LIS ensures quicker availability of test results, thereby reducing the time to report, which canÂ save invaluable patient lives
By Dhirendra Pratap Singh, firstname.lastname@example.org
Laboratories constitute the core operational componentÂ in any specialty hospital set up. Often, they are the mostÂ humongous generators of data and information, providingÂ the most crucial input for doctors to decide the course ofÂ treatment. With increased adoption of process automation inÂ hospitals, the demand and market potential for Laboratory InformationÂ Systems (LIS) is growing.
Laboratory information system is a generic term used to denoteÂ the computer systems in clinical and research laboratories. Â It is a suite of software applications for managing the dailyÂ operations/workflow of a laboratory. LIS has Â multiple modulesÂ for data collection, tracking, analysing, reporting or delivery ofÂ results. The data can be related to patients, lab employees,Â samples, results, instruments, consumables or reagents. LISÂ can be used for workflow management, accounts and controlÂ of instruments if integrated with the system.
While the LIS plays an important role in ensuring accurateÂ laboratory results, it does not work alone. The test results/reportsÂ of patients are usually interfaced with the electronic medicalÂ records (EMR) to ensure that clinicians can get access toÂ updated/complete test results.
Together with patientsâ results gathered from other departmentsÂ (e.g. Radiology), the EMR enables the clinician to obtainÂ a comprehensive overview of patientsâ medical histories. ThisÂ enhances the clinical decision-making process and ultimatelyÂ leads to improvement in standards of patient care. LIS canÂ support sub-specialties of the pathology laboratory, includingÂ haematology, chemistry, immunology, blood bank, surgicalÂ imporpathology,Â anatomical pathology, flow cytometry and microbiology.Â The inputs into a LIS have a uniquely identifiable physicianÂ order and a matching patient sample. These are thenÂ matched with the patient record and the order is processed. Â The outcome of the test is manually or electronically added toÂ the patient record for access by the physician.
LIS can ensure quick availability of test results and analysisÂ in ICUs, operating rooms and emergency room settings. WhenÂ there is faster turnaround time, there are better chances forÂ saving the life of a critically ill patient. LIS can be integrated withÂ point-of-care diagnostic devices at these locations for informationÂ management. The value of providing detailed results toÂ clinicians in real time cannot be undermined.Â A majority of initiatives advocating the use of informationÂ technology in hospitals or clinical practices focus on EMR systems.Â While advantages of EMR systems have been substantiallyÂ proven, an often-overlooked aspect of healthcare deliveryÂ automation is the use of information technology in clinicalÂ laboratories.
India is burdened with different types of cancer and infectiousÂ diseases. The country contributes over 132,000 casesÂ of the estimated 500,000 cervical cancer cases globally perÂ year. Thus Indiaâs contribution is of more than one-fourth of theÂ worldâs total cervical cancer cases.
The role of diagnostics in addressing rapidly growing diseasesÂ is significant. Local healthcare providers have increasedÂ their reliance on diagnostic testing systems in order to be ableÂ to make the best decisions for their patients. The growing middle-Â class also recognises the value of pathology testing and isÂ willing to pay for these tests. This is reflected in the over 20 percentÂ CAGR in the last five years in Indiaâs diagnostics industry.
LIS provides a number of benefits. It can ensure quicker availabilityÂ of test results and analysis in ICUs, operating rooms orÂ emergency room settings. LIS can be integrated with pointof-Â care diagnostic devices for information management. TheÂ value of providing detailed results to clinicians in real-time cannot Â be undermined. In a study conducted at MassachusettsÂ General Hospital, the cliniciansâ improved accuracy in 70-80Â percent of the cases, as expert opinions of pathologists gotÂ facilitated through the LIS. The concerned pathologist used an Â LIS with clinical decision support for providing narrative interpretationÂ with every lab result to cohort of clinicians.
