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Fighting resistance, many use PCs in wise and creative ways.

Laboratorians "have a barrier," says Lee Barbieri, operations director of hematology and transfusion services at Duke University Medical Center, "They look at a computer as a specific-use tool, like a miter box rather than a handsaw. A handsaw is a versatile tool that can cut rough wood or fine wood or do a corner. A miter box, on the other hand, has one function: to cut an angle."

According to MLO's 1991 survey of computer use, laboratory professionals use their Macs, IBMs, and clones mainly as specific-use tools. They select tasks from a list of priorities that includes (in descending order of popularity), word processing, quality control, workload recording, quality assurance, test result reporting, instrument interface, information (text) files, budgeting, database management, and archiving. Most of those jobs can be done with a manual typewriter and a pocket calculator.

* 'I hate computers.' "I am not an old, obsolete MT," says a veteran technologist who manages a physician office laboratory in Utah, "but I am not convinced that a PC will do much more than 'pretty up' things like reports or memos. That is nice, but not really cost-effective. How much is 'pretty' worth if it does not help the physician?"

This skeptical laboratorian, who does not use a PC, adds, "Most home applications of PCs beyond word processing actually take longer--and the PC certainly costs more than a checkbook register or receipt cards."

Such rejection of PCs is not uncommon. Larry V. Gibbs, laboratory education and quality assurance coordinator at Nashville Memorial Hospital in Madison, Tenn., notes that his lab's PC is currently used only to download QA data. "By the end of the third quarter of this year, an upgrade in the LIS will be in place," he says. "This will allow direct access of data from the LIS. The need for a PC in the future is questionable."

"We in the chemistry section use our antique PC for spreadsheets only," says the chemistry supervisor at a large Midwestern medical center. Since her lab has a popular brand of LIS, "our need for PCs is not that great," she feels. Besides, she says, "We have tried to receive [administrative] approval for upgrades but have been turned down."

That experience is echoed by Kenneth Nodes, a clinical chemist at St. Vincent's Charity Hospital in Cleveland. "Once an older computer is in place, it is very difficult to justify replacement with a newer model," he says, comparing an old XT-style model with its 8088 microchip to a newer and faster PC based on an 80386 or 80286 chip. An 8088 cannot be used to full capacity with today's programs, he concludes.

Recent boosts in PC storage capacity (and in software that requires a great deal of it) have made earlier equipment increasingly obsolescent, notes William R. Hliwa Jr., clinical assistant professor in the department of medical technology, State University of New York at Buffalo. "The perfectly adequate 5-mb hard disk of six or seven years ago will today barely be able to host even a single application such as WordPerfect or Harvard Graphics," he says. Requesting funds for a machine with a minimum storage of 100mb, Hliwa believes, is the answer. In many labs, such requests are more easily made than granted.

"We need more PCs in our lab, but sometimes it's hard to get them in the capital budget," says John J. Palmer, laboratory manager at City of Hope National Medical Center in Duarte, Calif. "Either there aren't enough funds or other equipment has priority."

Resistance to change and lack of money continue to limit PC use, notes one survey respondent. "PCs will become more effective tools once the 'old' pathologists and lab directors have accepted them in the workplace," says Lois Friia, assistant administrative director of pathology at Franklin Square Hospital Center in Baltimore. "Presently PCs are seen as glorified typewriters needed only by clerical and secretarial staff. Interested staff members often have to purchase a system for home and do all training independently, on their own time, even though their hospitals and labs benefit from it."

* 'I love computers.' Just as personal interest and dedication drive many technologists to enter the clinical laboratory field, many learn about computers because they love them and believe they will bring many benefits to the laboratory.

According to Ann A. McCabe, supervisor of the patient services center and support services at SmithKline Beecham Clinical Laboratories in San Francisco, "A few of us have PCs at home and use them for data relevant to our positions. I run the float crew--four techs, five to six phlebotomists, 45 labs or draw stations, and 60-plus people altogether. So I keep personal data: names and addresses of personnel in each place and a current update of floater notes per location."

