LIS与HIS集成研究

医院业务的发展要求能实现信息系统的集成.我们分析了医疗信息系统互联的不同方式,提出一种集成现有实验室信息系统(LIS)与医院信息系统(HIS)的方案.它使用多层分布式技术改进客户机/服务器应用模式,参考IHE(Integrating the Healthcare Enterprise)实验室技术框架(LAB-TF)确定参与工作流程集成的功能单元和事务,并采用Health Level 7(HL7)医疗信息交换标准实现信息交互.可保留原有的大部分处理,避免系统整合带来安全性、可维护性和实时性问题,保护了原有的投入,避免重建系统所带来的风险.     

Development of laboratory information system--quality standards

The aim of the study was to determine structural modules of laboratory information system (LIS) for the application of new biomedical and information technologies by utilizing current organizational trends. The method used included definition of structural modules according to significant LIS properties, e.g., a large number of data, automation of analyses and rapid exchange of information, and according to the process of information establishment the collection, organization, selection, synthesis and distribution. Thus, outdated distributed software at the Clinical Institute of Laboratory Diagnosis has now been replaced by modular organization. Modules have been developed for the following: data input, online operation of laboratory instruments, preparation of results, compilation of medical documentation on quality assurance based on the application of quality standards, management of finances, and for point of care testing. The method of re-engineering as well as adherence to EN and ISO quality standards were utilized in planning the development of LIS based on the application of new information technologies and in shaping business processes. The application of re-engineering in LIS development results in quality improvement, reduces the cost and time necessary for performance of procedures, and improves relations in organizational structure.     

Clinical laboratory system in a complete electronic hospital

The use of a Laboratory Information System (LIS) and Laboratory Automation System (LAS) are clearly superior to manual results in terms of completeness and legibility. As the current clinical information system (CIS) in Gifu University Hospital consists of a complete electronic medical record system, the clinical laboratory was re-engineered to simplify workflow, pay attention to quality assurance, and decrease various costs by an intelligent laboratory management system. We named the new system Gifu Premiotic Intelligent Laboratory System (GPILS). Further advances will concentrate on the cost-effective use of LIS, and the potential use of GPILS in our laboratories will be discussed. In addition, because one of our clinical laboratories currently provides various useful clinical laboratory-oriented information to physicians and patients, we have developed new tools named the "Reference Data Base (RefDB)". In the near future, several different types of computer technology for various clinical laboratory information will lead to the development of highly specific platforms for LIS corresponding to a complete electronic medical record system.     

Trends of utilization of information technologies in clinical laboratory and pathology domain

The life expectancy of the Japanese population is one of longest in the world. Society is aging, with fewer children, increasing the total national medical payment in Japan. This situation has forced the Government to reduce the payment and to increase the efficiency of the medical system, so information technologies are expected to contribute to these policies. Electronic patient record systems (EPR) were expected to be used widely, but only 23% of clinical training hospitals have implemented them. This is mainly due to the lack of incentives and large costs to install EPR. Standardization is a good method to reduce system construction cost and increase its quality. New global IHE activities are expected to solve these problems with methodologies of workflow analyses, standard applications, tests and demonstrations. Laboratory information systems (LIS) have a long history and tradition of standard interfaces for connecting computers with analyzers. IHE activities for LIS are providing easy and secure connections with hospital information systems (HIS). Pathology departments also have their own information systems. IHE activities for pathology were launched in 2005, and we are now developing in collaboration with the international IHE pathology working group, HL7 SIG pathology and DICOM WG-26. Pathologists and technical experts in Japanese laboratories are encouraged to join IHE activities to ensure good results.     

Is quality assurance in semen analysis still really necessary? A view from the andrology laboratory

Quality assurance (QA) is a fundamental part of laboratory medicine, of which internal and external QA (proficiency testing) is an important part. In a recent debate article published in Human Reproduction, it was argued that it was no longer necessary for semen analysis to be subject to QA, primarily because it is now being performed robustly and there is little evidence that it has any real clinical value. In response to this argument, it is suggested here that although there may have been some improvements in the training of laboratory scientists, recent studies have shown that the techniques of semen analysis are still poorly implemented at many locations. Moreover, as the impact of the introduction of QA into the andrology laboratory begins to take effect, there are a growing number of studies showing that the results of semen analysis do correlate well with natural conception and some assisted reproductive technologies. However, since the processes of QA are central to the principles of total quality management, which in turn underpins the process of laboratory accreditation, QA needs to remain in the andrology (and embryology) laboratory so that they can achieve the same accredited status as medical laboratories in other disciplines.     

