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)     

Applications of Artificial Intelligence in Clinical Microbiology Diagnostic Testing

The use of artificial intelligence (AI) computer software to interpret data has become part of our everyday lives, and these AI algorithms are becoming part of our everyday laboratory practices. Many AI tools are beginning to demonstrate their real or potential utility in clinical microbiology laboratory practice. In this introduction to applications of AI in clinical microbiology diagnostic testing, the authors introduce AI and machine learning to those familiar with routine clinical microbiology practice. The discussion explores the role of AI for image analysis including Gram stains, ova and parasite exam, and digital plate reading of bacterial cultures. AI's role in advanced analysis of matrix-assisted laser desorption-ionization/time of flight mass spectrometry (MALDI-TOF) mass spectral data and whole genome sequence data of microbes is also discussed. In the future, computers and clinical laboratory scientists will work more closely together to provide optimal efficiency and quality in clinical microbiology laboratory practice, and this close collaboration between humans and machines is expected to improve patient care.     

A computer system for clinical microbiology.

The Department of Clinical Microbiology at St Thomas' Hospital has been producing bacteriological reports on a computer for more than three years and is now producing some 2300 reports per week. The system is operated entirely by laboratory staff without special training, and involves the use of optical mark reader (OMR) forms as worksheets, automatic validation and release of most reports, the use of local terminals, and scrutiny of reports by pathologists using a visual display unit. The OMR worksheet records not only the final result but also most of the tests and observations made on the samples; it is the only working document used by technicians. One specialist clinic submits its laboratory requests on an OMR form, which is subsequently used to record the results. The reports are printed and also filed in the computer to produce analyses for hospital, laboratory, and clinical management.     

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.     

A View from the Other Side of the Table: Taking Clinical Microbiology Experience to Industry

Clinical microbiology is a dynamic field that offers many licensed professionals rewarding careers that have a direct impact on patient care. Alternative careers include numerous opportunities for bachelors, masters, and doctoral level scientists in the biotechnology industry, which also impacts human health. Understanding if you are interested in an industry position or where you can apply your skill set outside the routine laboratory is important for deciding a future career path. This article explores the diagnostic life cycle of a commercial product and its stakeholders, as well as providing insight into some of the roles a career in industry can offer those looking to take their clinical microbiology experience outside the clinical laboratory.     

GENFILES: A computerized medical genetics information network. I. An overview

GENFILES is a comprehensive computer information network to serve research, service, and administrative needs in medical genetics. Four major databases contain detailed information generated by the cytogenetics laboratory, the prenatal diagnosis program, the diagnostic and genetic counseling clinics, and the human cell culture facility. Unique aspects are the use of RAMIS, a commercial database management system, and of microprocessor computers as “intelligent” terminals with significant data-handling capabilities. All databases are on-line in a directly accessed large timesharing computer. The system, which has been designed, controlled, and maintained by regular genetics staff, is an easy to use, moderate-cost tool well suited for use as a regional clinical genetics information system.     

Moving Targets of Bacterial Taxonomy Revision: What Are They and Why Should We Care?

Due to the increased widespread use of molecular diagnostics, genome sequencing, and microbiome analysis in microbiology, the field has experienced a massive influx of novel taxa and nomenclature revisions. A subset of these changes is relevant to the clinical microbiology laboratory, particularly in the context of appropriate antimicrobial susceptibility testing and epidemiology of emerging infections. However, assimilation of these changes into daily clinical microbiology laboratory operations can be challenging for a variety of reasons. Recent taxonomic revisions to Enterobacteriaceae, as well as the genera Borrelia, Mycoplasma, and Mycobacterium, are reviewed as examples that illustrate discrepancies between resources of revision data, criticisms of potentially preliminary data, opinions of unnecessary taxonomic revision, and overwhelming data sets for which clinical relevance is difficult to ascertain. Suggestions for implementation of taxonomic revisions are introduced (including references to peer-reviewed biennial taxonomy revision compendia), which could be augmented by a future Clinical and Laboratory Standards Institute guideline.     

