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Available in most labs, fully utilized by few.

The first MLO panel study in seven years on the use of personal computers (PCs) in the laboratory indicates overwhelming reliance on the now-ubiquitous boxes. That summarizes the many revealing findings of MLO's latest poll, a questionnaire sent to 1,462 clinical laboratories nationwide who had agreed to participate in such surveys (see "Survey methodology," facing page). Well over half (58%), a statistically significant response rate, returned the questionnaires.

The vast majority (83%) of labs polled use PCs, mostly for quality assurance/quality control programs and other internal functions. Nearly one in four (23%) go even farther, tapping the vast wealth of outside databases for information of many kinds. Surprisingly, however, that last figure isn't much higher than the proportion (22%) who reported such activities in MLO's 1984 survey. [1]

The most popular uses for lab PCs are word processing, done in 80% of respondents' labs; QC, done in 56%; workload recording, 51%; QA, 50%; and test result reporting, 49%. The most marked change since the 1984 survey is a jump from 52% to 80% in the use of lab PCs for word processing.

These tasks represent what one laboratory operations director describes as "the scut work we do day in and day out" (more on this later). Nevertheless, a small but passionate group perform relatively high-end computing that is beyond the reach of most PC users in or out of the lab. Four percent of panelists use their PCs at least occasionally for artificial intelligence or expert systems, in which computer software mimics human thought well enough to make simple judgments. Even more impressive, double that figure (8%) plan to begin doing so within two years.

While 83% of polled labs have at least one PC, the average is seven. Only 54% of MLO respondents' labs had PCs in 1984.

The average lab acquired a first PC in 1985 and the most recent one in 1989. More than three-fourths (78%) of respondents' labs obtained their PCs through direct purchase; 39% received them through various arrangements with lab vendors. (The two groups overlapped somewhat.)

Independent and group practice lab (86%) were more likely than hospital labs (77%) to have purchased PCs. Labs in large hospitals (see "Hospital size," page 27) were more likely than those in midsize and small hospitals to purchase PCs (88% versus 71%) and to obtain them from noncomputer vendors (53% versus 41%).

* Hardware. Not surprisingly, one of the most dramatic changes since MLO's 1984 survey is increasingly sophisticated hardware. Seven years ago, the largest memory capacity of respondents' PCs was 256 kilobytes (256K), available to only 8%. Most panelists (62%) used 64K, memory that would seem grossly inadequate today. Hard disks were mainly in the future. In 1991, 59% of lab PCs have hard disks capable of strong more than 40 megabytes (40mb) of data. Of those, 24% have 80mb or more.

The amount of computer memory available for applications (random-access memory, or RAM) used by labs today far exceeds what was available to MLO panelists in 1984. The substantial 640K RAM is now used by 29% of laboratorians, while 17% use 1mb, 16% use 2mb, 5% use 512K, 4% use 4mb, and 3% use 256K. Twenty-two percent were unsure and 5% mentioned other memory capacities. The 37% of respondents who have at least 1mb RAM reflect new, complex software or multitasking that requires extensive memory. Other comparisons with the computer use of 1984 are found in Figure I.

* Outer space. One quick route to outside material is a CD-ROM drive. Employing compact disks that hold huge amounts of data, these drives make entire libraries available on the computer screen or in printout form. Most popular among the 10% of MLO panelists who use CD-ROM for such a purpose is Medline, an extended bibliography k of journal titles and abstracts from the National Library of Medicine in Washington, D.C. Medline is accessed by one-third (33%) of CD-ROM fans.

* Typical features. Figure II represents a composite of computer attributes and accessories in respondents' labs. The typical PC contains a 5.25-inch "floppy disk" drive, only slightly more popular among laboratories than the 3.5-inch drive, which holds the smaller disks covered in rigid plastic (78% versus 70%).

Hard disk storage of 40 to 80mb is available to 35% of respondents, while 24% have more and 19% have less. (Others were unsure.)

Other PC features now installed in panelists' labs are RAM of at least 1mb (37%); color monitor (75%); letter-quality printer (67%); expanded memory (39%) for complex work and multitasking (handling more than one job at approximately the same time); a 2400-baud modem (32%), popular among computer users in general for its acceptably fast transmission and relatively low price; and the handheld mouse (39%), pointed at appropriate spots on the screen to instruct the computer to perform defined tasks.

Fifteen percent of respondents' PCs access a CD-ROM drive (as noted, 10% have a compact disc database to use on it). Optical scanners for capturing and storing pictures are available to 10%.

