Lab info systems (LIS) ease workflow

March 1, 2004

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.

Real-time interface software

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.

LabDAQ Series 3

Antek Healthware

Client server-based system

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.

WindoPath/PocketPath/Vox Pap

Psyche Systems Corp.

Integrated lab network

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.

Orchard Copia

Orchard Software Corp.

Web-based LIS system

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.


Modulus Data Systems Inc.

Genetic/DNA LIMS

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: design/performance of molecular, diagnostic assays from fresh and paraffin-embedded tissue;
  • detection of infectious organisms, genetic
    rearrangements associated with malignant disease and hereditary,
    genetic abnormalities;
  • information analysis to identify, diagnose, and
    prescribe medical procedures;
  • patient records (including demographics, test
    history, personal gene databank, and family tree); and
  • billing.
  • Starfruit GeneTell LIMS

    Data Unlimited International Inc.

    Anatomic pathology software package

    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.


    Labsoft Inc.

    Global lab solution

    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.


    MediSolution Ltd.

    Streamlining lab processes

    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.

    NOVIUS Lab

    Siemens Medical Solutions

    New blood-bank donor solution

    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.

    Millennium PathNet Blood Bank Donor

    Cerner Corp.

    Graphical lab system

    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.


    Schuyler House

    “Case-centric” model

    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. PowerPaths case-centric model provides a solution that can scale from multisite, multientity healthcare enterprise to a single departmental laboratory. The systems 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. Tamtron PowerPath Anatomic Pathology System
    Impac Medical Systems

    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

    Watch and listen to the operation of the instrument. Look for abnormalities. It helps if you have experience with a properly operating instrument. In the barcode example, look for the red scan beam on the barcode reader. See if the lens is dirty.
  • Review the customer maintenance
    log for entries pertaining to the area you are examining. Perform all
    maintenance listed, even if it was recently completed. Routine steps
    have quickly resolved many issues.
  • Look for simple, inexpensive
    solutions that pose no threat to the system. Maybe the suspicious area
    has an easy alignment procedure. Replace the ink cartridge and paper
    on the printer.
  • 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
    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 manufacturers 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.

    March 2004: Vol. 36, No. 3