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.     

Future outlook for LAS,LIS

In Japan, the application of LAS/LIS was started in some hospitals in the 1970's. Thereafter, these systems rapidly developed, becoming established in new national medical university hospitals in the late 1970's, referring to the system introduced in the central laboratory of each hospital. Currently, the LAS/LIS application system is employed in the central laboratory. In addition, this system provides diagnostic information based on laboratory data, responds to various questions regarding clinical examinations, develops strategies for controlling hospital infection using the infection control system, and provides information on the appropriate use of antimicrobial agents. In the future, this system may become even more useful. In this study, we reviewed the current status and issues of the mutual utilization of medical information among medical institutions to achieve further advances.     

Controls in quality assessment in gynecologic cytology: A rational approach to workload limits for the ThinPrep imaging system

Major components of good quality assurance (QA) in cytology laboratories are measuring the screening accuracy of cytotechnologists (CTs) and determining appropriate workload limits for them. Currently, the FDA approved workload limits for image assisted Paps, however, are too high. In addition, the CLIA 88 mandated QA measures, by themselves, are insufficient to accurately measure the screening performance of CTs. Although the use of “controls” is fundamental to good practice in the clinical laboratory; this has not been emphasized in gynecologic cytology. In this review, we underscore the importance of using controls, such as monitoring morning and afternoon abnormal rates, in assessing CT performance and assigning reasonable workload limits. Using controls, however, requires significant alteration in the laboratory workflow, and much lower and variable workload limits for CTs, compared to those approved by FDA. Diagn. Cytopathol. 2010;38:772–775. © 2010 Wiley‐Liss, Inc.     

Digital workflow management for quality assessment in pathology

Information systems (IS) are well established in the multitude of departments and practices of pathology. Apart from being a collection of doctor's reports, IS can be used to organize and evaluate workflow processes. We report on such a digital workflow management using IS at the Department of Pathology, University Hospital Magdeburg, Germany, and present an evaluation of workflow data collected over a whole year. This allows us to measure workflow processes and to distinguish the effects of alterations in the workflow for quality assessment. Moreover, digital workflow management provides the basis for the integration of diagnostic virtual microscopy.     

A quality assurance program for image quality of cone-beam CT guidance in radiation therapy

The clinical introduction of volumetric x-ray image-guided radiotherapy systems necessitates formal commissioning of the hardware and image-guided processes to be used and drafts quality assurance (QA) for both hardware and processes. Satisfying both requirements provides confidence on the system's ability to manage geometric variations in patient setup and internal organ motion. As these systems become a routine clinical modality, the authors present data from their QA program tracking the image quality performance of ten volumetric systems over a period of 3 years. These data are subsequently used to establish evidence-based tolerances for a QA program. The volumetric imaging systems used in this work combines a linear accelerator with conventional x-ray tube and an amorphous silicon flat-panel detector mounted orthogonally from the accelerator central beam axis, in a cone-beam computed tomography (CBCT) configuration. In the spirit of the AAPM Report No. 74, the present work presents the image quality portion of their QA program; the aspects of the QA protocol addressing imaging geometry have been presented elsewhere. Specifically, the authors are presenting data demonstrating the high linearity of CT numbers, the uniformity of axial reconstructions, and the high contrast spatial resolution of ten CBCT systems (1-2 mm) from two commercial vendors. They are also presenting data accumulated over the period of several months demonstrating the long-term stability of the flat-panel detector and of the distances measured on reconstructed volumetric images. Their tests demonstrate that each specific CBCT system has unique performance. In addition, scattered x rays are shown to influence the imaging performance in terms of spatial resolution, axial reconstruction uniformity, and the linearity of CT numbers.     