Figure I

Lab PC use

in 1991 and 1984
Does your laboratory have
at least one PC?
 1991 1984 (1)
Yes 83% 54%
No 17 46
Does your laboratory have
a laboratory information sytem (LIS)?
 1991 1984 (1)
Yes 45% 40%
No 53 60
Unsure 2 N/A


In a May 1981 MLO survey on interpretive reporting, [2] 31% of respondents said their labs had a LIS; 69% said theirs did not.
Top 10 uses of PCs in the lab
 1991 1984 (1)
1. Word processing 80% 52%
2. Quality control 56 75
3. Workload recording 51 34
4. Quality assurance 50 N/A
5. Test result reporting 49 32
6. Instrument interface 46 33
7. Information (text) files 42 N/A
8. Budgeting 38 23
9. Database management 38 N/A
10. Arching 37 N/A
 N/A = Not asked. Some totals exceed 100% due
to multiple responses.
 (1) Hallam, K. Microcomputers in the lab: The
sudden boom. MLO 16(5):31-36, May 1984.
 (2) Benezra, N. Interpretative reporting: How far do
labs go? MLO 13(5):33-39, May 1981.


Respondents were asked what new features they would obtain in the next two years. The most popular hardware items were a laser printer, on the shopping lists of 43% of panelists; expanded memory (32%); optical scanner (30%); fax card (27%), discussed in greater detail in Part II of this article; color monitor (25%); and CD-ROM drive (20%).

* Interfaces. Of the typical laboratory's seven PCs, four are stand-alones--that is, terminals not linked to a mainframe or another PC. "While PCs are automating previously manual and labor-intensive processes such as QA/QC, workload recording, and pathology," says Barbara Drozd Mills, MT(ASCP), pathology laboratory systems manager at Humana Hospital--Michael Reese, Chicago, "The high number of PCs functioning as stand-alones suggests that there is a significant amount of redundant data entry on the front end and a fragmented clinical and management picture on the back." In other words, too many hands in a given laboratory are entering data in too many systems, yet management has no single source of information about what's happening in the lab.

Mills offers an example of fragmentation that is currently being corrected in her own lab. "We have a stand-alone LIS [laboratory information system], a stand-alone microbiology system, and no computer systems at all in transfusion and cytology," she says. "To do monthly and annual workload recording, someone in administration takes printed reports from the two stand-alone systems and manual tallies from the noncomputerized areas, collates all of that, and reenters it into a PC-based spreadsheet. We are in the process of replacing the LIS with a system that will do all that work for us.

"The challenge now," Mills continues, "is to harness computer power and the increasing computer competence of laboratories to produce information more productively and share it more readily."

Such sharing requires interfacing. The ability to communicate with other users and with data in other computers greatly expands a PC's usefulness. A discussion follows of how MLO panelists are faring with today's common interfaces.

LIS. A mini-mainframe-based laboratory information system is present in 45% of all respondents' labs. In large and mid-size hospitals, the proportion is higher (73% and 67%). A LIS resides in 21% of labs in small hospitals. In the labs of nearly three out of four (74%) respondents, at least one interfaces with the LIS. The average number of interfacing PCs is eight.

Communicaton to the institution beyond the lab could be a lot better. Well over half (60%) of laboratorians working in hospital labs report that none of their PCs interfaces with the hospital information system (HIS). Among those that do, an average of seven PCs are connected with the HIS. "The areas in which PCs are frequently used suggest that they are often filling gaps in the typical LIS or providing a piecemeal, fragmented LIS substitute," notes Barbara Mills.

LAN. Within the labs of 21% of respondents, PCs communicate internally with each other, forming a local area network (LAN). Such a connection is more common in midsize and large hospitals (25%) than in small ones (10%).

CD-ROM drive. One growing area of computer use in the lab is the ability to add an electronic library through a compact disc database. Ten percent of all respondents to the MLO survey do so; 11% of hospital labs and 15% of labs with LANs search for information on compact discs.

Combining these groups with the 20% of labs that plan to add the necessary hardware within the next two years reveals that as many as one-third of labs will be able to call up databases with CD-ROM
 Hospital size
 Hospitals and medical centers in
this article have been categorized
in the following groups:
Small 1-199 beds
Midsize 200-399 beds
Large 400 or more beds


in the near future. The popular scientific database Medline is available on compact disc from a number of electronic publishers (see "A sampler of CD databases of interest in the lab," page 31).

"CD-ROM technology is the coming thing," asserts John J. Palmer, CLS(NCA), laboratory manager in the department of clinical pathology at City of Hope National Medical Center in Duarte, Calif. Calling compact discs "mandatory tools in the lab to keep track of data and information," Palmer continues: "We are looking at CD-ROM as a way to get patient results on a PC that's been set up to record patient transactions from the LIS. One disc will hold all the raw data in the lab for a week. With compact disc storage, we'll be able to comply with accrediting agencies' requirement of making previous patient data available almost instantaneously."

