Clinical Laboratory Information Research Articles

Work on Clinical Laboratory Information Systems Standards Completed

Work on Clinical Laboratory Information Systems Standards Completed

A new clinical laboratory information system architecture from the OpenLabs project offering advanced services for laboratory staff and users

The OpenLabs project aims to improve the efficiency and effectiveness of clinical laboratory services by integrating decision support systems with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the EUCLIDES/OpenLabs coding scheme and an open architecture for clinical laboratory information systems have been specified. This article gives an account of the proposed architecture and outlines new software applications being developed using the architecture which provide advanced services for ordering and reporting of laboratory tests, advanced instrument workstation and laboratory management services, including an OpenLabs Service Manager application which co-ordinates the available services.

Apolipoprotein E: an important gene and protein to follow in laboratory medicine

The human apolipoprotein (apo) E gene is polymorphic, with three common alleles (epsilon 2, epsilon 3, epsilon 4) coding for three isoforms (E2, E3, E4). The isoforms differ from each other by a single amino acid substitution, and also differ in their binding affinity for the four apo E receptors. Apo E polymorphism is an important determinant of risk for the development of cardiovascular and Alzheimer diseases, the prevalence of the epsilon 4 allele being increased in both kinds of patients compared with control subjects. Furthermore, the prevalence of the epsilon 4 allele differs among populations (range 5-40%, respectively, for Taiwanese and Papua New Guineans). Genotyping or phenotyping needs to be introduced in clinical laboratories. The choice of the method should be based on the types of patients who are examined. The apo E genotype is also a determinant of apo E plasma concentration. Standardization of apo E measurement is an important prerequisite before investigating the clinical interest of plasma apo E concentration. Determination of apo E genotype/phenotype and later the plasma concentration are expected to yield useful clinical laboratory information.

Magnesium: the fifth but forgotten electrolyte.

Magnesium (Mg) is the second most abundant intracellular cation and is a cofactor in more than 300 enzymatic reactions involving energy metabolism and protein and nucleic acid synthesis. Ionized Mg is the physiologically active form of the element. Protein-bound and chelated Mg buffer the ionized pool. Approximately half the total Mg in the body is present intracellularly in soft tissue, and the other half is present in bone. Less than 1% of the total body Mg is present in blood. However, the majority of our clinical laboratory information comes from the determination of total Mg in serum. Currently, the clinical laboratory evaluation of Mg status is limited primarily to the total serum Mg concentration and a 24-hour urinary excretion. Instrumentation to determine ionized Mg in serum (ion-selective electrode) and in soft tissue (nuclear magnetic resonance spectroscopy) should be available in the near future. Magnesium may be a factor in the treatment of acute myocardial infarction and the rate of atherosclerosis. Chronic changes of Mg status, that may be latent, are poorly understood and require a better knowledge of ionized Mg metabolism.

High Transdermal Fentanyl Requirements in a Patient with Chronic Cancer Pain

To report a case of high transdermal fentanyl dosage requirements in a patient with chronic cancer pain. Clinical studies, review articles, and relevant laboratory information. A 42-year-old woman with cervical cancer was admitted for control of her pain. Her outpatient analgesic regimen was a continuous intravenous infusion of morphine sulfate (MS) via an ambulatory infusion device. Upon admission, supplemental doses of intravenous MS were administered in an effort to eliminate the pain. Transdermal fentanyl therapy was initiated on hospital day 1 at 100 micrograms/h and the MS continuous intravenous infusion dosage was increased. Over the next four days, the patient experienced episodes of inadequate pain control and the transdermal fentanyl dosage was increased in increments of 100 micrograms/h. On hospital day 4 the MS continuous infusion was converted to patient-controlled analgesia (PCA). The patient reported acceptable pain control with a regimen of transdermal fentanyl 500 micrograms/h and MS via PCA and she was discharged home on hospital day 7. This patient's high transdermal fentanyl dosage requirement was related to disease progression. She experienced an acute pain episode that may have been effectively managed by increasing the dosage of her continuous intravenous MS infusion.

Migrating a clinical laboratory information system between technologies

The technical revolution that has strongly driven events in the clinical laboratory for the last thirty years is now threatening to make obsolete what has become the central pillar of operation in many laboratories, the minicomputer-based laboratory information system. Some of its functions could easily be absorbed by the personal computers which are proliferating in the laboratory, but any single step leap between systems risks replacing order with chaos. Appropriate use of networking tools, together with essential software development, can provide a systematic migrational path for both the administrative and technical computer support from one environment to another without the trauma of a massive replacement step.