The use of LIS for blood usage review. Experience in a children's hospital

To comply with the requirements of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) and to facilitate the review process, the authors designed a program to screen for the appropriateness of packed red cell (PRC) and platelet concentrate (PLT) transfusions. The purpose of this report is to describe the methodology of the review process. A quality assurance (QA) monitor was created in the Laboratory Information System (LIS) to screen indicators: hemoglobin for PRCs and platelet count for PLTs. Numerical value limits were defined to determine acceptable ranges. Each week, the LIS compiles a list of all patients who received transfusions and for whom the QA monitor determined that the values of the screened indicators were outside the defined appropriate limits. A detailed transfusion record is generated for each patient identified. During a six-month evaluation of this program, a total of 1,788 PRC and 3,109 PLT units were transfused. Of these, 582 PRC (32.5%) and 2,219 PLT (71.4%) units were within the acceptable guidelines. Lists for the remaining 1,206 PRCs and 890 PLTs were generated. Review of the transfusion record and other laboratory values from the LIS established the appropriateness of 1,052 PRC and 782 PLT transfusions. At the conclusion of the six-month period, the medical charts for 181 (11%) PRC and 108 (4.5%) PLT transfusions required chart review. This method provided major reduction in time of the transfusion review process. Similar guidelines may be used to monitor other transfusion products such as fresh frozen plasma.     

The role of methodologies to improve efficiency and effectiveness of care delivery processes for the year 2013

This paper aims at further expanding the vision of future health care delivery systems presented by Haux et al. (2002). Starting from the observation that information and communication technology (ICT) is deeply transforming the shape of organizations as expected, we argue that the coordination of work activities is a fundamental need for any organization. This is even more important for health care organizations since there is an increasing pressure to increase quality of care they deliver without further increasing its costs. However ICT by itself will not cause the desired changes without rethining the way of managing best practice biomedical knowledge and care delivery processes. Thus the paper focuses on the need of developing intense research efforts in the fields of knowledge management and workflow modelling, which have been identified as fundamental to provide suitable solutions to the problems of designing and building innovative health care information systems. Moreover, the paper discusses the role of mobile communication systems. Moreover, the paper discusses the role of mobile communication and speech understanding technologies to support a satisfactory user-system interaction in daily work.     

Early Experience Using an Online Reporting System for Interventional Radiology Procedure-Related Complications Integrated with a Digital Dictation System

The absence of user-friendly systems for reporting complications is a major barrier to improving quality assurance (QA) programs in interventional radiology (IR) services. We describe the implementation of a QA application that is completely integrated with the radiology dictation system. We implemented an IR QA process as a module within the electronic medical record and radiologist dictation system applications used at our institution. After a radiologist completes a dictation, he or she must select from a drop-down list of complications before proceeding to the next case. Delayed QA events can be entered using the same applications. All complication entries are sent to a database, which is queried to run reports. During the study period, all the 20,034 interventional procedures were entered in the QA database, 1,144 complications were reported, 110 (9.6%) of which were classified as major. Although majority of the complications (996) were entered at the time of dictation, 148 complications (12.9%) were entered afterwards. All major complications were referred to the IR peer review committee, and 30 of these were discussed in the morbidity and mortality meetings. We studied post-lung-biopsy pneumothorax and chest tube rates and initiated a quality improvement process based on the results.The integration of the IR QA reporting system into the workflow process and the mandatory requirements for completion has the potential to minimize the work effort required to enter complication data, and improve participation in the QA process.     

二维条形码技术在实验室信息管理系统（LIS）中的应用

目的利用二维条形条码技术,减轻实验室信息管理系统(LIS)瓶颈,提高网络速度,为LIS增加更多功能(例如智能审核,图像传输等)创造良好的条件。方法设计与制作二维条码标签,以Windows2000AdvancedServer或Windows2000Server为服务器操作系统;以有极佳性价比的MicrosoftSQLServer2000数据库;以PowerBuilder8.0为前台开发工具;以Windows2000Professional或WindowsXPRrofesional为客户端操作系统;把客户端联接成网并入LIS服务器,再与医院信息系统(HIS)联接。结果通过DENSO二维条码数据采集器BHT103Q扫描标本容器上的二维条码,直接获得全部病人资料(包括基本资料和检验信息)。最后将测定结果发送回HIS。结论通过使用二维条形码技术,减少LIS数据库的访问量和网络数据流量,从而有效减轻LIS瓶颈,提高了系统速度。为以后完善和丰富LIS的功能创造了良好的条件。     

Technical Standards and Guidelines for Huntington Disease Testing

One mission of the ACMG Laboratory Quality Assurance (QA) Committee is to develop standards and guidelines for clinical genetics laboratories, including cytogenetics, biochemical, and molecular genetics specialties. This document was developed under the auspices of the Molecular Subcommittee of the Laboratory QA Committee by the Huntington Disease (HD) Working Group. These guidelines are not to be interpreted as restrictive or the only approach but to provide a helpful guide. Certainly, appropriately trained and credentialed laboratory directors have flexibility to utilize various testing platforms and design testing strategies with considerable latitude. We felt that it was essential to include technique-specific guidelines of several current technologies commonly used in laboratories providing HD testing, because the technologies discussed are available commercially and are widely utilized. We take the view that these technologies may change, and thus this document may change with future review.     

