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Affects of It on the Healthcare Industry - Laboratory Information System (Lis)

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Affects of IT on the Healthcare Industry

Laboratory Information System (LIS) There has been numerous technological advances in the past decade that have affected the healthcare industry. With the networking and communication systems development, the amount of information exchanged between healthcare professionals has also risen dramatically. IT has had a significant impact on the healthcare delivery system in all areas and it is believed that it will continue to do so into the next century. In this research, I will only discuss the Laboratory Information System (LIS) and also briefly explain the Hospital Information System (HIS), that are being used in the healthcare industry.

Laboratory Information System A laboratory information system (LIS), is a type of software that handles receiving, processing and storing information generated by Medical laboratory processes. These systems must interface with instruments/analyzers and other information systems such as hospital information systems (HIS). An LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models. Deciding on an LIS vendor and installing of an LIS software could take a lab from a few months to a few years, depending on the complexity of the organization. LIS’s are complex software applications. There are as many variations of LIS’s as there types of lab work. Disciplines of laboratory science include many aspects such as hematology, chemistry, immunology, and several others.

Hospital Information System On the other hand, there is also what is knows as a hospital information system (HIS). It is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines. As an area of medical informatics the aim of an HIS is to achieve the best possible support of patient care and administration by electronic data processing. It can be composed of one or few software components with specialty specific extensions. It can also be composed of a large variety of sub-systems in medical specialties (e.g. Laboratory Information System, Radiology Information System). Therefore, the LIS is a sub-system of the HIS.

LIS Operation LIS’s are usually part of an integrated informatics system that involve many unrelated applications. The use of an LIS is a critical piece of clinical IT and has a significant contribution to the overall care given to patients. The LIS is used in inpatient and outpatient settings and in many cases is designed to support both. From an outpatient perspective, the LIS interaction begins after a physician has arrived at an initial diagnosis. For example, a patient enters the hospital looking pale and complaining of fatigue. The physician, suspecting anemia, might decide to order a complete blood count. In an inpatient setting when the sick patient in the above example is admitted into the hospital, the LIS application is called upon frequently by many in the healthcare industry to order tests, provide specimen processing assistance, receive the results from instrumentation and report on the patient testing in a timely manner hat has to be easy to review by the individual that is looking at the report.

Order Entry, Check In, and Specimen Receiving An order is placed in the system usually by a physician, physician’s assistant, nurse, office clerk, or laboratory technician. The order request would contain a request of which tests are supposed to be performed. In many cases, each order is tracked with a unique identifier, which is usually a number and is usually referred to as an accession number. For example, if a complete blood count request is requested for a patient, and this consists of many blood-related tests (such as white and red cell counts), then multiple specimens will be collected from the patient and placed in different tubes. The LIS will print labels with a barcode on them to be placed on the tubes. Each barcode contains an accession number. The appropriate specimen is taken from the patient and is labeled with a barcode specimen label. This provides the ability to track the chain of custody of the specimen from the point it is taken from the patient to the point that it gets discarded. In many cases, the patient is given a Patient ID (PID) number and the patient is given a demographic record and then the Sample ID (SID) number is linked to the patient through the PID. After the specimen is collected, it is then sent to the appropriate lab for processing. This is recorded in the LIS. Once the testing lab received the specimen(s), either manual or automated lab work can begin. Personally, the analyzers that I worked on, are designed where the performed tests are automated.

Send Test Orders to Analyzers LIS systems can be configured to download the specimen data to an analyzer either after the order is placed or when a specimen is received in a testing lab. When the barcoded specimen is read by the analyzer, the unique ID is read off the label and matched with the order previously downloaded to the analyzer. However, there are some LIS systems that use a more efficient system which is called “Host Query”, where the analyzer reads the barcode on the specimen and sends a query request to the LIS for the test orders. The LIS would be connected to a network and listening on a communication port for queries. Some analyzers are set where they query their own local database first and then the LIS application. The “Host Query” is done through a hospital system known as the Hospital Gateway, which is a system that is responsible for maintaining the connection between the analyzer, the LIS and the Database which could be hosted on a separate machine.

