Labs go Hi-Tech LIS ensures quicker availability of test results, thereby reducing the time to report, which can save invaluable patient lives By Dhirendra Pratap Singh, firstname.lastname@example.org
aboratories constitute the core operational component in any specialty hospital set up. Often, they are the most humongous generators of data and information, providing the most crucial input for doctors to decide the course of treatment. With increased adoption of process automation in hospitals, the demand and market potential for Laboratory Information Systems (LIS) is growing. Laboratory information system is a generic term used to denote the computer systems in clinical and research laboratories. It is a suite of software applications for managing the daily operations/workflow of a laboratory. LIS has multiple modules for data collection, tracking, analysing, reporting or delivery of results. The data can be related to patients, lab employees, samples, results, instruments, consumables or reagents. LIS
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can be used for workflow management, accounts and control of instruments if integrated with the system. While the LIS plays an important role in ensuring accurate laboratory results, it does not work alone. The test results/reports of patients are usually interfaced with the electronic medical records (EMR) to ensure that clinicians can get access to updated/complete test results. Together with patientsâ€™ results gathered from other departments (e.g. Radiology), the EMR enables the clinician to obtain a comprehensive overview of patientsâ€™ medical histories. This enhances the clinical decision-making process and ultimately leads to improvement in standards of patient care. LIS can support sub-specialties of the pathology laboratory, including haematology, chemistry, immunology, blood bank, surgical
pathology, anatomical pathology, flow cytometry and microbiology. The inputs into a LIS have a uniquely identifiable physician order and a matching patient sample. These are then matched with the patient record and the order is processed. The outcome of the test is manually or electronically added to the patient record for access by the physician. LIS can ensure quick availability of test results and analysis in ICUs, operating rooms and emergency room settings. When there is faster turnaround time, there are better chances for saving the life of a critically ill patient. LIS can be integrated with point-of-care diagnostic devices at these locations for information management. The value of providing detailed results to clinicians in real time cannot be undermined. A majority of initiatives advocating the use of information technology in hospitals or clinical practices focus on EMR systems. While advantages of EMR systems have been substantially proven, an often-overlooked aspect of healthcare delivery automation is the use of information technology in clinical laboratories. India is burdened with different types of cancer and infectious diseases. The country contributes over 132,000 cases of the estimated 500,000 cervical cancer cases globally per year. Thus India’s contribution is of more than one-fourth of the world’s total cervical cancer cases. The role of diagnostics in addressing rapidly growing diseases is significant. Local healthcare providers have increased their reliance on diagnostic testing systems in order to be able to make the best decisions for their patients. The growing middle-class also recognises the value of pathology testing and is willing to pay for these tests. This is reflected in the over 20 percent CAGR in the last five years in India’s diagnostics industry.
Benefits LIS provides a number of benefits. It can ensure quicker availability of test results and analysis in ICUs, operating rooms or emergency room settings. LIS can be integrated with pointof-care diagnostic devices for information management. The value of providing detailed results to clinicians in real-time cannot be undermined. In a study conducted at Massachusetts General Hospital, the clinicians’ improved accuracy in 70-80 percent of the cases, as expert opinions of pathologists got facilitated through the LIS. The concerned pathologist used an LIS with clinical decision support for providing narrative interpretation with every lab result to cohort of clinicians. Sanjay Kumar Jain, Managing Director, Akhil Systems Pvt Ltd., says, “The flexible and easy to configure setups help meet the reporting requirements of all branches of the laboratory. The product is designed for automated bi-directional data exchange with the laboratory equipment, which will help reduce chances of incorrect data entry and also help reduce the time involved in processing the final reports. The system is capable of communicating with external systems using HL7 and EDI standards.” He adds, “When the lab receives any specimen in the system, the specimen is assigned a chorological number accord-
“The product is designed for automated bidirectional data exchange with the laboratory equipment, which helps reduce the time involved in processing the final reports” Sanjay Kumar Jain Managing Director, Akhil Systems Pvt. Ltd ing to the predefined defined criteria for each branch of the laboratory. The systems also generates bar coded labels, which are run on the laboratory equipments. The labels are scanned and the patient’s tests and related information are read by the machine and the tests are processed further.”
LIS and SaaS Cloud computing offers a new approach that will transform the delivery and consumption of IT services of a company in future. In cloud computing, Software as a Service (SaaS) is a very promising field, one that brings a lot of benefits in LIS. SaaS is a model of software deployment, where an application is hosted as a service provided to customers across internet. Peter Jose Palal, Product Manager, Encora Technologies, says, LIS on a SaaS platform presents a cohesive model of applications that helps hospitals and labs of disparate nature to seamlessly interact among themselves and execute lab orders and receive results in a faster and efficient way. LIS on SaaS platform makes information technology available to the patient, physician, lab technician, etc., making them a close knit community and is the best example of software emancipation of humankind. It can be called ‘The Facebook of LIS’, except that it’s highly confidential!” The online services in SaaS include subscription-based models, on-demand applications and hosted services. They provide end users with a consistent experience across various client devices. Microsoft SharePoint Online is an example of such a service. Google, Amazon, SalesForce.com, IBM, Zoho and CRM are examples of SaaS cloud providers. SaaS (software as service) is being used to deliver a variety of e-Governance cloud services, such as Singapore’s Trade Net-a Single electronic window platform, that enables imporfebruary / 2012 www.ehealthonline.org
central monitoring system, which picks up subtle changes in trends. Such a system is being set up under the World Bank funded Integrated Disease Surveillance Project in India. LIS can provide surveillance data to public health agencies, using the accepted standards, and these data could be about reportable diseases, infections, tumour registries, etc.
Evidence based medicine tools
“LIS on SaaS platform is the best example of software emancipation of humankind” Peter Jose Palal Product Manager, Encora Technologies
tant stakeholders within the supply chain to reduce the time needed to facilitate the trade process. In 2009, SaaS had a worldwide market share of USD 9.6 billion, while IaaS (Internet as a service) had a worldwide market share of USD 1.3 billion. By 2013, the SaaS market will grow to USD 17 billion, while in the same time frame IaaS will have an almost six-fold growth to USD 7.6 billion. IaaS will be on a high growth trajectory given that it provides options for customisation and standardisation. Disease surveillance for earlier detection of epidemics is another important benefit. LIS systems can be connected with a
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LIS can also facilitate evidence-based medicine. As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved beneficial for all stakeholders - clinical teams, hospital management, and the patients. Evidence based medicinal tools, like clinical protocols and clinical pathways, provide explicit and well defined standards of care for the clinical teams and support multidisciplinary care planning. From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction. These tools can also be integrated with the existing EMR for providing decision support to the clinical teams. Clinical protocols and pathways based on evidence available from the Indian sub-continent are now available and need to be adopted in healthcare settings to achieve the next level of quality. The right amalgamation of modern infrastructure, innovative technologies and clinical skills guided by evidence based tools will go a long way in bridging the gap in the Indian healthcare industry. The systems can be used for trend analysis, tracking of disease profiles and conducting research studies. Laboratories generate a lot of data, running into millions of test outcomes everyday. This data can be matched with appropriate clinical records to determine outcomes, which could dynamically influence the treatment plan. In a study, about 25 percent of primary care physicians found the expectations of care beyond the scope of their knowledge.The physicians will be well served with a LIS, which helps to provide interpretations to ordering physicians that are specific to patients’ needs and conditions.