"Since we're a small independent laboratory," says a Texas lab manager, "getting any hardware has been an uphill struggle." This survey respondent's PCs are labeled "hand-me-downs" obtained from physicians and modified to suit. "I bought most of the software myself because [purchasing] it was not approved by the board of directors. Computer literacy has come very slowly to some clinic doctors and not at all to others."

"I must do a great deal of work on my PC at home because I can't do it at work," says the chief technologist at an independent lab in the West. "This does not make me or my family happy, yet it is expected by my manager, who doesn't know how to use a PC and doesn't want to learn."

According to JoAnn Seeley, night operations manager at Doctors Clinical Laboratory, an independent lab in Cincinnati, "Too few laboratories utilize he poential of the PC systems they currently possess because no one is trained to know or understand the equipment. Most of the time, laboratory 'computer experts' are people who have taught themselves, so their knowledge is incomplete."

Laboratorians' self-directed computer efforts shine especially brightly in their efforts to develop software.

"Our staff has written our entire lab software because no one system could perform all necessary tasks," says Sharon Heritage, manager of quality assurance at SciCor Inc., an independent laboratory in Indianapolis. "I hope to see impred, easy-to-use QA/QC software become available."

Many laboratorians have wish lists of programs they would like to buy. Here are some typical observations:

No lab input. "Many labs seem to get packages that are substandard because the hospital got them without [soliciting] strong input from laboratorians," says Susan Meeboer Roberts, lab manager at the Lufkin (Tex.) State School. "We need to have efficiency in lab entry and the control of information in formats that are useful to managers."

Inflexible. "Software needs to be less 'all purpose,' which often causes labs to adapt to it unnecessarily," rather than the other way around, says Joseph T. Cortese, laboratory manager at Montefiore-Riker's Island Health Services, a prison facility in New York City.

Uneditable. "Most PC-based lab programs are incomplete," says Shawn Carroll, lab director at Allergy & Arthritis Family Treatment Center, a POL in Fitchburg, Mass. "With QC we get rough Levey-Jennings charts, but input is generally awkward, with no good editing options for a supervisor and no way to document the action taken on the bench in response to failing QC. This is a real need, especially for POLs in light of CLIA '88."

User-hostile. "Most software is geared toward the business market," says David D. DeHority, microcomputer coordinator in clinical pathology at the State University of New York Health Science Center at Syracuse. "Medical statistical packages that are user-friendly are desperately needed."

James Braun, a technologist at the Marion Health Center, a not-for-profit hospital in Sioux City, Iowa, pinpoints several needs, including "a comprehensive quality assurance program that is able to be modified to fit individual institutions and would fulfillrequirements for QA found in CLIA '88." He also asks for "a procedure manual-writing program that would stepthe user through the how, when, where, and why of the procedure and print it in a format that met the requirements of all inspecting agencies."

Another need: "expert systems, developed by instrument manufacturers, toaid in trouble-shooting laboratory instruments." Braun continues, "As more is learned about an instrument, the software can be updated to reflect the latest knowledge availble for troubleshooting."

In their search for worthwhile programs, laboratorians might turn to low-cost public domain software (shareware) more often than they do. Exactly half (50%) of laboratories represented in MLO's 1991 survey do not use shareware, but more than one-third (36%) of respondents said that they did. Fourteen percent were unsure.

* Self-help. PCs are maintained by computer-literate staff members in 37% of panelists' labs. Taken with the large number of laboratories who are inclined to buy or write their own software and do their own computer maintenance, the extent to which lab PC usage is an altruistic endeavor becomes apparent.

One negative result of so much do-it-yourselfism is that the extensive use of begged, borrowed, or downloaded programs heightens the risk of accidentially introducing viruses to the system. A discussion of that problem appears in Part I of this article.

* Enthusiasm. Whatever the obstacles, laboratorians remain passionate about their machines' capabilities. "PCs are available in all hospital departments for multitasking, and the days of paper files are virtually gone," writes the laboratory manager at a not-for-profit hospital in Washington State. "Productivity is the key word these days. PCs allow you to improve productivity along with quality and improve customer service."

