| Medical Laboratory Observer |
| Product focus |
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Lab info systems (LIS) ease workflow |
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Laboratories, more than ever before, are depending on information systems to combat the critical staff shortage, the increased demand for faster turnaround times, and the ever-growing burden of security and regulatory compliance. Connectivity, scalability, automation of processes that streamline laboratory workflow and integration of laboratory data into enterprise-wide information are key issues addressed by the software systems summarized below. |
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Real-time interface software
LabDAQ Series 3 Antek Healthware
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Client server-based system
WindoPath/PocketPath/Vox Pap Psyche Systems Corp.
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Integrated lab network
Orchard Copia Orchard Software Corp.
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Web-based LIS system
MODU-LIS II Modulus Data Systems Inc.
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Genetic/DNA LIMS
Starfruit GeneTell LIMS Data Unlimited International Inc.
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Anatomic pathology software package
PacePath Labsoft Inc.
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Global lab solution
MediLab MediSolution Ltd.
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Streamlining lab processes
NOVIUS Lab Siemens Medical Solutions
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New blood-bank donor solution
Millennium PathNet Blood Bank Donor Cerner Corp.
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Graphical lab system
SchuyLab/SchuyNet Schuyler House
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"Case-centric" model
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The 10 Commandments of LIS Troubleshooting
By Roy Motley
Problems involving new technology are best solved with an old-world approach. Whether you are faced with an isolated instrument glitch or searching out answers to deeper and more technical dilemmas, these 10 Commandments offer a disciplined, systematic, rock-solid route to customer-service solutions — stone tablets not included.
I. Thou shalt know thy symptom before intervening. This first step is the most important. Poorly defined symptoms trigger most of the misery involved in troubleshooting. The instinct to "ready, fire, aim" is a primary sin that leads to ineffective troubleshooting. Accurately and concisely define the symptoms, as well as verify that they exist. Define the system area responsible for the problem. As a hypothetical symptom, let us say an instrument is failing to read the barcode on a sample tube. This symptom is contained in the barcode system area.
II. Know thy processes. A system area can involve many individual processes. For example, creating, attaching, and reading the barcode labels are three different processes. Define and investigate the individual processes in the system. A properly defined problem is a joy to fix. A good troubleshooter is like a detective. To properly define a problem, thoroughly examine the instrument and interview the operator. Explore the logbooks for clues, and ask the operators open-ended questions. Take good notes. III. Thou shalt not do needless work. Once you identify a problem and the proper process, use maintenance and observation to attempt to fix it before moving on to more difficult steps:
IV. Thou shalt gain insight from looking into the past. Investigate change! It worked yesterday; it does not work today. What changed? Isolate the differences that may cause this failure. Are the labels created in the ER the only ones that fail? Did the failures start after scanner maintenance?
V. Thou shalt not exceed thy capabilities or transgress into deep thought. Modern technology needs an empirical approach to avoid "paralysis by over analysis." Test and experiment to help eliminate suspected problems in the process. Any test that can eliminate a specific component is useful, but tests that divide the failure into a specific area are invaluable. This is called "divide and conquer." If you had a thousand suspect components in a system and could devise tests that split the system in half each time, it would take only 10 tests to discover the cause. Examine the diagnostic manuals to learn more about divisional tests already built into many systems. The manufacturer may have already developed an elimination process coupled with automated tests. In the case of the barcode reader, using a barcoded item that you know had worked within the past few days would provide a valuable division. The most valuable division tool involves Commandments I and II. Most of the likely causes can be eliminated by properly performing these steps.
VI. Thou shalt not rush to conclusions. Do not fixate on trying to resolve the problem. Instead, try using the process of elimination to determine what is not the problem. Eliminate each section until the cause is all that remains.
VII. Thou shalt not be led astray by false prophecies. Be sure that what you find is truly the root cause. Recurring problems are often due to this oversight. For example, excessive debris in the read area could have dirtied the barcode lens. The dirty lens is just a byproduct of the real root cause — excessive debris. Once a cause is isolated, verify that it is the root of the problem. Always try to analyze why the component failed. During root-cause analysis, have an alternate goal of making sure the problem never happens again. For instance, if the root cause is poor maintenance, new training in this area is needed.
VIII. Thou shalt not make matters worse. Once the root cause is identified, formulate an action plan to resolve the issue. Consider the safety of all personnel involved, as well as possible harm to the system under repair. Take this step before invasive procedures are performed.
IX. Thou shalt confirm all repairs. Once you perform the repair, verify that the entire system is operating properly. This step is often overlooked in the joy of success. Problems introduced during the troubleshooting process can induce other unwanted effects throughout the system.
X. Thou shalt approach this process with joy in thy heart. Anger and panic have no place in troubleshooting. A solution can be found. People made it thus; people can fix it. If negative emotions emerge, take a five-minute walk. When you return, concentrate on one thought: What experimental tests can be performed that will narrow the focus of your search even further? By employing this systematic approach, take pride in the fact that you are making progress toward the solution by pinpointing the problem. Do not just think of success as fixing the problem; narrowing the focus of the search is success in and of itself and paves the way for the next step in remedying the problem. That remedy, may involve you, another technologist, a manufacturer’s help desk representative — or even a visit from a service engineer.
Success is within your grasp when you use these problem-solving strategies — and you shall even help add long life to thine instruments. Roy Motley is manager of automated service processes for Beckman Coulter Inc. in Fullerton, CA.
