Microcomputers in the lab: the sudden boom.
Today, more than half the clinical laboratories in the nation use the compact data processors, compared with less than 20 per cent two years ago. That's the most striking finding in the latest survey of lab directors, managers, and supervisors on MLO's Professional Advisory Panel. Some 450 panelists participated.
Among the factors contributing to the ascent of microcomputers: price reductions in recent years, including the ultimate reduction--"giveaways" of units by diagnostics firms; improved hardware and more and better software for laboratory purposes; pressures on labs to heighten efficiency, especially under prospective payment; and the snowballing effect from word-of-mouth and published reports of user experiences in such areas as quality control, word processing, test reporting, workload recording, and management analyses. Budget restraints are the principal braking influence on microcomputer acquisitions.
Figure I shows how the trend is gathering momentum. Two-thirds of the laboratories with microcomputers obtained their first unit in 1982 or 1983, with the biggest part of the boom occurring last year. If tentative purchasing plans materialize, 80 per cent of the responding labs will have microcomputers by 1986.
The larger laboratory information system (LIS), typically based on a minicomputer, is also gaining ground. Forty per cent of the labs surveyed operate such systems, up from the 31 per cent recorded in a May 1981 MLO survey on interpretive reporting.
Breakdowns by type of computer user reveal these patterns:
* Microcomputers are in a greater proportion of hospital laboratories (nearly 60 per cent) than in independent labs (40 per cent). The likeliest site is a laboratory at a hospital with 400 or more beds--70 per cent in this category have microcomputers, versus 57 per cent of medium-size hospital labs and 48 per cent of labs at hospitals with fewer than 200 beds. By region, the Midwest and West lead the way, with microcomputers in 61 per cent of all their labs.
* Two or more microcomputers are at work in the majority of independent and large hospital user laboratories, in nearly half the medium-size hospital laboratories, and 25 per cent of small hospital labs. Six or more microcomputers are found in 13 per cent of the independents, 7 per cent of large hospital labs, and 2 per cent of medium hospital labs. In all, 241 laboratories in our survey had about 700 microcomputers.
* As one would expect, large hospital laboratories also are the top LIS operators--nearly 60 per cent have the bigger computers, compared with half the independent labs, a third of medium-size hospital labs, and 15 per cent of small hospital labs. Regionally, the North and South are a bit more active on labwide systems than the Midwest and West, a reversal of the microcomputer picture.
Four out of 10 laboratories with microcomputers also have an LIS, most frequently in large hospitals. The two types of systems cover different jurisdictions. Possessing considerable memory, an LIS more often will carry out laboratorywide programs and interface with a hospital mainframe computer. Microcomputers, on the other hand, tend toward localized uses--reporting on particular types of tests and panels, other tasks in individual lab sections, and perhaps broader activities in small labs.
There are, in fact, strict boundaries btween systems. "Our turnkey lab computer is programmed in FORTRAN," notes Holly Alexander, Ph.D., a technical consultant and scientific director of microbiology at 750-bed Wesley Medical Center, Wichita, Kan. "The software is very complex and specialized; few lab staff members have experience with this type of programming."
When a Wesley technologist wants to develop a program, it's done on a microcomputer. "The microcomputers give our laboratory the programming flexibility we need, as well as extra terminals for interfacing," Alexander says. "It's easier for the technologist to learn programming on a personal computer, and if someone makes a major mistake, it is far cheaper to repair."
In 38 per cent of all the laboratories with microcomputers, and in 60 per cent of independent labs, units are interfaced to other computers or instruments (Figure II). Nearly three-quarters of the labs report interfacing microcomputers with instruments, three out of 10 with lab information systems, two out of 10 with an outside data base, and one of 10 with a hospital information system. For an examination of how various levels of computers mesh at a 476-bed hospital, see the box on page 35.
What are the most common microcomputer applications? Quality control is an almost automatic choice--75 per cent of the microcomputer users cite QC applications (Figure III). Other major programmed functions are word processing, named by half the users, and instrument interfacing, workload recording, test reporting, and test interpretation, mentioned by 30 to 40 per cent of the users. We'll discuss these areas in more detail in Part II.
Seven out of 10 laboratories with microcomputers have them at the bench (Figure IV). Nearly a third also use them in clerical offices, and a quarter in the lab manager's officer. In 15 per cent of the labs, microcomputers are in pathologists' offices.
In labs with bench microcomputers, two-thirds of the chemistry sections have one or more, as do roughly a third of the microbiology and hematology sections, 14 per cent of the immunology sections, and 12 per cent of the blood banks. A wide array of other sections use bench microcomputers less frequently: coagulation, special chemistry, RIA, toxicology, histology, and anatomic pathology, among others.
Some of the panelists' labs have set up computer rooms, while other use microcomputers in their classrooms or training laboratory. Microcomputers can also be found in separate quality control rooms, as well as in a special assay development lab.
Because of their narrowly defined functions, microcomputers are used by a relatively small proportion of lab employees. There was a median number of 54 FTEs, including clerical staff, in labs with microcomputers. The median number of employees routinely using computers was 7.7.
At Wichita's Wesley Medical center, however, the rate of usage is somewhat higher. Some 75 laboratorians--out of a total of 250 FTEs--work with nine microcomputers on a regular basis. In chemistry, about 40 technologists on the first two shifts turn to the microcomputer for quality control. With a spreadsheet program, the hematology staff is able to project the effects of pricing changes. The immunology microcomputer is interfaced to the fluorescent-activated cell sortor. One microbiology computer is interfaced to a Bactec blood culture instrument, and another is part of a system to read MIC results. Additional units are in the LIS computer room, the director's office, and pathologists' homes. When on call, pathologists can utilize a modem interface to review test results without traveling to the medical center.