Decision support alerts for clinical laboratory and blood gas data

We have designed and implemented a computerized Intensive Care Unit (ICU) decision support alerting system which analyzes all incoming laboratory and blood gas data for critically abnormal values and trends. A computerized patient data management system (HP 78709A PDMS, Hewlett-Packard Co., Waltham, MA) serving 20 Surgical ICU beds is networked to a Clinical Laboratory Information System and a blood gas computer system. The ALERTS subsystem operates on the PDMS as an automatic program triggered by the receipt of fresh laboratory data. Three types of ALERTS are detected: (1) high and low critical values, (2) calculation-adjusted critical values, and (3) critical trends. Once detected, a specific ALERT message is displayed at the bottom of the patient's bedside PDMS terminal and at the central station. Over an eight month period a total of 1,515 ALERTS were detected from amongst approximately 115,000 laboratory data results transmitted to the Surgical Intensive Care Unit (SICU). Slightly over half of all ALERTS were caused by critical blood gas values. ALERTS were found to be a sensitive indicator of severity of illness: patients with one or more ALERTS suffered an ICU mortality of 9.52%, compared to 0% mortality in patients with no ALERTS. We conclude that automated laboratory data ALERTS represent a valuable decision support tool for the management of high risk ICU patients.

The assessment and treatment of theophylline poisoning.

Theophylline poisoning long has been recognized as difficult to treat and still has an over-all mortality rate of about 10%. In recent years, the increasing use of sustained-release preparations has changed the pattern of toxicity. The management of theophylline toxicity is compounded by clinical differences between chronic (overmedication) intoxication and acute single ingestions of a large amount of the drug, inter- and intraindividual variability in theophylline metabolism and dose-dependent kinetics in poisoned patients. Management decisions should be based on both clinical assessment and laboratory information (particularly theophylline concentrations).

Long-term data storage in a clinical laboratory information system.

The clinical laboratory is pressured on one side by physicians and regulators who want the laboratory to keep more detailed patient records available for longer periods and on the other side by physical space and cost constraints which favor rapidly transferring such records to Medical Records or a warehouse from which retrieval is slow and difficult. Various forms of inactive data storage and archiving in machine-readable form are available to address this dilemma, yet these solutions can create even more difficult problems. Two different approaches were developed within the framework of Relational LABCOM to address both the intermediate and long-term storage of data. In this paper we examine the two methods as solutions to the problems, discuss their limitations, and determine why one is superceding the other in the installation base.

Clinical Pathology of Llamas

Examination of the diseased llama often relies on clinical laboratory information to supplement that from the physical examination and history. Because of the llama's only recent importance as a companion animal, little information is available on the analysis and interpretation of clinical laboratory parameters in this species. Llamas possess red blood cells with a unique shape, small size, and high hemoglobin content. The hemoglobin has a high oxygen affinity, which helps the animal adapt to high altitudes and presents with an oxyhemoglobin dissociation curve shifted to the left. The llama maintains high resting blood glucose, creatinine, and urea nitrogen levels. It is very efficient at recycling urea nitrogen via nonrenal pathways. Most of the clinical pathologic parameters can be utilized and interpreted as in other species, but with a different baseline of normal values.

The development of a third generation system for entering microbiology data into a clinical laboratory information system.

Increased demands on technologists' time and the desire to have electronic storage of patient information have led to numerous computer-based efforts to manage microbiology data. Our approach to the design of a new microbiology subsystem has been to maximize the functionality without requiring unusual input devices. DEC VT100-compatible terminals are used for data entry and display. Data are displayed taking advantage of such features of these terminals as reverse video, highlighting, and scroll windowing. Numerous single-key instructions for invoking functions and changing cursor positions have been implemented to minimize keystrokes and to anticipate the entry sequences of the technologists. A program that allows the quick location and display of specimens and results is also included in the package.

Laboratory Diagnosis in Ophthalmology

Designed for residents and practicing ophthalmologists, this multiauthored text edited by Dr Karcioglu is intended to detail in step-by-step fashion those laboratory procedures that supplement clinical and radiological observations in reaching a diagnosis. The first section of the book is devoted to anatomic pathology. Chapter 1 by R. Jean Campbell is an excellent, concise review of eyelid and conjunctival lesions. Dr Karcioglu discusses orbital lesions in chapter 2 and, with the collaboration of Barrett Haik, intraocular tumors in chapter 3. However, the book does not discuss the histopathology of the cornea or lens, although corneal buttons and cataracts are common ocular specimens in many surgical pathology laboratories. [It] give[s] the practicing ophthalmologist access to clinical laboratory information that is not readily available elsewhere. In chapter 4, the application of new immunopathologic techniques to ocular diagnosis is reviewed in a scholarly and rigorous fashion by L. David Ormerod, Delia Sang, and

Implementing an Information System

Careful attention to the implementation of a clinical laboratory information system is critical to the success of the system. Aspects of implementation, including installation of hardware, training of personnel, and preparation of the data base, are outlined. Commonly encountered problems—and how to avoid them—are highlighted.

CLIS, a clinical laboratory information system designed to optimize microcomputer operation.