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| March 2004: Vol. 36, No. 3 |
| © 2004 Nelson Publishing, Inc. All rights reserved. |
The new LabDAQ Series 3 opens new windows for
the laboratory in flexibility, communication, and security. Because this
software is organized to keep track of all open functions and move
efficiently through the system, users can move from one function to
another, review results, validate QC, order tests, and add new patient
records simultaneously. Its reputation for scalability is maintained
with Series 3, supporting either a single workstation, or a network of
labs located in different cities. All communications are HIPAA
compliant, and interfaces conform to industry standards. LabDAQ3
provides a complete set of security tools to meet individual needs, as
well as regulatory requirements.
WindoPath is a sophisticated anatomic pathology and
cytology information system, which is client server-based for complete
case processing, with CLIA compliance and HIPAA-related security/privacy
provisions. In addition to case development and reporting, the system
incorporates many advanced and custom-designed features as standard,
such as voice capabilities, image management, and tumor staging. This
scalable LIS delivers extensibility, allowing for continuous development
and customization to meet individual needs. Two new applications have
been introduced: PocketPath, a mobile application that gives physicians
point-of-care access to patient diagnoses via a PDA, and Vox Pap
conversational computing software, designed to allow technicians to
simultaneously focus on specimens while creating reports.
Designed to work with most existing laboratory
information systems, the Orchard Copia is a browser-based system, which
electronically links laboratories and manages lab order logistics and
result delivery. From any Web-based PC, users place orders in a single
order-entry screen. Copia reviews each order, identifies potential
reimbursement issues, and automatically handles patient insurance and
lab routing preferences. Phlebotomists can generate draw lists, produce
barcode labels, view clinical questions/container types/personalized
comments, and complete shipping manifests. Results are consolidated into
a single report, and providers may review current and past results.
Copia provides integrated delivery networks with the advantage of
multisite communications.
Building on the technology, adaptability, and speed
of the MODU-LIS I, the new Web-based MODU-LIS II offers easier access to
laboratory information for healthcare professionals. Key to its design
is the report and ordering system, which can be used as part of a total
LIS system, or as a stand-alone accessory to any other LIS system. The
server communicates with any LIS or HIS via HL7 interface protocol,
which can bring real-time clinical results to physicians in almost any
environment. The capabilities addressed by the MODU-LIS II provide
access to laboratory information from any desktop computer by way of the
Internet or through wireless communications and use of PDA within
hospital facilities.
Incorporating both software and configurable
database, the Starfruit GeneTell, a laboratory information management
system, meets the specific needs of genetic-testing and
molecular-diagnostic laboratories for the electronic storage and
retrieval of data relating to:
PacePath, a comprehensive anatomic pathology software
system, streamlines lab workflow, as well as data entry and report
delivery. The package features modules for cytopathology, FNA biopsy,
and surgical and autopsy pathology, all with full imaging capabilities.
PacePath allows users to quickly retrieve information, generate reports,
and analyze data. The easy-to-use windows provide complete patient and
case histories, all on one patient look-up screen. Coded diagnoses
maximize information retrieval, and unique comparison methods allow
automated correlation of all results.
MediLab, a third-generation product,
offers a comprehensive management solution for the central laboratory.
While providing a wide range of capability for the management of
information, organization and workflow, the system enhances
communications for all in-house and global system users. The MediLab
software manages all laboratory activities and is scalable to meet the
needs of small, single-discipline laboratories to large,
multidisciplinary/multisite institutions. Features include patient file
management, Web-enabled accessioning, positive ID for specimen
collection and identification, sample/request dispatching, instrument
interfaces, QC, result consolidation/distribution, technical/clinical
validation, billing, and statistics.
The NOVIUS Lab System streamlines lab
processes with management reports and tools that help administrators
monitor quality indicators and improve outcomes. An automated
"turnaround time monitor" helps technologists prioritize and
manage their workload, and a patient-report designer provides physicians
with results in the format most useful to them. Operational and clinical
rules are built into the system, so that it can be tailored to the needs
of single or multisite facilities. The system integrates with reference
laboratories, point-of-care data managers, instruments, lab automation
systems, clinical repositories, and financial systems, providing
information at the point of need.
Recently FDA cleared, the Millennium
PathNet Blood Bank Donor solution automates the management of the
blood-donation process and assists users in determining donor
eligibility and blood-product suitability. Features include streamlined
workflow with barcoding; online donor recruitment lists; donor
management to track eligibility/demographics; and blood-drive
scheduling. The product supports blood-inventory management, delivering
review warnings or exceptions for changed products’ ABO/Rh, promoting
safety measures, and guarding against risk. ISBT-28 is fully supported
from printing labels to reading all barcoded fields, making it compliant
with global labeling standards for world-wide distribution, tracking,
and handling of blood bags and blood components.
Suited to either network or single PC
environments, the SchuyLab Windows-based LIS provides an easy-to-use
icon-based program that interfaces with instruments, tracks specimens,
monitors QC, compiles worksheets/daily logs, and provides
cumulative/consolidated patient reports. The system is capable of
communicating with office or hospital information systems using HL7
protocol, and offers additional modules that include autofaxing,
barcoding, dial-in results, medical necessity, and direct
Medicare/Medicaid billing. The Internet-results module, SchuyNet, allows
doctors to securely access patient reports on any PC and review the most
recent lab data.
Specifically designed software for laboratories
providing surgical pathology, cytology, and autopsy services, the
Tamtron PowerPath Anatomic Pathology System, is a comprehensive LIS that
enables the integration and streamlining of diagnostic, management, and
business needs. PowerPath’s case-centric model provides a solution
that can scale from multisite, multientity healthcare enterprise to a
single departmental laboratory. The system’s key benefits include
simplistic data entry, enhanced research, and service functions,
customized report formats, improved quality assurance, and increased
capture of professional and technical charges.