Use of whole slide imaging in surgical pathology quality assurance: design and pilot validation studies

By imaging large numbers of slides automatically at high resolution, modem automated whole slide imaging (WSI) systems have the potential to become useful tools in pathology practice. This article describes a pilot validation study for use of automated high-speed WSI systems for surgical pathology quality assurance (QA). This was a retrospective comparative study in which 24 full genitourinary cases (including 47 surgical parts and 391 slides) were independently reviewed with traditional microscopy and whole slide digital images. Approximately half the cases had neoplasia in the diagnostic line. At the end of the study, diagnostic discrepancies were evaluated by a pathology consensus committee. The study pathologists felt that the traditional and WSI methods were comparable for case review. They reported no difference in perceived case complexity or diagnostic confidence between the methods. There were 4 clinically insignificant discrepancies with the signed-out cases: 2 from glass slide and 2 with WSI review. Of the 2 discrepancies reported by the WSI method, the committee agreed with the reviewer once and the original report once. At the end of the study, the participants agreed that automated WSI is a viable potential modality for surgical pathology QA, especially in multifacility health systems that would like to establish interfacility QA. The participants felt that major issues limiting the implementation of WSI-based QA did not involve image acquisition or quality but rather image management issues such as the pathologist's interface, the hospital's network, and integration with the laboratory information system.     

Predicting treatment process steps from events

MotivationThe primary economy-driven documentation of patient-specific information in clinical information systems leads to drawbacks in the use of these systems in daily clinical routine. Missing meta-data regarding underlying clinical workflows within the stored information is crucial for intelligent support systems. Unfortunately, there is still a lack of primary clinical needs-driven electronic patient documentation. Hence, physicians and surgeons must search hundreds of documents to find necessary patient data rather than accessing relevant information directly from the current process step. In this work, a completely new approach has been developed to enrich the existing information in clinical information systems with additional meta-data, such as the actual treatment phase from which the information entity originates.MethodsStochastic models based on Hidden Markov Models (HMMs) are used to create a mathematical representation of the underlying clinical workflow. These models are created from real-world anonymized patient data and are tailored to therapy processes for patients with head and neck cancer. Additionally, two methodologies to extend the models to improve the workflow recognition rates are presented in this work.ResultsA leave-one-out cross validation study was performed and achieved promising recognition rates of up to 90% with a standard deviation of 6.4%.ConclusionsThe method presented in this paper demonstrates the feasibility of predicting clinical workflow steps from patient-specific information as the basis for clinical workflow support, as well as for the analysis and improvement of clinical pathways.     

Proving Value in Radiology: Experience Developing and Implementing a Shareable Open Source Registry Platform Driven by Radiology Workflow

Numerous initiatives are in place to support value based care in radiology including decision support using appropriateness criteria, quality metrics like radiation dose monitoring, and efforts to improve the quality of the radiology report for consumption by referring providers. These initiatives are largely data driven. Organizations can choose to purchase proprietary registry systems, pay for software as a service solution, or deploy/build their own registry systems. Traditionally, registries are created for a single purpose like radiation dosage or specific disease tracking like diabetes registry. This results in a fragmented view of the patient, and increases overhead to maintain such single purpose registry system by requiring an alternative data entry workflow and additional infrastructure to host and maintain multiple registries for different clinical needs. This complexity is magnified in the health care enterprise whereby radiology systems usually are run parallel to other clinical systems due to the different clinical workflow for radiologists. In the new era of value based care where data needs are increasing with demand for a shorter turnaround time to provide data that can be used for information and decision making, there is a critical gap to develop registries that are more adapt to the radiology workflow with minimal overhead on resources for maintenance and setup. We share our experience of developing and implementing an open source registry system for quality improvement and research in our academic institution that is driven by our radiology workflow.     

Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams

OBJECTIVE: The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN: We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS: We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION: The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.