Results Entry and Lab Reporting When results of lab tests are available, they are entered into the system manually or automatically downloaded from an analyzer. Once these results are double checked by the medical technician, they are released. LIS systems provide additional resulting functions and patient care assistance by providing Delta Checking. Released results are often automatically printed to lab reports which are delivered to the attending physician. Lab Reports are the final output of all LIS systems and, usually the primary LIS interaction with healthcare professionals outside of the lab. They can either be printed or faxed in paper-based labs, or delivered via email, file or HL7 interface in paperless installations.

Basic Features Laboratory Information Systems commonly support the following features: • Patient Check In • Order Entry • Specimen Processing • Result(s) Entry • Reporting • Patient Demographics • Physician Demographics

Additional Features In addition LIS’s commonly support the following: • Web based order entry • Web based results inquiry • Faxing and emailing of lab reports • Custom report creation • HL7 interfaces with reference labs and EMRs • Preliminary reporting • Final reporting • Med tech worksheets • Workload balancing • Medicare medical necessity checking • Billing • Public health reporting • Rule engines

Types There are many laboratory disciplines requiring the support of computerized informatics. These include: • Hematology • Chemistry • Immunology • Blood bank donor center • Blood bank transfusion • Surgical Pathology • Anatomical Pathology • Cytology (Cytopathology) • Microbiology • Flow cytometry

Other Commercial Laboratory Information Systems There are a few commercial LIS’s in the market and here are a few examples of those: • LabDAQ Laboratory Information System, which could be viewed at the following link: http://www.antekhealthware.com/labdaq.php • ClinLab LIS - Laboratory Information Systems, which could be viewed at the following link: http://www.clinlabinc.com/ • Matrix, which could be viewed at the following link: http://www.matrix.inf.br/ • Cobas IT 5000 Roche Diagnostics, which could be viewed at the following link: http://www.roche.de/diagnostics/labor/labkomsys.htm#cobasIT5000 • Cerner PathNet® LIS, which could be viewed at the following link: http://www.cerner.com/public/Cerner_3.asp?id=199 • Autolims LIS - Laboratory Information Systems, which could be viewed at the following link: http://www.netlims.com/ • GLIMS, which could be viewed at the following link: http://www.mips.be/home.cfm?lang=en • IntelliLab LIS, which could be viewed at the following link: http://www.impac.com/products/lab/index.html • Lab Pro 2004, which could be viewed at the following link: http://www.healthcare.latentlogics.com/ • Misys Commercial Lab, which could be viewed at the following link: http://www.misyshealthcare.com/ • Orchard Harvest LIS, which could be viewed at the following link: http://www.orchardsoft.com/ • OMNILAB LIS, which could be viewed at the following link: http://www.omnitechlabs.net/ • Quadramed Affinity Lab, which could be viewed at the following link: http://www.quadramed.com/care_management/index.cfm#qal • SchuyLab, which could be viewed at the following link: http://www.schuylab.com/ • SCC SoftLab, which could be viewed at the following link: http://www.softcomputer.com/products/laboratory.php • Seacoast Lab Data Systems SurroundLab Plus, which could be viewed at the following link: http://www.sldsi.com/ • iSoft, which could be viewed at the following link: http://www.isoftplc.com/ • The Computer Solution Company: Forensic Advantage, which could be viewed at the following link: http://www.tcsc.com/softwareproducts.htm

References • College of American Pathologists 2005 Survey of LISs, http://www.cap.org/apps/docs/cap_today/surveys/11_05_24-56_LISsurvey.pdf • Ohe, Kazuhiko; Kaihara, Shigekoto; Ishikawa, Koichi Benjamin; Hishiki, Teruyoshi; Nagase, Toshiko; Sakurai, Tunetaro, Hospital Information System and the Internet, http://www.isoc.org/HMP/PAPER/238/ • http://www.biohealthmatics.com/technologies/his/lis.aspx • Associate Professor, Kyoto Sangyo University, The Effects of Information Technology and Organizational Change in Medical Organization: The Case of EMR Introduction in Rakuwakai; 21COE, University of Tokyo MMRC Discussion Paper No. 109; http://www.ut-mmrc.jp/dp/PDF/MMRC109_2007.pdf • http://www.wikipedia.org • Basi, Andy; Developing an LIS-clinic interface. Medical Laboratory Observer (3/1/1989); http://www.encyclopedia.com/doc/1G1-7494807.html • Devaraj, Sarv & Kohli, Rajiv; 2000; Information technology payoff in the health-care industry: a longitudinal study; http://portal.acm.org/citation.cfm?id=1189427.1189430

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