How to tell when it's time to replace your laboratory computer.
* Response time. If there is one universal sign of computer problems, it is poor response time. Response time delays are often seen during work at video display terminals (VDTs). Typically the user notices the change while waiting for a reaction after data entry, such as the appearance of the next prompt asking for the next set of data.
Response time delays are analogous to fever in providing a sign that something is amiss without indicating the cause. In complex systems such as laboratory computers, this condition doesn't always signal a need to replace the system. The cause might be any of numerous software and hardware situations, many of which can be fully corrected--after which the system may return to acceptable performance standards.
In other cases, basic limitations of the system preclude improvements in response time, especially if the cause is increasing volume over the years coupled with an inability to expand the system configuration (hardware). This condition is often the case with certain older laboratory computer models. Use of outdated technology severely limits growth in CPU power and main memory. The situation is associated with bulky equipment that requires significant computer room floor space, such as disk drives with small storage capacity.
Furthermore, earlier versions of software were harder to set up and maintain. In our laboratory, for example, the last system included a maximum of 2 megabytes of main memory. The disk drives, with storage of 880 Mb, consumed 32 square feet of prime floor space in the computer room, not to mention access of two or three feet around each of the seven cabinets for maintenance.
When we purchased this system, it was considered one of the best available and was reputed to have the largest number of installed systems for labs processing a medium or large volume of tests. We were very pleased with its performance for about six years. Nevertheless, computer technology changes rapidly. Hardware shrinks, yet becomes more powerful, while capabilities multiply. New software designs provide more features and facilitate use of the system by those who are not computer specialists. We used the system fairly happily for three more years. Meanwhile we were looking around for something better.
* Print bound. A second symptom of impending computer insufficiency is a condition known as being "print-bound." This situation occurs when there isn't enough time in the day or capacity in the printers to print the various types of reports requested by laboratory and hospital personnel. Besides patient report printing, which is the computer's primary reporting mission, other types of available reports may include test volume and revenue statistics, epidemiology data, CAP workload data, laboratory test logs and pending logs, culture review reports, and abnormal reports, among others.
Computer users quickly learn that laboratory computers can provide many useful and informative reports. While attempting to accommodate all requests for printing reports, our computer personnel learned after a few years that even with two and later with three high-speed line printers, it was still not possible to print all the desired reports within the requested schedule framework.
Many of these reports have long print times, typically several hours, some of them preceded by several more hours in which the computer must sort and format the data before printing can begin. Occasional special needs included such matters as a request by the hospital epidemiologist that her reports be sorted in four different ways--thus requiring four times as much printer usage.
Before obtaining approval to replace a computer system, laboratories may need to find ways to reduce their scope of report printing. Our first step in this direction was to try to learn which reports were being used only minimally, or perhaps not at all. We had realized through experience that some reports had been requested with the best of intentions, then would remain essentially unused because they did not serve the intended purpose or because the person who asked for them did not have time to study them. Most such individuals, once identified, were willing to forgo reports when we explained the problems with our print schedules.
* Number of complaints. Another means of determining the true utility of a report occurs when for one reason or another, it stops being printed. If the intended recipient promptly seeks out computer personnel to determine why there was no report at the expected time, that sends a strong signal concerning its usefulness. If no one ever inquires, further checking may indicate that there is no reason to continue printing the report.
An example of this latter case occurred at our hospital when we found it burdensome for the system to continue printing the afternoon unit report, which displayed the day's test results. The report took several hours to print, during which the system response time lagged noticeably. It also interfered with other reports needed in the afternoon, especially the microbiology supervisory review report. Whenever this latter report was late, microbiology personnel would track down the computer operator and wait for their report. It was clear that a genuine need existed.
We suspected that unit reports had become unnecessary. Whenever the report was delivered late, we noticed that we received few complaints from the nursing units. Later, when computer terminals capable of displaying laboratory results were installed at the nursing units, very few questions arose when report printing was occasionally canceled. As it became apparent that the system was no longer capable of printing this report anyway, we sent a message to each nursing unit explaining that we could not print this report anymore, and stopped printing it the following week. Receiving not a single telephone call or other inquiry from the hospital staff proved to us that the report had outlived its usefulness.
* Storage. Another area of computer insufficiency can become evident during attempts to archive data for long-term storage, particularly in microfiche. If data are stored on magnetic tape that is not especially formatted for microfiche, older systems may not have the capability to reformat for microfiche storage. Even if they do, they may not have the power to process archived data for microfiche without severely restricting other users of the system. In our case, after amassing outpatient results on several hundred magnetic tapes that were not formatted for microfiche, we determined that use of microfiche would be a more convenient and less space-consuming form of storage.