Usual methods of teaching personnel to operate microcomputers are on-the-job training and group presentations by skilled supervisors or employees, and staff instruction from manufacturer or vendor or workshops and self-study with the help of manuals are other ways of picking up microcomputer techniques.
Most of the time, but far from always, the laboratory, pays for the hardware. While 70 per cent of the labs in our survey bought all or some of their units. Figure V shows that pathologists, lab managers, supervisors, and employees also purchase microcomputers, partly for work purposes--and at nearly 40 per cent of the labs, a vendor included a microcomputer as a bonus in a diagnostics sale or as an element of a quality control system.
Steven McAtee, laboratory supervisor at Jewell County Hospital in Mankato, Kan.--which has 12 beds for acute care and 49 for long-term care--bought his own TRS-80 color computer. "It cost $700 for the system--personal computer, printer, and software--but it has been well worth the money," McAtee says. At home, he runs his self-designed programs for workload recording, inventory control, and word processing. When the lab has especially heavy demands for the computer, he packs it up and brings it to work. He bought the TRS-80 in 1983, but before then he used to run off the hospital laboratory's workload recording program at the high school where he took his first computer course.
Diagnostics suppliers may give microcomputers to labs or lend them out for the term of a contract on one or several of their products. Many panelists point out that nothing is truly free: Reagent prices are often higher to offset the microcomputer bonus. But an education coordinator at a large Atlanta hospital, whose laboratory acquired an Apple IIe through a one-year reagent contract, notes that a direct microcomputer purchase would not have been approved.
Some laboratories base their choice of reagent vendor on how good a computer deal they can get. "We had a microcomputer in mind and shopped around for the best package," a chief technologist at a Michigan hospital says.
Apple models, led by the IIE, turn up most frequently in laboratories, followed by IBM PCs and the Radio Shack TRS-80 line. Then come Hewlett-Packards and Commodores, along with a variety of other brands cited less often by panelists.
What guides a lab's selection of a particular microcomputer? The major reasons, ranked by how widely they were cited in the survey, are the computer's inclusion in a contract to purchase reagents, an attractive price, the availability of useful software, the versatility of the computer, its compatibility with other systems in the lab, expansion possibilities, ease of operation, and the manufacturer's reputation.
The capacity of the microcomputer's main memory is 64K in most cases (Figure VI). Disk drives are used with microcomputers by nearly all labs; some also employe cassettes. Eight out of 10 have monitors with their microcomputers; two-thirds have standard printers; and four out of 10 have letter-quality printers. About four out of 10 possess word processing systems. A like proportion use telephone modems to interface with units outside the lab.
Forty per cent of the labs spent less than $5,000 for all their microcomputer hardware. Another 27 per cent acquired their microcomputers and accessories for less than $10,000. At the high end of the scale, 7 per cent reported spending more than $30,000.
Prospective payment gives rise to a Catch 22 situation with regard to hospital lab acquisition of microcomputers. On the one hand, data processing systems are more essential than ever, not only to handle many tasks with greater efficiency but also to monitor DRGs and their consumption of resources. On the other hand, administrators may reject a microcomputer purchase because of limits on resources imposed by DRGs.
Jeanette Walter, assistant chief technologist at Community Hospital in McCook, Neb., comments that the only way her laboratory might acquire a microcomputer is to demonstrate that it will pay for itself. "Unfortunately, I doubt it's possible to do this in a 56-bed hospital. The hospital recently purchased a microcomputer for purchasing and pharmacy, but I don't see the laboratory getting one in the near future."
Many respondents, however, expect prospective payment to boost their chances for a computer purchase. "Our hospital realizes it must get computers into the DRG game in order to play it," says Wesley Kriedemann, administrative director of laboratories at 282-bed St. Joseph Hospital in Elmira, N.Y., A microbiologist at another New york hospital similarly states that DRG accelerated computerization in her institution.
George M. Brake, chief technologist at 248-bed Craven County Hospital in New Bern, N.C., says: "One of the things a laboratory computer system can do is reduce the patient's length of stay by cutting turnaround time and improving communication between the lab and nursing units."
He explains that computers can reduce the problem of duplicate orders and draws, speed up the processing of specimens, and minimize transcription errors. Then there's the biggest time-saver: "Once the test is done, the data are available instantaneously to nurses and physicians, via the hospital information system. Decreasing each patient's stay by even one tenth of a day represents a lot of money and will justify the purchase of any computer on the market."
One West Coast technologist really took matters into his own hands. He built a microcomputer--a Heath Zenith H100--for his microbiology section. As a ham radio operator, he was experienced in assembling Heath kits.
"It cost $1,000 to build, but I got a 128K microcomputer, a disk drive, and a printer for my money." He had previously constructed a monitor that he was also able to use with the computer.
Knowing the computer inside out, as he does, is invaluable when something goes wrong. "I do my own repairs for very little money, and I don't have to wait days for a service representative."
Thus far, this enterprising technologist has designed programs for quality control, instrument maintenance, and epidemiology. That last one enables the lab to pinpoint the foci of nosocomial infections and monitor their spread.
One way or another, microcomputers are continuing their march throughout the clinical lab. In Part II, which follows, we'll explore in detail the work they do once they arrive in a lab.
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|Title Annotation:||Part 1|
|Publication:||Medical Laboratory Observer|
|Date:||May 1, 1984|
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