A system of computer-generated laboratory reports for clinical use

A hospital medical care system can usefully use many more reports than are usually output by laboratory information systems. Scheduled reports include: (1) current reports by ward, service, attending, and ad hoc groups; (2) cumulative reports; (3) laboratory records. Many other classes of reports are feasible in a computer-based system.     

Format change of a laboratory test order form affects physician behavior

Purpose

Our study was designed to find whether a change in physician ordering of laboratory testing could be obtained by the simple strategy of changing the set-up of the check-box laboratory order form that is embedded in a computerized medical record.

Methods

This prospective intervention study was undertaken in Maccabi Healthcare Services, a Preferred Provider Organization that has used a computerized medical record since 1992. We examined data from 865 primary healthcare physicians over 3 years. In May 2005 we changed the order form and reduced the number of tests that can be ordered using a check-box form from 51 to 26. Twenty-seven tests were removed from the form and two tests were added. The total number of laboratory test orders and the median rate of test orders per visit to physician during each of the study periods were calculated separately for each test.

Results

Tests that were added to the computerized laboratory order form showed an increase of 60.7% in the first year and a further 90% increase in the following year. For the unchanged tests the percentage changes over the same periods were +18.4% and −22.4%. For the deleted tests the change was −27% and −19.2% for the respective years.

Conclusions

Changes in format of laboratory test order forms can change physician test ordering and may be useful together with other interventions to improve appropriateness of laboratory testing. A thoughtfully built test ordering form can reinforce clinical guidelines for the performance of some preventive testing and follow-up.     

Computer-printed labels for efficient processing of clinical specimens

Computer-printed labels are useful in laboratory collection of clinical specimens to provide: (1) control of the collection; (2) verification of input request; (3) reporting of non-collected specimens; (4) intra-laboratory routing of specimens; (5) reduction in input errors; (6) improvement in reporting speed; (7) overall reduction of laboratory costs.     

Clinical laboratory data processing with a central hospital computer

A system for storing, retrieving and organizing laboratory test request and result information within the biochemistry, hematology, immunology, microbiology and urinalysis sections of a large clinical laboratory is described. All data files are maintained in a central hospital computer system separate from the laboratory. Specific items of information as well as various groupings of data can be retrieved in real-time by laboratory technologists and clinicians. Schedules, batch processing routines are used to produce more complex reports which are not required at a moments notice. Critical factors in the design of such an information handling system are discussed.     

Efficiency and cost of primary care by nurses and physician assistants.

We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints--respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs--including practitioner time and charges for laboratory tests and medications--were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs.     

A system for graphical display of clinical laboratory data

Although in referral medical centers, laboratory tests related to patient management decisions may be more numerous than tests used for diagnostic decisions, little emphasis has been placed on the development of decision support systems that focus on laboratory tests in management decisions. Many of these decisions hinge on time-related series of laboratory test results. Graphical presentation of such data might be a more effective means of facilitating patient management decision making than is the conventional tabular report. The authors developed an easily used system for the graphical display of time-related laboratory results. The system presents the physician a convenient and rapid means of selecting the patient, test, and time period of interest, and provides a number of different graphical display formats. Physician acceptance of the display system has been enthusiastic. Careful attention to human factors considerations may promote physician acceptance of computer-based aids of this form.     

高致病性禽流感实验室检测能力评估体系的建立

目的 建立高致病性禽流感实验室检测能力评估指标体系,以规范评价目前我国禽流感检测能力状况,提高检测能力.方法 结合德尔斐法和层次分析法,构建可全面评价高致病性禽流感实验室检测能力的量化评估体系.结果 建立了以质量管理、实验室设置、仪器设备、人员、检测能力、生物安全、能力验证活动为一级指标的量化评估体系.结论 所建立的量...     

