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Developing an LIS-clinic interface.

Our on-site clinical laboratory provides hematology, microbiology, urinalysis, and a limited amount of chemistry testing for a 40-physician medical clinic. The parent laboratory (Metropolitan Clinical Laboratory), a quartermile away, provides chemistries and radioimmunoassays for the clinic.

We used to have a small standalone microcomputer systemone terminal, two printerswhich accessioned specimens, produced labels and worksheets, generated dally and monthly workload units, and calculated expected revenue on the basis of each test's total volume.

This system did not interface with the medical clinic's CoStar system, which used a DEC PDP 11/44 minicomputer, or with lab instruments. In 1985, we started a search for a laboratory information system that would interface and accomplish our goal of pro-, viding on-line test results.

We talked to eight vendors at the start. The field narrowed down to two microcomputerbased systems after we considered prices, features, vendor ability to build an interface with the clinic computer for a reasonable cost, and references from other users we phoned.

I and a computer specialist from the parent laboratory went to California to visit a clinic labthat used one vendor's system and a hospital lab that used the other's. We prepared detailed evaluation reports on the two contenders.

The system we chose and implemented in February 1986 was a Cyberiab I LIS from Creative Computer Applications, (CCA), Calabasas, Calif., a company well known for its instrument interfaces. The hardware consisted of a Compupro/Viasyn 816 central processing unit with 1 -megabyte high-speed RAM; a 40-megabyte hard-disk drive; a 10-megabyte removable cartridge disk drive; a 5 1/4-inch floppy disk drive; three Wyse 50 terminals (we later added a Qume terminal); nine serial 1/0 ports; a Coulter S790 interface; an Ames Clinitek 200 interface; and interfaced keypads to input differential and urine microscopic findings. The Cyberlab software consisted of a reporting system and an on-line quality control system. This package cost over $30,000 (U.S. ).

At an additional cost of about $4,000, CCA and a computer programmer at the clinic developed an interface enabling us to download laboratory results to the clinic computer. They compiled a translation directory (the lab system used COBOL language, the clinic system MUMPS), and they wrote software for the interface. Additional software enabled our parent laboratory to send its chemistry and RIA results to the clinic computer via a modem.

Apart from the factors already mentioned, another reason we bought the Cyberlab system was the vendor's willingness to provide troubleshooting by phone via a modem. The company could dial directly from California into our computer in Vancouver.

While Cyberlab comes pre-programmed, the user defines and fills in desired test names, test abbreviations, normal ranges, critical values, and other basic information. Changes in worksheets and reporting forms-such as the addition of tests to the lab menucan also be made without the help of a programmer.

Here's how the system works:

An outpatient comes downstairs from the clinic to the laboratory with a test requisition filled out by a doctor. A terminal at the front desk is dedicated to accessioning. If the patient has been in before, all we do is enter his or her chart number and the demographics appear on the screen. For a new patient, we enter the chart number, name, date of birth, and other demographics.

A unique accessioning number is assigned to the patient, and we enter the tests that have been requested. As soon as we verify that the data are correct, specimen labels are printed out. The computer can also automatically generate collection lists, worksheets, and load lists for automated instruments, at our request.

(We obtained a labeling modification from CCA. Originally, the system printed only one test per label; now all ordered tests are printed on each label.)

Two other terminals enable us to review automated hematology and urinalysis results. Once these results are verified, they are transmitted to the laboratory information system. Results from other areas are also entered into the LIS where they are collated under the same accession number and merged with the patient's demographics. The LIS searches for any other pending results, such as on a microbiology test ordered two days earlier, and adds them to the report as well. Through a dedicated fourth terminal, we send the results to the clinic's computer. Interim and cumulative reports are generated individually or in batch, upon request.

Our laboratory-clinic custom interface insures that the right results are transmitted to the right patient's chart by verifying that several checkpoints match in laboratory and clinic information about the patient. These checkpoints include the chart number, a discrete check letter following the chart number, and the patient's name, age, and sex. When any of these do not match, the transmission of results is rejected and an error message appears on a laboratory printer. The message states the specimen number and the item of information that did not match. We are also told whether the fault lies with the laboratory or the clinic.

We collect specimens for tests to be performed by our parent laboratory and send them by courier together with the requisitions and labels. Results are transmitted from that lab's Prime 9755 computer (using software that was developed by the parent company under PRIMOS/Information operating system to the clinic. We receive copies of the test reports by courier, and we double-check that all results sent from the parent laboratory have reached t computer.

Ideally, the next stage within the clinic would be for the doctors, who all have terminals in their offices, to actually request tests on their clinic computer. Then these requests could be downloaded to the laboratory computer, saving us the trouble of laboriously entering patient demographics and test requests. This would also eliminate the possibility of order-entry errors in the laboratory.

One future goal is to establish a direct link between the clinic/laboratory computer system and the local area network at Vancouver General Hospital. Then, when clinic patients are admitted to the hospital, we could transmit data to their medical records. We also hope to transmit patient data to the hospital emergency room.

Computerization opens up many possibilities.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Title Annotation:laboratory information system
Author:Basi, Andy
Publication:Medical Laboratory Observer
Date:Mar 1, 1989
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