One of the major advantages that our laboratory expected to derive from a computer system was the efficiency and availability of retrieving archived data from microfiche. As the lack of throughput of our computer over time limited our ability to retrieve data from tape, we found after several years that we could no longer print reports from tape on the day shift when we received calls from physicians' offices. As time went on, it became possible to print these reports only on weekends. This situation severely limited our ability to respond to physicians' needs for such data in a timely fashion.
We therefore purchased software from our computer vendor that would write outpatient data to tape in a format compatible with microfiche. The plan was to send these tapes to a microfiche vendor to convert the data stored on the tapes to microfiche cards. After the software was purchased, however, we learned to our chagrin that our capacity and throughput problems were limiting our ability to use the software.
The outcome was that we were forced to wait until our new computer was in full operational use and keep the older system running simultaneously in the computer room so that we could obtain our microfiche tapes from it before disposing of the older hardware. The inability to use the microfiche software before the system was deactivated for operational use was another indication of our need to change to a faster, more powreful system that would provide greater capacity.
Laboratory personnel deciding whether to replace a laboratory computer are often swayed to say yes by their awareness of the many desirable features available on the newer generation of systems that older computers either do not support or cannot run due to insufficient power. These attractive features include a turnaround time report to measure elapsed time for the laboratory to report Stat specimens on an average basis.
When we were making our decision, our laboratory was using a program written in Basic to run on a personal computer (PC). It was very effective, but data collection and entry took several hours. Newer, more powerful laboratory computers can perform this function in "background processing" without additional labor on the part of the laboratory staff. Other features of potential interest include support for bar coding for specimen labels and use of laser printers for patient reporting.
The newer computers for laboratory computer operations staff and other lab personnel use database software. Using this software offers two important benefits. First, it permits the database to be created with English language entries rather than in hexadecimal code or other methods considered arcane by non-computer personnel. Second, it allows the staff of each laboratory section to enter that section's methodology requirements into the system before it becomes operational--a factor providing the twin advantages of involving the lab staff in computerization and releasing the system manager for more technical tasks. When difficulties occur after the system is "live," members of the laboratory staff may recognize them promptly because they became more familiar with database manipulations during the installation period.
In certain laboratories it may be necessary to keep the old and new systems running simultaneously. Perhaps the laboratory staff does not fully accept the new system right awawy after experiencing initial difficulties in using it. Another reason, which was the case at our site, is the need to archive existing patient data residing in the older system. Since we had been unable to convert our data in the old system to microfiche while it was in operational use, we were forced to plan two separate installations: first, with both systems compressed into the computer room, and later, with the new computer hardware modified for a significantly altered layout after the old system was gone.
This process required two separate installation plans. When both systems were running, they were crowded into the room in a manner that left little space for access to the equipment cabinets for maintenance and other ordinary needs. We had no reasonable alternative, however, because both computers required the environmental conditions and security that only the computer room offered. We were forced to delay installation of the uninterruptible power supply we had purchased with the new system because of its bulk; it occupied three cabinets. It took approximately six months--about three times our original estimate--to convert our outpatient data to microfiche-compatible magnetic tape.
* Disposal of old equipment. Once you have decided to replace your computer, how can you dispose of the old hardware and software? Local hospitals in your area that still use the same model may be interested in buying parts of the old system. Some vendors are willing to buy used equipment. We were able to sell everything, although our hospital did not receive any significant sums from the sales. As far as we could tell, the going rate for equipment is about 1% of its original list price. On the other hand, if we had been unable to sell it, the hospital would have been forced to pay someone to remove it from the premises.
Before disposing of an old computer, make sure you have erased the operating system, application programs, and patient data. Almost all vendors of laboratory software retain ownership of their programs, which are merely licensed, not sold, to users. Therefore it is incumbent on laboratory personnel to insure that data on disk packs and backup tapes are erased before turning over the equipment to a purchaser. For the sake of patient confidentiality and to protect the hospital from liability, all patient data must be deleted.
* Out of steam. Laboratorians suffering under the conditions described in this article may have to face the fact that their LIS has run out of steam. If so, the sooner plans are under way to find a replacement, the sooner they will meet the expectations of laboratory and hospital staff for effective data processing support.
Stephen L. Stadler is manager of laboratory services at Thomas Jefferson University Hospital, Philadelphia, Pa.
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|Title Annotation:||Computer Dialog|
|Author:||Stadler, Stephen L.|
|Publication:||Medical Laboratory Observer|
|Date:||Mar 1, 1992|
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