An ideal of future medical technologist and a relation with clinical laboratory physician

As most important things one of medical care system reform of Japan, improvement of the medical treatment related of job was taken in. When it is accompanied to "An ideal of future medical technologist and a relation with clinical laboratory physician" from the meaning, it is necessary to just meet it and in needs at first to be clinical, does the basis with EBM early and time. In addition, it promotes the purchase of economic reagent/articles of consumption than it considered a medical care reward mark while taking that effective medical treatment of patient standard is demanded into consideration and introduces a system of ISO15189 of clinical laboratory. It is necessary for the charm that can support education more and research to aim at a certain medical technologist. Therefore it is for medical technologists to contribute to medical treatment while taking cooperation to be a clinical laboratory physician.     

Meeting regulatory requirements by the use of cell phone text message notification with autoescalation and loop closure for reporting of critical laboratory results

Critical laboratory results require timely and accurate transmission to the appropriate caregiver to provide intervention to prevent an adverse outcome. We report the use of text messages to notify critical laboratory results in a large teaching hospital to manage the documentation and audit requirements of critical result reporting by regulatory agencies. The text messaging system (critical reportable result health care messaging system [CRR-HMS]) allows a receiver to acknowledge or reject a critical result by short message service reply. Failure to obtain a confirmatory receipt within 10 minutes produces an automated escalation to an alternative physician according to a roster. The median time required for physician response decreased from 7.3 minutes to 2 minutes after implementation of the CRR-HMS. The CRR-HMS is a clinically useful tool to rapidly communicate critical results to targeted physicians to facilitate rapid and timely intervention. This feature seems to be an important laboratory process mediator, and recent Joint Commission reviews have placed this as a requirement.     

The impact of computerised physician order entry systems on pathology services: a systematic review

PURPOSE: Computerised physician order entry (CPOE) systems hold the promise of significant improvements to health care delivery and patient care. The implementation of such systems is costly and complex. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services. METHODS: This paper presents a review of the literature (1990-August 2004) about CPOE systems and identifies indicators for measuring the impact of CPOE on pathology services. RESULTS: Nineteen studies which contained some form of 'control' group, were identified. They featured a variety of designs including randomised controlled trials, quasi-experimental and before and after studies. We categorised these into three groups: studies comparing pathology CPOE systems (with no decision support) to paper systems; pathology CPOE systems (with decision support) to paper systems; and pathology CPOE systems with specific pathology features compared to systems without those features. We identified 10 areas of impact assessment and 39 indicators used to measure the impact of CPOE on different stages of the pathology test ordering and reporting process. CONCLUSION: We conclude that while some data suggest that CPOE systems are beneficial for clinical and laboratory work processes, these data are limited, and further research is needed. Few data are available regarding the impact of CPOE on patient outcomes.     

Consulting work performed by the hospital laboratory: the usefulness of the laboratory information office in Tenri Hospital

We introduced a consultation process to the clinical laboratory in our hospital. The laboratory information room has been installed for three years in the hospital, and all questions concerning the laboratory tests are received. A clinical laboratory physician and an experienced medical laboratory technician address any complex or technical questions. The clinical laboratory physician is necessary in the laboratory information room because of his or her knowledge of the clinical tests based on clinical experience, and his or her knowledge of the aspects of epidemiology and laboratory management. Clinical experience is especially necessary to communicate between doctors and nurses and medical laboratory technicians. Because managing the business of the laboratory information room by a clinical laboratory physician alone is unrealistic for a lot of hospitals, most laboratory information room must have several medical laboratory technicians and a few clinical laboratory physicians to cooperate with them and help their work.     

Optimal utilization of the laboratory in making clinical decisions

The clinical laboratory is an essential component in the medical care system, and laboratory information is necessary in many clinical decisions. There is no inherent conceptual reason why laboratory information should be used any differently in the decision making process from the information collected by the physician himself, but there are logistic and economic factors that prevent this. The laboratory can be considered an information system, and the performance of the entire system depends upon the effectiveness of each of the sequential steps in the information generating process. Optimization of laboratory utilization requires the identification of explicit criteria regarding when laboratory tests should be used and the development of methods to insure that the resulting data are utilized properly.     