Reaching outside databases. The fastest (and most expensive) modem model, at 9600 baud, is available to 11% of respondents, and 12% say they expect to buy one within two years. Other lab PCs use 2400 baud (32%) or 1200 baud (27%). Medline, the database most commonly sought outside the lab, attracts almost half (43%) of the 23% of laboratorians who use telephone databases. Robert Farnham, M.D., a pathologist at Presbyterian Hospital in Charlotte, N.C., prefers getting Medline by phone instead of disc. "You can only put a few years of a journal on a disc," he says, "but the biggest limitation is that you only get two or three years of Medline to search." CompuServe and Prodigy, general-interest commercial computer "bulletin boards," are used by 24% and 16% of panelists with telephone databases, respectively.

Laboratorians who use their PCs for external exploration spend an average of two hours per week inside databases beyond the
 Figure III
 How
 outside databases
 are used
Search for journal abstracts 58%
Search for journal titles 48
Electronic mail (E-mail) 34
Download data 31
Download software 21
Purchase items for lab 19
Upload material 15
 Total exceeds 100% due to
multiple responses.


lab. Their main activity is to search for journal abstracts and titles. Also popular are corresponding with other lab people via electronic mail (E-mail), downloading data (obtaining material through modems), and purchasing items for the lab (Figure III).

* Where the PCs are. When asked to pinpoint the location of lab PCs, more than two out of three (68%) respondents pointed to the bench. Clerical stations house 57% of PCs, followed by the offices of the lab manager (51%), lab director (37%), pathologist (25%), and supervisor (7%). (Responses overlapped.)

In what areas or sections of labs are PCs used? More than three out of four laboratorians (79%) identified lab use by administration or management (Figure IV). Among bench sections, chemistry is number one (65%), followed in decreasing order by microbiology, hematology, pathology, and blood bank.

* Who uses PCs? Eighty-seven percent of respondents said they personally use one or more PCs. When asked the titles of those using PCs in the lab, the MLO panelists cited medical technologists 75% of the time. Supervisors were close behind (74%), followed by secretarial and clerical workers (71%), laboratory managers (68%), medical technicians (49%), and pathologists (29%).

PC maintenance is performed by an outside vendor in 38% of respondents' labs. In nearly as many (37%), a computer-literate laboratorian handles that chore. HIS or data processing staff members do PC maintenance in 35% of cases, followed by lab electronics or computer technicians (17%) and computer hardware manufacturers (15%).

In 48% of labs, one or more staff members write PC software programs--15% of them often, and 33% occasionally. In the 1984 MLO survey, an only slightly smaller proportion of labs (38%) used programs developed in-house.

After reviewing the survey findings used as the basis of this article, Donna Walsh, M.S., MT(ASCP), laboratory scientist
 Figure IV
 Lab sections that
 use PCs
Administration
 management 79%
Chemistry 65
Microbiology 49
Hematology 41
Pathology 37
Blood bank 30
Specimen processing
 and receiving 27
Immunology 27
Cytology 17
Autopsy 12
 Total exceeds 100% due to multiple
responses.


(and software writer) at New England Deaconess Hospital in Boston, announced herself "pleasantly surprised to find how many other people are writing software." Software to facilitate method evaluation and many other topics is sorely needed, she observes.

"The only source of diagnostic software I've seen is diagnostic vendors," Walsh says, "but they'll only give it to you if you buy their reagents." Opportunities for laboratorians who can write good lab software are tremendous, according to Walsh; they can help fill "a big hole in the computer marketplace."

* What PCs are used for. PC applications most used by laboratorians in 1991 as well as those that will be acquired within two years (Figure V) suggest that for the near future, computers will remain glorified typewriters and calculators for many. Does this overwhelming reliance on PCs for management and housekeeping tasks diminish the value of the instrument?

Yes, affirms Lee Barbieri, MT(ASCP), operations director of hematology and transfusion services at Duke University Medical Center in Durham, N.C. Barbieri feels that laboratorians "don't look at PCs as being the same kind of tool as a spectrophotometer, but as something they don't know anything about."

Using a high-level machine solely for routine tasks, he says, ignores its tremendous potential. "CD-ROM is exciting, and artificial intelligence has been bandied about, but little of this has filtered down to the lab," Barbieri concludes. (For a discussion of more potentially productive uses, see Iart II of this article, which follows in this issue.)

Advanced uses. Limitations of the many do not deter the few. Anatomic or surgical pathology and cytology data tracking programs are frequently run on 34% of respondents' computers. Another 40% intend to add the programs within two years. If the latter group's plans come through, more than three-fourths of lab PCs will use this sophisticated feature by the end of 1993. "Picture archiving on CD-ROM" in Part II of this article describes how computers help pathologists conduct long-distance consultations and save pictures for future reference.

