These systems often must interface with instruments and other information systems such as hospital information systems HIS An LIS is a highly configurable application which is customized to facilitate a wide variety of laboratory workflow models Deciding on an LIS vendor is a major undertaking for all labs Vendor selection if done properly should take months of research and planning Installation takes from a few months to a few years depending on the complexity of the organization These are complex software applications which comprise hundreds of tables and critical definitions to build validate and maintain There are as many variations of LISs as there types of lab work Some vendors offer all components others specialize in specific modules Disciplines of laboratory science include hematology chemistry immunology blood bank Donor and Transfusion Management surgical pathology anatomical pathology flow cytometry and microbiology This article mainly covers clinical lab which encompasses hematology chemistry and immunology
Contents hide Basic Operation Order Entry and Check In Specimen Receiving Send Test Orders to Analyzers Results Entry Lab Reporting Basic Features Additional Features Types External links
edit Basic Operation Laboratory Information Systems are often part of an integrated informatics system which involve many disparate applications Use of an LIS is a critical piece of the clinical IT spectrum of systems and contributes significantly to the overall care given to patients The LIS is used in inpatient and outpatient settings and in many cases is designed to support both From an outpatient/ambulatory perspective LIS interaction frequently begins after a physician has arrived at an initial diagnosis For example a patient enters the hospital looking pale and complaining of fatigue The physician suspecting anemia might decide to order a complete blood count CBC In an inpatient setting when that patient is admitted into the hospital the system is called upon often by many in the healthcare industry to order tests provide specimen processing assistance receive the results from instrumentation and report on the patient testing in a timely and easy to review manner
edit Order Entry and Check In
An order is placed in the system usually by a physician physician's assistant nurse office clerk or laboratory technologist The order or lab request contains a request of tests to be performed In many cases each order is tracked with a unique identifier This identifier which is usually a number is called many things by many systems and is most prominently referred to as an accession In this hypothetical case a CBC is ordered which is a panel of sub tests including white blood cell count red cell blood count and other blood-related [[tests
A phlebotomist will be called upon to collect the specimens from the patient Often different specimens will be collected so as to provide a different tubes with a specific cap color for each analyzer that will process the samples In this case the appropriate specimen Lavender top tube is taken from the patient labeled with a bar code specimen label produced by the LIS The LIS will print barcoded labels with the unique accession for the draw tubes In some cases more advanced LIS products will also provide a unique identifier for each specimen This provides the ability to track at the specimen level the chain of custody from the point it is taken from the patient to the point that it gets discarded The specimen-accession-patient hierarchy is linked in a tree like numeric structure In other cases the patient is identified by a Patient-ID and the Sample-ID is linked to the patient's demographic record through the Patient-ID
edit Specimen Receiving
After the specimen is collected it is sent/brought to the appropriate lab for processing typically in a batch This event should be recorded in the LIS Upon reception in the appropriate testing lab either manual or automated lab work can begin CBCs are performed by automated analyzers
edit Send Test Orders to Analyzers
Most LIS systems can be configured to download the specimen data to an analyzer either after the order is placed or when a specimen is received in a testing lab When the barcoded specimen is read by the instrument the unique ID is read off the specimen label and matched with the order previously downloaded to the instrument This system is often called Batch Download A more efficient system is called Host Query where the instrument reads the barcode on the specimen and queries the LIS for the test orders The LIS will be listening on a communication port for queries and will download the requests only when required
edit Results Entry
When results of lab tests are available they are entered into the system manually or automatically downloaded from an instrument Once these results are double checked by the medical technologist or autoverified they are released Released results are often automatically printed to lab reports which are delivered to the attending physician LIS systems often provide additional resulting functions and patient care assistance by providing Delta Checking and Reflex Testing functionalities
edit Lab Reporting
Lab Reports are the final output of all LIS systems and in many cases the primary LIS interaction with healthcare professionals outside of the lab They can either be printed or faxed in paper-based labs or delivered via email file or HL7 interface in paperless installations The degree to which an LIS supports customizable lab reports and flexibility in modes of delivery of results is one major factor in determining its success in the marketplace
edit Basic Features
Laboratory Information Systems commonly support the following features:
Patient Check In Order Entry Specimen Processing Results Entry Reporting Patient Demographics Physician Demographics edit Additional Features In addition LISs commonly support the following:
Web based order entry Web based results inquiry Faxing and emailing of lab reports Custom report creation HL7 interfaces with reference labs and EMRs Preliminary reporting Final reporting Med tech worksheets Workload balancing Medicare medical necessity checking Billing Public health reporting Rule engines edit Types There are many laboratory disciplines requiring the support of computerized informatics These include:
Hematology Chemistry Immunology Blood bank donor center Blood bank transfusion Surgical Pathology Anatomical Pathology Cytology Cytopathology Microbiology Flow cytometry