The brain-to-brain loop concept for laboratory testing 40 years after its introduction

Forty years ago, Lundberg introduced the concept of the brain-to-brain loop for laboratory testing. In this concept, in the brain of the physician caring for the patient, the first step involves the selection of laboratory tests and the final step is the transmission of the test result to the ordering physician. There are many intermediary steps, some of which are preanalytic, ie, before performance of the test; some are analytic and relate to the actual performance of the test; and others are postanalytic and involve transmission of test results into the medical record. The introduction of this concept led to a system to identify and classify errors associated with laboratory test performance. Errors have since been considered as preanalytic, analytic, and postanalytic. During the past 4 decades, changes in medical practice have significantly altered the brain-to-brain loop for laboratory testing. This review describes the changes and their implications for analysis of errors associated with laboratory testing.     

Good laboratory management and clinical laboratory physician

Medical expenses have been increasing annually, and reducing expenses while maintaining effective medical care is desirable. In the late 1990s, Japanese government introduced policies expected to improve the medical security system. In the clinical laboratory field, some revisions such as packaging of certain tests(blanket test), separation between performance and interpretation fees for laboratory test, proper use of tumor markers, and additional fees for sample management. Japanese government also wants the clinical laboratory to return accurate laboratory test result to patients and physicians. Laboratory physicians have to make a great effort to manage clinical laboratories according to the guideline for GIOs of laboratory physicians from the Japanese Society of Clinical Pathology. The laboratory physician is the key person for good laboratory management.     

Centralization of all medical laboratory data by laser disk filing system

In recent years, the medical laboratory system is being widely applied. We describe the medical laboratory system of our Saga Medical School Hospital, including the electrocardiogram (ECG) and electroencephalogram (EEG) laser disk data filing systems. The main computer system of FUJITSU M-730/4 (main memory of host computer 13 MB) handles a large amount of data, in the fields of chemistry, hematology, serology, microbiology, blood banking and histology laboratory. All 17 chemistry and hematology automatic analyzers are linked through communication lines to the main computer. The important tasks of this system are data processing, storing of information in the database, data reporting and quality control statistics. This laboratory system is also connected to the total hospital information system of FUJITSU M-760, main memory 48 MB. For pattern recognition, ECG and EEG laser disk data filing systems have been constructed. The main purpose of these filing systems is mass storage of analog data signals in laser disk, computer assisted analysis and data communication. ECG and EEG analog data are converted into digital form by the analog-to-digital converter, and then transmitted over hospital telephone lines to the central computer system for analysis. The computer assisted statements are then sent back to the ECG terminals at the nurse station. As necessary, after the physician reads over the ECG, statements are printed in the final reports. These optical reporting systems are also linked to the total hospital information system. One of the main tasks in the laboratory is the control of the seemingly endless paper work.(ABSTRACT TRUNCATED AT 250 WORDS)     

International standards for tuberculosis care: relevance and implications for laboratory professionals

On World Tuberculosis (TB) Day 2006, the International Standards for Tuberculosis Care (ISTC) was officially released and widely endorsed by several agencies and organizations. The ISTC release was the culmination of a year long global effort to develop and set internationally acceptable, evidence-based standards for tuberculosis care. The ISTC describes a widely endorsed level of care that all practitioners, public and private, should seek to achieve in managing individuals who have or are suspected of having, TB and is intended to facilitate the effective engagement of all healthcare providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative and extra-pulmonary TB, TB caused by drug-resistant Mycobacterium tuberculosis and TB/HIV coinfection. In this article, we present the ISTC, with a special focus on the diagnostic standards and describe their implications and relevance for laboratory professionals in India and worldwide. Laboratory professionals play a critical role in ensuring that all the standards are actually met by providing high quality laboratory services for smear microscopy, culture and drug susceptibility testing and other services such as testing for HIV infection. In fact, if the ISTC is widely followed, it can be expected that there will be a greater need and demand for quality assured laboratory services and this will have obvious implications for all laboratories in terms of work load, requirement for resources and trained personnel and organization of quality assurance systems.     

Physician satisfaction and emergency department laboratory test turnaround time.