The use of PCs to assist in teaching lab procedures and formulating diagnoses is growing. While only 6% of labs now frequently use computer-assisted instruction
 Figure V
 Current and upcoming uses of lab PCs
 Use Adding within
 frequently two years
Word processing 80% 12%
Quality control 56% 18
Workload recording 51 23
Quality assurance 50 23
Test result reporting 49 15
Instrument interface 46 18
Information (text) files 42 12
Database management 38 20
Budgeting 38 18
Archiving 37 22
Anatomic and/or surgical pathology
 and cytology data tracking 34 40
Management analysis 34 17
Microbiology tracking and recording 34 15
Inventory control 26 31
Billing and accounts receivable 27 20
Scheduling 25 24
Blood bank management 22 30
Instrument maintenance log 21 22
Utilization reviews 19 20
Diagnostic coding 18 23
Test interpretation 15 15
Electronic mail (E-mail) 13 20
Forecasting 8 10
Computer-assisted instruction (CAI) 6 10
Computer-assisted diagnosis
 (CADx) and test interpretation 5 11
Optical character recognition (OCR) 4 12
Image analysis 4 6
Artificial intelligence/expert systems 2 8
 Totals exceed 100% due to multiple responses.


(CAI), 10% plan to add it soon. Computer-assisted diagnosis (CADx) and test interpretation are used frequently by only 5% of panelists' labs now but are expected to be used by another 11% within two years. Two percent of respondents use artificial intelligence or expert systems programs frequently; another 2% do so occasionally, and 8% plan to add this advanced ability within two years.

* Security. More than half (53%) of the laboratorians surveyed said their labs had a security system for PCs. Such systems are more likely to be installed in computers that interface with an LIS or LAN
 Figure VI
 Budgets for multiple PCs
$50,000 or more 8%
$10,000-$50,000 14
Under $10,000 9
None 42
Unsure 27
Total 100%
 Figure VII
 Views on what's new
 What do you consider the most
exciting new developments in PCs
for the lab?
LIS 12%
Interfacing, networking,
 expanded access 11
CD-ROM 11
LAN 8
QA/QC 7
Increased speed 6
Windows 6
Bar coding 5
HIS 5
Optical scanning, storage 5
 Total is less than 100% due to partial
responses.


(57% and 72%, respectively) than in those that do not (49% in both cases). Among labs using security measures, 86% employ a pass-word system, 21% use a lock and keys, and 12% are literally bolted to the table.

Virus problems are rare in laboratory PCs, but when they occur, they can be serious. Fortunately, most respondents (84%) said their lab PCs had never had such a problem, nor did they know of one that had. But 7% of respondents' labs, most often those in large hospitals (10%), have encountered such an attack.

Among small hospitals, 3% suffered that fate. Overall, three cases of infection by a disgruntled employee were noted; in three cases, all data were lost. A fuller discussion of computer viruses among panelists' labs appears in "Cure for computer virus infection: Eternal vigilance," page 28.

Far more common than viral "infection" is accidental destruction of data by users themselves. Notes Farnham: "Employees often play games on computers. Simply because they don't know what they're doing, they can destroy large amounts of important data." The only defense, he says, is continual backup.

There are many ways to do the job; simplest is manually, on floppy disks. Alternatively, a simple magnetic tape device that costs about $300 will back up a system automatically at preset intervals. "We lost a procedure manual once," Farnham unhappily recalls. "Saving one manual is worth 20 tape drives."

The question is no longer when a lab will obtain a PC, but how many it will get. As with other capital expenditures, money is definitely an object.

More than three out of four (78%) laboratorians surveyed report having no budget to purchase a lone PC in 1991. Of the few planning to buy one PC, the average budget is $500--not nearly enough. As for multiple units, they are excluded altogether from the budgets of 42% of all respondents. The average budget of those who do have funds assigned for purchasing multiple units is $11,670 (Figure VI).

* Developments. Respondents were asked what they considered the most exciting new developments likely to affect the use of PCs in the lab (Figure VII). Overwhelmingly, they said the future lies in the instruments' ability to interface with other electronic systems--the LIS, the HIS, other PCs in an LAN, and a CD-ROM drive. Nearly half (47%) of laboratorians listed some combination of communicating systems as the way to go.

Taking personnel off the bench to make them wiser in the ways of the computer can be difficult, says Barbieri, but it is necessary. "Just as we invest in continuing education," he says, "we have to invest the time to teach people to use computers as an integral tool in the department. The same manager who will turn a technologist loose on a $150,000 chemistry analyzer on a weekend, when nobody else is there, won't provide a free hand with a $3,000 computer."
COPYRIGHT 1991 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Personal Computers in the Clinical Laboratory, part 1; includes information on survey methodology, how to prevent computer virus infection, and a sampler of CD databases of interest in the lab
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Date:Aug 1, 1991
Words:3491
Previous Article:GAO urges further cuts in lab fee schedule.
Next Article:Fighting resistance, many use PCs in wise and creative ways.
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