Laboratory information system
Encyclopedia
A lab information system ("LIS") is a class of software that receives, processes, and stores information generated by medical laboratory
processes. These systems often must interface with instruments
and other information systems such as hospital information system
s (HIS). A LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models. Deciding on an LIS vendor is a major undertaking for all labs. Vendor selection typically takes months of research and planning. Installation takes from a few months to a few years depending on the complexity of the organization. There are as many variations of LISs as there are types of lab work. Some vendors offer a full-service solution capable of handling a large hospital lab's needs; others specialize in specific modules. Disciplines of laboratory science supported by LISs include hematology
, chemistry
, immunology
, blood bank (Donor and Transfusion Management), surgical pathology
, anatomical pathology
, flow cytometry
and microbiology
. This article covers clinical lab which encompasses hematology, chemistry and immunology.
. Use of an LIS is a critical piece of the clinical IT spectrum of systems and contributes significantly 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/ambulatory perspective, LIS interaction frequently 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
(CBC). In an inpatient setting when that patient is admitted into the hospital, the system is used to order tests, provide specimen processing assistance, receive the results from analyzers and deliver lab reports to the attending physician.
A phlebotomist
will be called on to collect the specimen(s) from the patient. Often, different specimens will be collected, so as to provide different tubes (each with a specific cap color) for each analyzer that will process the samples.
In this case, the appropriate specimen (using a vacutainer tube with a lavender top) is taken from the patient and labeled with a bar code specimen label produced by the LIS. The LIS will print barcode
labels (with the unique lab ID) for the draw tubes. In some cases, more advanced LIS products will also provide a unique identifier for each specimen. The newest of these systems are using RFID to eliminate human errors and automate the data capture.
Serialized data through barcode or RFID provides the ability to track the specimen's chain of custody from the point it is taken from the patient to the point that it gets discarded. The specimen-accession-patient hierarchy is linked in a tree like numeric structure. In other cases,the patient is identified by a Lab ID linked to the patient's demographic record through the Hospital number.
Medical laboratory
A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
processes. These systems often must interface with instruments
Automated analyser
An automated analyser is a medical laboratory instrument designed to measure different chemicals and other characteristics in a number of biological samples quickly, with minimal human assistance....
and other information systems such as hospital information system
Hospital information system
There are various titles and acronyms which all declare similar approaches to managing the information flow and storage in hospital routine services, as*Hospital Information System , or*Healthcare Information System, or...
s (HIS). A LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models. Deciding on an LIS vendor is a major undertaking for all labs. Vendor selection typically takes months of research and planning. Installation takes from a few months to a few years depending on the complexity of the organization. There are as many variations of LISs as there are types of lab work. Some vendors offer a full-service solution capable of handling a large hospital lab's needs; others specialize in specific modules. Disciplines of laboratory science supported by LISs include hematology
Hematology
Hematology, also spelled haematology , is the branch of biology physiology, internal medicine, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases...
, chemistry
Chemistry
Chemistry is the science of matter, especially its chemical reactions, but also its composition, structure and properties. Chemistry is concerned with atoms and their interactions with other atoms, and particularly with the properties of chemical bonds....
, immunology
Immunology
Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
, blood bank (Donor and Transfusion Management), surgical pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
, flow cytometry
Flow cytometry
Flow cytometry is a technique for counting and examining microscopic particles, such as cells and chromosomes, by suspending them in a stream of fluid and passing them by an electronic detection apparatus. It allows simultaneous multiparametric analysis of the physical and/or chemical...
and microbiology
Microbiology
Microbiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
. This article covers clinical lab which encompasses hematology, chemistry and immunology.
Basic operation
Laboratory Information Systems are often part of an integrated informatics solution which involves many disparate applicationsApplication software
Application software, also known as an application or an "app", is computer software designed to help the user to perform specific tasks. Examples include enterprise software, accounting software, office suites, graphics software and media players. Many application programs deal principally with...
. Use of an LIS is a critical piece of the clinical IT spectrum of systems and contributes significantly 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/ambulatory perspective, LIS interaction frequently begins after a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
has arrived at an initial diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
. For example, a patient enters the hospital looking pale and complaining of fatigue
Fatigue (physical)
Fatigue is a state of awareness describing a range of afflictions, usually associated with physical and/or mental weakness, though varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles...
. The physician, suspecting anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, might decide to order a complete blood count
Complete blood count
A complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
(CBC). In an inpatient setting when that patient is admitted into the hospital, the system is used to order tests, provide specimen processing assistance, receive the results from analyzers and deliver lab reports to the attending physician.