Development of a microbiology data warehouse (Akita-ReNICS) for networking hospitals in a medical region

The active involvement of hospital laboratory in surveillance is crucial to the success of nosocomial infection control. The recent dramatic increase of antimicrobial-resistant organisms and their spread into the community suggest that the infection control strategy of independent medical institutions is insufficient. To share the clinical data and surveillance in our local medical region, we developed a microbiology data warehouse for networking hospital laboratories in Akita prefecture. This system, named Akita-ReNICS, is an easy-to-use information management system designed to compare, track, and report the occurrence of antimicrobial-resistant organisms. Participating laboratories routinely transfer their coded and formatted microbiology data to ReNICS server located at Akita University Hospital from their health care system's clinical computer applications over the internet. We established the system to automate the statistical processes, so that the participants can access the server to monitor graphical data in the manner they prefer, using their own computer's browser. Furthermore, our system also provides the documents server, microbiology and antimicrobiotic database, and space for long-term storage of microbiological samples. Akita-ReNICS could be a next generation network for quality improvement of infection control.     

A clinical virology database for a regional virology service

We describe a laboratory information system employing a virus and chlamydia database developed over seven years which is used by a regional laboratory, performing virus and chlamydia testing. The information system is implemented on a University mainframe computer and accessed by computer terminals in the laboratory. The database is used to identify patients, store patient test results, minimize clerical work and improve accuracy of reported results. The database also serves as a patient registry for use in education and research.     

A data processing system adapted to the special needs of the emergency laboratory.

A data processing system for the emergency laboratory was integrated in our clinical laboratory computer system, its prime objective being the service requirements of the laboratory. It included the possibility of simultaneous optical reading of request forms and on-line capturing, processing, and printing of laboratory test data. Priority request forms, which allow the clinician to specify the interval by which emergency test results must be available, are registered by an optical reader and arranged according to urgency by the computer. The production of worksheets is replaced by visual display of information required for accurate specimen analyses on a large colour TV screen. The individual processing status of all tests from as many as 30 request forms is displayed in a colour code. For process control the updated delay time for test performance is faded in. All reports are produced by direct machine transfer of verified test results. For security purposes all steps of sample processing (request, result, report) are recorded via line printers outside the emergency laboratory. The capacity of the computer for managing sample and data processing reduces the work load for technicians. This results in a reduction of the turn-round time of tests. 95% of all requested tests are performed and reported within the requested time period and in emergencies, test results are available within 5-10 min. There has been no major breakdown of the system in over one year of use.     

Use of bar code readers and programmable keypads to improve the speed and accuracy of manual data entry in the clinical microbiology laboratory: experience of two laboratories.

AIM: To assess the effect of the use of bar code readers and programmable keypads for entry of specimen details and results in two microbiology laboratories. METHODS: The solutions selected in each laboratory are described. The benefits resulting from the implementation were measured in two ways. The speed of data entry and error reduction were measured by observation. A questionnaire was completed by users of bar codes. RESULTS: There were savings in time and in reduced data entry errors. Average time to enter a report by keyboard was 21.1 s v 14.1 s for bar coded results entry. There were no observed errors with the bar code readers but 55 errors with keystroke entries. The laboratory staff of all grades found the system fast, easy to use, and less stressful than conventional keyboard entry. CONCLUSIONS: Indirect time savings should accrue from the observed reduction in incorrectly entered data. Any microbiology laboratory seeking to improve the accuracy and efficiency of data entry into their laboratory information systems should consider the adoption of this technology which can be readily interfaced to existing terminals.     

The future of clinical laboratory database management system]

To assess the present status of the clinical laboratory database management system, the difference between the Clinical Laboratory Information System and Clinical Laboratory System was explained in this study. Although three kinds of database management systems (DBMS) were shown including the relational model, tree model and network model, the relational model was found to be the best DBMS for the clinical laboratory database based on our experience and developments of some clinical laboratory expert systems. As a future clinical laboratory database management system, the IC card system connected to an automatic chemical analyzer was proposed for personal health data management and a microscope/video system was proposed for dynamic data management of leukocytes or bacteria.     

