Laboratory information system

A lab information system (LIS), is a class of software which handles receiving, processing and storing information generated by medical laboratory processes. 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, typically takes months of research and planning. Installation takes from a few months to a few years depending on the complexity of the organization. There are as many variations of LISs as there types of lab work. Some vendors offer a full service solution capable of handling a large hospital lab's needs, others specialize in specific modules. Disciplines of laboratory science supported by LIS' include hematology, chemistry, immunology, blood bank (Donor and Transfusion Management), surgical pathology, anatomical pathology, flow cytometry and microbiology. This article covers clinical lab which encompasses hematology, chemistry and immunology.

Basic operation
Laboratory Information Systems are often part of an integrated informatics solution 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 used to order tests, provide specimen processing assistance, receive the results from analyzers and deliver lab reports to the attending physician.

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 list of tests to be performed on one or more patient specimens, for example blood or urine. In many cases, each order is tracked with a unique identifier. This identifier (which is usually a number) is often 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 specimen(s) 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.

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 anaylzers.

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. In cases where the LIS transmits data such as test orders or control messages to analyzers the communication is set up to be bi-directional.

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.

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.

Basic features
Laboratory Information Systems commonly support the following features: Patient Check In Order Entry Specimen Processing Result(s) Entry Reporting Patient Demographics Physician Demographics

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

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 Pathology <li>Cytology (Cytopathology) <li>Microbiology</li> <li>Flow cytometry</li>