Order entry and check in
An order is placed in the system usually by a physician or laboratory scientist. The order or lab request contains a list of tests to be performed on one or more patient specimens (e.g., blood or urine). In many cases, each order is tracked with a unique identifier. This identifier (which is usually a number) is often referred to as Lab ID. In this hypothetical case, a CBC is ordered which is a panel of sub-tests including white blood cell count, red cell blood count and other blood-related tests.A phlebotomist
Phlebotomist
Phlebotomists are individuals trained to draw blood from a live person or animal.Phlebotomists collect blood primarily by performing venipuncture and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick...
will be called on to collect the specimen(s) from the patient. Often, different specimens will be collected, so as to provide different tubes (each with a specific cap color) for each analyzer that will process the samples.
In this case, the appropriate specimen (using a vacutainer tube with a lavender top) is taken from the patient and labeled with a bar code specimen label produced by the LIS. The LIS will print barcode
Barcode
A barcode is an optical machine-readable representation of data, which shows data about the object to which it attaches. Originally barcodes represented data by varying the widths and spacings of parallel lines, and may be referred to as linear or 1 dimensional . Later they evolved into rectangles,...
labels (with the unique lab ID) for the draw tubes. In some cases, more advanced LIS products will also provide a unique identifier for each specimen. The newest of these systems are using RFID to eliminate human errors and automate the data capture.
Serialized data through barcode or RFID provides the ability to track the specimen's chain of custody from the point it is taken from the patient to the point that it gets discarded. The specimen-accession-patient hierarchy is linked in a tree like numeric structure. In other cases,the patient is identified by a Lab ID linked to the patient's demographic record through the Hospital number.
Specimen receiving
After the specimen is collected, it is sent/brought to the lab for processing typically in a batch. This event should be recorded in the LIS. On reception of the specimen in the testing lab, either manual or automated lab work can begin. Many tests, such as CBCs or Chemistry profiles, are performed by automated analyzers.Send test orders to analyzers
Most 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 specimen's barcode is read by the instrument, the unique ID from the specimen label is matched with the order previously downloaded to the instrument. This system is often called "Batch Download". A more efficient system is called "Host Query", where the instrument reads the barcode on the specimen and "queries" the LIS for the test orders. The LIS will be listening on a communication port for queries and will download the requests only when required. In cases where the LIS transmits data such as test orders or control messages to analyzers the communication is set up to be bi-directional.Results entry
When results of lab tests are available, they are entered into the system manually or automatically downloaded from an instrument. Once these results are double-checked by the Medical Laboratory Scientist or autoverified, they are released. Released results are often automatically printed or written on lab reports which are delivered to the attending physician or clinic. Results must be verified and released to attending physicians as soon as possible.Lab reporting
Lab Reports are the final output of all LIS systems and, in many cases, the primary LIS interaction with healthcare professionals outside the lab. The reports can either be printed or faxed in paper-based labs; they can be delivered via email or file in paperless labs. The degree to which an LIS supports customizable lab reports and flexibility in modes of delivery of results is one major factor in determining its success in the marketplace.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 LISs 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
- Report check by reputed pathologist and senior technologist
Types
There are many laboratory disciplines requiring the support of computerized informatics. These include:- HematologyHematologyHematology, also spelled haematology , is the branch of biology physiology, internal medicine, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases...
- ChemistryChemistryChemistry is the science of matter, especially its chemical reactions, but also its composition, structure and properties. Chemistry is concerned with atoms and their interactions with other atoms, and particularly with the properties of chemical bonds....
- ImmunologyImmunologyImmunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders ; the...
- Blood bank donor center
- Blood bank transfusion
- Surgical Pathology
- Pathology
- Cytology (Cytopathology)
- MicrobiologyMicrobiologyMicrobiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
- Flow cytometryFlow cytometryFlow cytometry is a technique for counting and examining microscopic particles, such as cells and chromosomes, by suspending them in a stream of fluid and passing them by an electronic detection apparatus. It allows simultaneous multiparametric analysis of the physical and/or chemical...
- TB
See also
- Clinical PathologyClinical pathologyClinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
- Laboratory information management systemLaboratory Information Management SystemSometimes known as a laboratory information system or laboratory management system , a laboratory information management system is a software-based laboratory and information management system that offers a set of key features that support a modern laboratory's operations...
- Laboratory informaticsLaboratory informaticsLaboratory Informatics is the specialized application of information technology aimed at optimizing laboratory operations. It encompasses electronic lab notebooks, sample management, data acquisition, data processing, reporting and scientific data management...
- Medical technologistMedical technologistA Medical Laboratory Scientist is a healthcare professional who performs chemical, hematological, immunologic, microscopic, and bacteriological diagnostic analyses on body fluids such as blood, urine, sputum, stool, cerebrospinal fluid , peritoneal fluid, pericardial fluid, and synovial...
- HistopathologyHistopathologyHistopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
- Anatomic Pathology
- Genetic Laboratories
External links
- 2005 Survey of LISs, College of American PathologistsCollege of American PathologistsThe College of American Pathologists , is a medical society serving more than 17,000 physician members and the laboratory community throughout the world....