Information technology (IT) has revolutionized all facets of human life, including health care delivery. In the laboratory setting, in particular, the integration of IT in the laboratory, through the application of laboratory information systems (LIS) and laboratory information management systems (LIMS), has enhanced a range of services, including the ordering of laboratory tests, advanced instrument workstation services, reporting of laboratory data, dynamic test scheduling, and advanced facilities management. In addition, general IT services have provided a venue for laboratory staff to learn and interact with peers, ease communication between different departments, and educate patients/clients.
These systems ensure that patient records and data are properly stored such as to enable features such as patient/client history tracker, where a returning patient’s history can aid the laboratory in deducing what type of test a visitor would request for, as well as statistical reports generation, where useful information is inferred based on the test result. Historically, LIS was used to record, manage, and store data for clinical settings while LIMS was preferred for large manufacturing and research labs.An effective LIS solution can greatly improve the quality of clinical delivery through the elimination of challenges associated with manual record-keeping, for instance;
- Reduced errors: Clerical errors at the pre-analytic and post-analytic stages make the bulk of errors in laboratories. An electronic LIS that performs precise validation of reference ranges and allowable values at the point of data entry can reduce the number of such errors.
- Reduced waiting time and more reliable results for patients: When the bulk of data maintenance is done by the LIS, laboratory technicians can focus on their main task of performing and interpreting tests. This leads to lesser reduced times for patients and to more accurate test results.
- Lowers the burden of record-keeping; As sample analysis passes through different stages, the software solution maintains consistency and persistence of entered data. This goes a long way in reducing the burden of record-keeping on laboratory staff at every stage.
- Fast traceability of patient and specimen history; A simple lookup for a patient name or sample ID on a logbook can take a lot of time especially if the date of registration is not known. An electronic LIS enables fast and precise retrieval of patient data.
- Ease of generation and dissemination of reports; Generating cumulative statistics is straightforward on an electronic LIS, whereas generating a simple count of tests done over a time period can take hours as the logbook entries need to be read sequentially for manual counting.
- Ability to view and analyze cumulative trends; Once data is consistently being maintained in a laboratory information system, it opens up possibilities to perform various kinds of analysis on test results and to infer trends and patterns. This can, in turn, facilitate informed decision making by the attending physicians or in the allocation of laboratory services and resources.
The design of the LIS should be a collaborative effort between the designers, the lab management, and the lab staff intended to use the system. The system designers should identify the end-users’ short- and long-term needs, and ensure that the system can match these needs. It is important that the designers obtain constant feedback from the staff after the implementation so as to match the user requirements to the system capabilities. The following are the main phases of LIS design;
Requirements gathering phase:
This phase is useful for getting a sense of the laboratory environment, the basic needs to be fulfilled by the system analysis, and the extent to which the existing paper-based methods are augmented by information technology.
In this phase, several iterations of user evaluation are collected. The evaluations typically contain 4-6 tasks for the technicians to perform on the system. This helps to improve and simplify the user interface along with obtaining a list of further features to be added to the LIS.
This phase starts by identifying pilot laboratories or departments and performing focused user evaluations and system refinement for them. Factors such as facility size, number of personnel, and site location are taken into an account to ensure that the LIS is tested on a wide variety of laboratory environments. This would help in gauging the degree of customizability and system stability in response to the variable workload and workflows.
This phase is subdivided into smaller stages that consist of the following steps;
- Installation of computer hardware, server, and peripheral equipment
- Installation of LIS software, customization, and configuration
- Loading of test data and trial clinical orders
- Validation of the system
- Training of laboratory staff
- Feedback and finetuning of the system
A good LIS software is simple in its interface design and should meet the requirements and needs of the end-users. The lab management should ensure the design has the following;
- Progress awareness; The user should be aware that the system is working even though the screen does not change for a brief period. The screen should show small animated page elements called progress spinners that indicate that a new page is loading or form submission is in progress. This is to avoid repeat commands that could cause the over-extension of the system.
- Selective disclosure of user interface; Only the required parts of the screen should be displayed at any given point in time. This can be done by on-demand loading of required page elements for example; when the user selects a menu option.
- Simple color scheme; A good LIS interface should have a limited number of colors on the screen so as not to overwhelm or confuse the end-user.
- Relevant hints; The user should always have a quick reference to help information when needed. Short and precise hints about the relevant task can be presented to the user in the form of tips boxes on the screen without the need to navigate to another page.
- Document management; The system should be able to process and convert data to a certain format and manage how documents are distributed and accessed.
- Instrument calibration and maintenance; It should schedule important maintenance and calibration of lab instruments and keep detailed records of such activities.
- Quality assurance and control; An effective LIS should integrate set laboratory standards by enforcing data entry standards and workflows, maintain a complete audit trail, and sample traceability.
The incorporation of IT in laboratory management systems improves the efficiency and effectiveness of clinical laboratory services by integrating decision support systems with laboratory information systems and equipment. A properly developed Medical Laboratory information system will greatly increase productivity, reduce costs, increase profits, and enhance the quality of services delivered by the facility while greatly reducing the amount of man-hours put into the delivery of laboratory services.
The use of a LIS in the running of a medical laboratory facility greatly improves the documentation process; makes patient’s records retrieval a lot easier and faster, records are not lost, and is kept safe via regular backup. In addition, the use of LIS can aid in the generation of inferences generated from its statistical analyses. Laboratories using technological solutions are able to meet patient/client demands for faster, quality services.
- Robert Martin, Ralph Timperi, Ramesh Krishnamurthy, Laboratory Information Management Systems in Resource-Limited Environments, Making the eHealth Connection, Bellagio, Italy, July-August 2008
- Miller WD, Kalfoglou AL, LeRoy L, editors. Medicare Laboratory Payment Policy: Now and in the Future. Washington (DC): National Academies Press (US) Institute of Medicine (US) Committee on Medicare Payment Methodology for Clinical Laboratory Services; ; 2000. 3, Technology Trends in the Clinical Laboratory Industry.
- Jin H. and Li F. Design and implementation of laboratory information management systems based on hybrid mode. Proceedings of 2008 IEEE International Symposium on IT in Medical and Education. 2008, 631 – 635
- Alanazi, F. Evaluating the usability of the laboratory information system (LIS) in Coombe Hospital and Hail Hospital. 2015 (A master dissertation). Dublin Institute of Technology, Leinster, Ireland.