"We have seen a massive increase in the use of PCs to the point where we can't exist without them," says John Palmer at City of Hope. "When we realized that use of these things was exploding, we found that we had to set up a microcomputer training support center. We now have a staff dedicated to training, software development, and purchasing."

* Training. "We have about 35 PC users in our lab. Over 20 of them have had outside training courses that cost $150 to $750," says Bruce Roberts, Ph.D., a clinical chemist and manager of microcomputers at St. Mary's Medical Center in Knoxville, Tenn. "This has been money well invested."

The data processing department at Kaiser Permanente Medical Center, a not-for-profit hospital in South San francisco, Calif., trains employees in word processing programs such as WordPerfect and in spreadsheet programs such as Lotus 1-2-3, as well as in local area networking. Says lab supervisor Rosita C. Dong, "I hope all our techs will be able to attend these classes and show interest in them. Some are still afraid of computers."

* Joke. Pathologist Robert Farnham tells a joke that illustrates a key problem: Do the people for whom PCs are obtained know how to use them?

An executive is showing off the magnificent new PC on his desk. He boasts to a visitor, "It can do everything. It has all the latest features. Would you like a demonstration?"

"Sure," the visitor says.

The executive sticks his head out the door and yells, "Hey, Shirley, come in here and show us how to use the computer."

Farnham, of Presbyterian Hospital in Charlotte, N.C., uses this story to illustrate what he calls executive syndrome: "If you have a computer and don't know how to use it, either learn or give it to someone who does."

"This is a fairly common problem," he adds. "A lab gets computers as benefits from drug companies and they wind up on an administrator's desk. The people who can use them are supervisors or on the bench and don't have access. I've fought this a lot. I nat and weedle and whine and slowly bring people around."

* CD-ROM. Laboratorians who take the time to become computer literate often avail themselves of the instruments' advanced capabilities, such as the ability to access a CD-ROM drive for research or archiving.

Disc storage. According to Kenneth Nodes of St. Vincent's Charity Hospital in Cleveland, "Our initial step into CD-ROM will probably be storing lab data as read-only files. We'll try to put a year's worth of data on CD-ROM so people can look things up without going to the mainframe and pulling tapes. As things are now, we keep everything online for four months and then start archiving to tapes and microfiche. Doctors frequently ask forinformation from six monthsago or more. Once it's stored on ROM, it can be pulled out easily."

Image archiving. Compact discs can store optical images alongside other data,lending them special importance to pathologists (see "Picture archiving on CD-ROM," page 32). An optical scanner, which records images for eventual storage on a compact disc, is the third most popular hardware item that MLO survey respondents' labs plan to add in the next two years, after a laser printer and expanded memory. The fourth most frequently planned item is a fax card.

PC-fax connection. In the realm of clever ideas by laboratorians to improve their lot, the fax card deserves special mention. Also known as a fax board, this handy devices special mention. Also known as a fax board, this handy device slides into one of the PC's expansion slots and, for as little as several hundred dollars, turns the PC into a part-time fax machine. It didn't take laboratorians long to think of applications for this accessory (see "Fax cards: Innovative link between physician and lab," page 34).

* GIGO. "Computers are great at storing and retrieving information. However, information from a computer system is only as good and complex as the information put in," says Lynn Snyder, hematology director of Mountain View Hospital in Payson, Utah, articulating the concept known as GIGO: garbage in, garbage out. If used properly, computers can help us do our jobs. There must be programs--interfaces between techs and computer systems--that are user-friendly, productive, and most important, worth the effort needed to use them."

For that to happen, Snyder says, "programmers must know the needs of administrators, secretaries, doctors, laboratorians, ward clerks, and nurses, and [must] write programs that will be valuable and useful to all of them."
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 picture archiving on CD-ROM and on fax cards for linking physician & laboratory
Author:Jahn, Mike
Publication:Medical Laboratory Observer
Date:Aug 1, 1991
Previous Article:Available in most labs, fully utilized by few.
Next Article:What has happened to patient confidentiality?

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