OBJECTIVES: To determine the length of time for the components of the emergency department (ED) turnaround time (TAT) study in 1998 and to ascertain physician satisfaction concerning laboratory services to the ED. METHODS: Using forms supplied by the College of American Pathologists Q-Probes program, participants conducted a self-directed study of ED TAT over a 4-week period. Data requested included various times of day associated with the ordering, specimen collection, laboratory receipt, and result-reporting stages of stat ED TATs for potassium and hemoglobin. Additionally, practice-related questions associated with the laboratory were asked. Participating laboratories also provided a physician satisfaction survey for up to 4 physicians who were users of ED services. Results of both the TAT study and the physician satisfaction survey were returned by mail. Participants were drawn from the 952 hospital laboratories enrolled in the 1998 College of American Pathologists Q-Probes study on ED TAT. The main outcome measures included the components of the ED TAT process, factors associated with decreases in ED TAT, and the results of the physician satisfaction survey. RESULTS: Six hundred ninety hospital laboratories (72.4% response rate) returned data on up to 18 230 hemoglobin and 18 259 potassium specimens. Half of these laboratories responded that 90% of potassium tests were ordered and reported in 69 minutes or less, whereas the TAT for 90% of hemoglobin results was 55 minutes or less. Comparison of the components of TAT for both potassium and hemoglobin with similar studies done in 1990 and 1993 showed no change. Factors found to statistically contribute to faster TATs for both tests were laboratory control of specimen handling and rapid transport time. When whole blood specimens were used for potassium determination, TAT improved. Emergency department physicians chose the study-defined lower satisfaction categories of Often, Sometimes, Rarely, and Never for the questions concerning the laboratory being sensitive to stat testing needs (39.1%) and meeting physician needs (47.6%). Many of the physicians surveyed believed that laboratory TAT caused delayed ED treatment more than 50% of the time (42.9%) and increased ED length of stay more than 50% of the time (61.4%) when compared with other specialty users of the ED. CONCLUSIONS: Laboratory ED TATs have remained unchanged for almost a decade. Emergency department physicians are not satisfied with laboratory services. Although it appears that one issue may relate to the other, the interaction between the laboratory and the ED is quite complex and has been evolving for at least 30 years. Improvement in interoperability between the departments is essential for operational efficiency and patient care. Effective communication channels need to be established to achieve these goals.     

植入式实验动物血糖动态监测装置的设计

目的 设计、研制一种用于实验动物的全植入式血糖浓度检测系统,通过一次植入手术可获得实验动物自然状态下经无线方式传输的动态血糖监测数据.方法 监测系统包括植入体和体外接收端两部分.植入体尺寸设计为11.5 mm×16.0 mm×5.0 mm,不超过实验大鼠体积的1/10.以SOF-SENSOR植入式葡萄糖传感器及其外围三电极伏安测量电路为核心,采用锂电池和稳压芯片构建供电,测量数据通过CC2540低功耗蓝牙系统芯片无线传输至体外.植入体外层包裹医用硅胶材料,以保护电路和提高植入体生物相容性.结果 体外验证实验表明,本系统可在2～34 mmol/L范围较准确地测量葡萄糖浓度(r=0.996 7),平均标准误差为0.193 mmol/L,灵敏度为9.24 nM(mmol/L),能够满足设计要求.结论 植入式实验动物血糖动态监测装置体积小,适合植入.体外血糖测量验证实验表明本装置的血糖测量范围、准确性、灵敏度及标准误差等均能满足设计要求.此装置有望为糖尿病病理和药效学研究提供重要的技术支持.     

Patterns of delays in diagnosis amongst patients with smear-positive pulmonary tuberculosis at a teaching hospital in Turkey

In total, 151 newly diagnosed patients with smear-positive pulmonary tuberculosis were studied. The mean time from the onset of symptoms to the first visit to a physician was 46.4 days; the mean referral delay was 28.9 days; the mean delay in diagnosis was 2.4 days; and the mean delay in treatment initiation was 0.8 days. There was a delay in consulting a physician by 49% of patients. A low index of suspicion for tuberculosis on the part of the physician and healthcare system and laboratory delays were the most common reasons for delays in diagnosis.