An interactive microcomputer-based graphics system for analysis of cardiodynamic function

An on-line interactive, modular, menu-driven microcomputer-based data acquisition and analysis system was designed and implemented. This system includes a low-cost commerical desk-top graphics computer with a modular construction. All these operations are performed using extended BASIC “CALL” statements. The system is designed to be used in a cardiovascular research and laboratory environment where the assessment of hemodynamic and cardiodynamic function includes routine measurements of pressure and flow. In addition, the measurement of regional and global left ventricular chamber dimensions have been implemented. The modular design of the software system is “human-engineered” to enable a simple, cost effective computer system to perform physiological measurement and control. Extended BASIC language instructions provide the casual computer user with a simple yet effective means of implementing on-line data acquisition, analysis and graphic production and display.     

Data processing in microbiology: an integrated, simplified system.

A MUMPS based computer system is described for the processing of data in a microbiology laboratory. The system uses visual display units and mnemonic codes for data input. All functions are carried out within the department by the medical, technical, and clerical staff. While the system described is integrated with other user-systems in the hospital, it is readily adaptable, and portable to a stand-alone system.     

Clinical Microbiology Informatics

SUMMARY

The clinical microbiology laboratory has responsibilities ranging from characterizing the causative agent in a patient''s infection to helping detect global disease outbreaks. All of these processes are increasingly becoming partnered more intimately with informatics. Effective application of informatics tools can increase the accuracy, timeliness, and completeness of microbiology testing while decreasing the laboratory workload, which can lead to optimized laboratory workflow and decreased costs. Informatics is poised to be increasingly relevant in clinical microbiology, with the advent of total laboratory automation, complex instrument interfaces, electronic health records, clinical decision support tools, and the clinical implementation of microbial genome sequencing. This review discusses the diverse informatics aspects that are relevant to the clinical microbiology laboratory, including the following: the microbiology laboratory information system, decision support tools, expert systems, instrument interfaces, total laboratory automation, telemicrobiology, automated image analysis, nucleic acid sequence databases, electronic reporting of infectious agents to public health agencies, and disease outbreak surveillance. The breadth and utility of informatics tools used in clinical microbiology have made them indispensable to contemporary clinical and laboratory practice. Continued advances in technology and development of these informatics tools will further improve patient and public health care in the future.     

What should a laboratory physician expect from a microbiology laboratory?

Remarkable changes are affecting the discipline of Clinical Pathology/Laboratory Medicine in Japan. Laboratories are changing from revenue centers to cost centers that have many serious problems(ex. closure of the clinical laboratories in the hospitals and outsourcing of laboratory tests due to restructuring in response to economic aspect, limited numbers of certified laboratory physicians, and other factors). And many clinicians in university hospitals do not know what they should expect correctly from the microbiology laboratory. Therefore, we, laboratory physicians and medical technologists must modify our behavior effectively and establish a good collaborative partnership with physicians, nurses and other health care professionals. The microbiology laboratory should provide information that will affect clinical management guidelines for obtaining specimens, microbial identification, antimicrobial susceptibilities, reporting of data and educational updating. Leadership and management skills must be increasingly critical to the success of laboratory physicians in and outside of academic centers.     

Computer-assisted interpretive reporting with trend analysis of creatine kinase and lactate dehydrogenase isoenzyme determinations

A program has been developed for a central laboratory computer that provides rapid, comprehensive interpretation of CK and LDH isoenzyme determinations. The laboratory computer can receive data on line from a densitometer or by manual result entry from a cathode ray tube. The program algorithm is based on extensive literature references and yields combinations of narrative comments selected from a file of statements. The algorithm is flexible and easily modified; it permits result correlation of simultaneously ordered CK and LDH studies as well as stand-alone interpretation of these tests requested separately. Trend analysis permits identification of changes from previous results and detection of asynchronous appearances of CK-MB and LD-1 as diagnostic of myocardial injury. The output can be formatted to suggest a strategy for further laboratory evaluation of a patient with suspected myocardial injury. Blind sample analysis of 1,500 sets of patient isoenzyme data, comparing human and computer results, has shown that the program is accurate, consistent, and reliable in a variety of clinical circumstances.