Journal Article CLIS, a clinical laboratory information system designed to optimize microcomputer operation. Get access C Bishop C Bishop Search for other works by this author on: Oxford Academic Google Scholar Clinical Chemistry, Volume 27, Issue 5, 1 May 1981, Pages 704–708, https://doi.org/10.1093/clinchem/27.5.704 Published: 01 May 1981

Introduction of computer facilities to a clinical chemistry laboratory.

A clinical chemistry laboratory information system based on MUMPS is described, together with the problems associated with its implementation. Tabular displays and cusum charts as well as cumulative records are available on a real-time basis. Data capture is by both on-line and off-line techniques. After 18 months' live running the management of information within the laboratory has been significantly improved.

Commentary: Clinical laboratory information systems

Clinical laboratory testing accounts for over eight percent of health care expenditures in the U.S. The use of computer technology has led to improved analytical instrumentation as well as to data acquisition and data management systems. Clinical laboratory, information systems have demonstrated their ability to reduce clerical and technical labor costs while providing more accurate and readable reports to the physician. The majority of systems currently operating were developed by commercial systems houses, and costs can range from under $100 000 to over $1 000 000. A major challenge is the use of such systems for the collection and analysis of large databases for clinical research.

New Concepts in the Design of a Clinical Laboratory Information System (LIS)

Laboratory computers have expanded in potential and are now capable of handling a communication system to support patient care. New technics and interactive software to expand this function are described and were developed because of serious deficiencies discovered in the hospital laboratory operation. New concepts in ordering of tests, collection and identification of samples, reporting of results, and retrieval of data are described.

A System Approach to Medical Information

Most effort using computers in medicine the past few years has been spent on optimizing the subsystems, e.g., the clinical laboratory, electrocardiogram analyses, business and administrative information, etc. While these areas are important, it is time more effort should be expended in terms of a system to integrate these subsystems. Goals and requirements for such a system are discussed. An operating system capable of handling and modularly adding all medical data, for the subsystems, in a systematized and standardized way is described. The system features a flexible, comprehensive and efficient computer medical record which has the capability of keeping all data over the lifetime of each patient.

Fixed Combinations of Antimicrobial Agents

A detailed review is offered of the claims that are put forward for the use of penicillin-sulfonamides, penicillin-streptomycin, and certain other fixed combinations of antimicrobial agents. The judgments presented are based upon an extensive review of the literature, and a roster of pertinent references is appended. It is the opinion of the five panels that the penicillin-sulfonamide and penicillin-streptomycin combinations are “ineffective as fixed dose combinations.” This means that, although the individual active ingredients may be useful in specific disease entities, no greater effectiveness can be expected for the combination than for any one ingredient. The report also considers the adverse effect of such fixed combinations on the practice of medicine. It is the judgment of the five panels on anti-infective drugs that the use of these fixed combinations should be discontinued and that the physician should use the individual components according to his best clinical judgment and laboratory information.

An on-line computer facility for systematized input of radiology reports.

Stimulated by both the increased demand for medical care and the rapid growth of medical knowledge, the practice of medicine today, in both small and large medical centers, is involved with fragments of information from a variety of sources. As the patient load grows and the number and variety of tests, procedures, examinations, consultations, etc., increase, it becomes more difficult to manage the large amount of pertinent information accumulated on a single patient. The need for improved information-processing, especially in large medical centers, is increasingly evident. Hospitals have little or no documentation of the cost of their present information-processing technics, but it has been estimated that it may be as much as 25 per cent of a total hospital operating budget (1). The costs are usually not visible, however, and the direct and indirect development and utilization costs of automated information processing are often difficult to justify on economical considerations alone. Presumably better patient care will result, but it is difficult if not impossible to translate this intangible benefit into economic savings. Nevertheless, the spector of increasing proliferation of hospital paperwork and the growing scarcity of both professional and nonprofessional staff forces us to examine and evaluate the use of computer systems in the hope that automated information-processing will provide some alleviation of these problems. For several years our Laboratory of Computer Science has been developing computer systems for clinical data management: to process clinical laboratory information, to obtain patient histories, to generate progress notes, to assist in medical diagnosis and patient treatment-planning, and, most recently, to create x-ray reports. Data are put into the computer system by imposing a structured dialogue on the recording process. Free text can be entered at the end of the report or by subsequent dictation, but in general we prefer that the information enter the computer through words and phrases anticipated and presented by the program. This use of prestructured text provides a significant degree of quality control and facilitates retrieval and analysis of data in a fashion not possible in records composed of unconstrained narrative text. Although our radiology reporting system has been designed to be part of an evolving hospital-wide information system (Fig. 1), it will also operate separately or as a part of a limited information system. Obviously, the radiological consultation is an integral part of the patient's record, and a major weakness of present systems of radiology reporting in most medical centers is the time lag between interpretation of the study and the availability of the report to the interested physician. Although many factors contribute, the delays usually occur in the transcribing, typing, filing, checking, and transportation process.