peer network. The system design is based on commonly available hardware and software and utilizes existing equipment to minimize implementation expense. The system is relatively easy to implement and maintain, involves minimal training, and should quickly become a financial asset. In addition, such a system can improve access to laboratory procedure manuals so that resources can be better used on a daily basis.

Preparing the lab for the year 2001: workstation consolidation

Laboratories willing to integrate workstation by reorganizing lab space and staffing, advancing ancillary services, and purchasing flexible, high-throughput instrumentation are on the fast track to success as they head toward the 21st century.

Workflow computing. Improving management and efficiency of pathology diagnostic services

Traditionally, information technology in health care has helped practitioners to collect, store, and present information and also to add a degree of automation to simple tasks (instrument interfaces supporting result entry, for example). Thus commercially available information systems do little to support the need to model, execute, monitor, coordinate, and revise the various complex clinical processes required to support health-care delivery. Workflow computing, which is already implemented and improving the efficiency of operations in several nonmedical industries, can address the need to manage complex clinical processes. Workflow computing not only provides a means to define and manage the events, roles, and information integral to health-care delivery but also supports the explicit implementation of policy or rules appropriate to the process. This article explains how workflow computing may be applied to health-care and the inherent advantages of the technology, and it defines workflow system requirements for use in health-care delivery with special reference to diagnostic pathology.

[Laboratory systematization]

We have built a clinical laboratory system incorporating automatic analyzers (chemistry, immunology and hematology) and automatic sample dispensers. This laboratory system is linked with a main computer through communication lines. Patient's serum specimens are first treated with an automatic sample dispenser and then analyzed at random with automatic analyzers. Specimens which need to be analyzed in commercial laboratories can be dispensed with another automatic sample dispenser. Consequently, cost of reagents and overtime payment can be reduced. Security for avoiding infectious diseases is provided for laboratory technicians. Our clinical laboratory system can reduce the turnaround time for reporting diagnostic data to 30 to 40 minutes. Also, this system can reduce personnel expenses. However, the profits are still not satisfactory compared with those of commercial laboratories. Therefore, we will continue to make every effort to cut down the expenses for the future.

Cost analysis of point-of-care laboratory testing in a community hospital

Point-of-care testing (POCT) is a means of providing patient services more rapidly. Most evaluations of bedside laboratory testing devices have emphasized analytical performance in tertiary care settings. In contrast, the authors compare the operating cost of POCT for glucose and an electrolyte/glucose/blood urea nitrogen chemistry panel with the cost of central laboratory stat testing in a 204-bed community hospital. In scenarios studied, POCT costs exceed central laboratory stat costs from 1.1 to 4.6 times. The more POCT is used, the greater the excess costs compared to the central laboratory. Cost analysis demonstrates that the investment in acquiring automated transport and data management systems for the authors' hospital was far less expensive than POCT for both an individual stat test and on an annual cost basis. The authors urge fiscal caution before indiscriminately implementing POCT.

Results of the CLMA membership survey on laboratory information systems

This article presents the results of the CLMA membership survey concerning Laboratory Information Systems. A variety of factors are discussed, including purchase and maintenance cost of systems, user satisfaction, staffing requirements, processor location and control, applications installed, and interfacing to the Hospital Information System.

'Top 10' LIS vendors jockey for position

The laboratory information system market remains volatile despite a "flattening out" in overall sales, says industry consultant and analyst Sheldon I. Dorenfest. Vendors that were giants just a few years ago have been felled by smaller competitors, but no company can afford to rest easy in its current position.