Sanjay Kumar Jain, Managing Director, Akhil Systems PvtÂ Ltd., says, âThe flexible and easy to configure setups helpÂ meet the reporting requirements of all branches of the laboratory.Â The product is designed for automated bi-directionalÂ data exchange with the laboratory equipment, which will helpÂ reduce chances of incorrect data entry and also help reduceÂ the time involved in processing the final reports. The systemÂ is capable of communicating with external systems using HL7Â and EDI standards.â
Sanjay Kumar Jain
Managing Director, Akhil Systems Pvt. Ltd
âThe product is designed for automated bidirectional dataÂ exchange with the laboratory equipment, which helpsÂ reduce the time involved in processing the final reportsâ
He adds, âWhen the lab receives any specimen in the system,Â the specimen is assigned a chorological number accord-Â ing to the predefined defined criteria for each branch of the laboratory.Â The systems also generates bar coded labels, whichÂ are run on the laboratory equipments. The labels are scannedÂ and the patientâs tests and related information are read by theÂ machine and the tests are processed further.â
Peter Jose Palal
Product Manager, Encora Technologies
âLIS on SaaS platform is the best example of softwareÂ emancipation of humankindâ
LIS and SaaS
Cloud computing offers a new approach that will transform theÂ delivery and consumption of IT services of a company in future.Â In cloud computing, Software as a Service (SaaS) is a veryÂ promising field, one that brings a lot of benefits in LIS. SaaSÂ is a model of software deployment, where an application isÂ hosted as a service provided to customers across internet.
Peter Jose Palal, Product Manager, Encora Technologies,Â says, LIS on a SaaS platform presents a cohesive model of applicationsÂ that helps hospitals and labs of disparate nature to Â seamlessly interact among themselves and execute lab ordersÂ and receive results in a faster and efficient way. LIS on SaaSÂ platform makes information technology available to the patient,Â physician, lab technician, etc., making them a close knit communityÂ and is the best example of software Â emancipation ofÂ humankind. It can be called âThe Facebook of LISâ, except thatÂ itâs highly confidential!â
The online services in SaaS include subscription-basedÂ models, on-demand applications and hosted services. TheyÂ provide end users with a consistent experience across variousÂ client devices. Microsoft SharePoint Online is an example ofÂ such a service. Google, Amazon, SalesForce.com, IBM, Zoho Â and CRM are examples of SaaS cloud providers.
SaaS (software as service) is being used to deliver a varietyÂ of e-Governance cloud services, such as Singaporeâs TradeÂ Net-a Single electronic window platform, that enables imporpathologyÂ tant stakeholders within the supply chain to reduce the timeÂ needed to facilitate the trade process.
In 2009, SaaS had a worldwide market share of USD 9.6 billion,Â while IaaS (Internet as a service) had a worldwide market
share of USD 1.3 billion. By 2013, the SaaS market will grow toÂ USD 17 billion, while in the same time frame IaaS will have anÂ almost six-fold growth to USD 7.6 billion. IaaS will be on a highÂ growth trajectory given that it provides options for customisationÂ and standardisation.
Disease surveillance for earlier detection of epidemics is anotherÂ important benefit. LIS systems can be connected with aÂ central monitoring system, which picks up subtle changes inÂ trends. Such a system is being set up under the World BankÂ funded Integrated Disease Surveillance Project in India. LISÂ can provide surveillance data to public health agencies, usingÂ the accepted standards, and these data could be about Â reportable diseases, infections, tumour registries, etc.
Evidence based medicine tools Â
LIS can also facilitate evidence-based medicine. As theÂ healthcare industry matures Â in terms of infrastructure and innovativeÂ technologies, the next goal of care delivery demandsÂ clinical excellence through evidence based medicine toolsÂ and benchmarks. Evidence based medicine is already beingÂ promoted globally and has been proved beneficial for all stakeholders – clinical teams, hospital management, and theÂ patients. Evidence based medicinal tools, like clinical protocolsÂ and clinical pathways, provide explicit and well definedÂ standards of care for the clinical teams and support multidisciplinaryÂ care planning.
From a management perspective these tools reduceÂ healthcare costs, reduce patient documentation, optimiseÂ management of resources andÂ help continuous clinical audit. Â They improve clinical care byÂ delivering superior outcomes,Â improved clinical effectiveness Â and patient satisfaction. TheseÂ tools can also be integrated withÂ the existing Â MR for providingÂ decision support to the clinicalÂ teams.
Clinical protocols and pathwaysÂ based on evidence availableÂ from the Indian sub-continentÂ are now available and needÂ to Â be adopted in healthcare settingsÂ to achieve the next level ofÂ quality. The right amalgamationÂ of modern infrastructure, Â innovative Â technologies and clinicalÂ skills guided by evidence basedÂ tools will go a long way in bridgingÂ the gap in the Indian healthcareÂ industry.
The systems can be used for trend analysis, tracking of diseaseÂ profiles and conducting research studies. LaboratoriesÂ generate a lot of data, running into millions of test outcomesÂ everyday. This data can be matched with appropriate clinicalÂ records to determine outcomes, which could dynamicallyÂ influence the treatment plan. In a study, about 25 percent ofÂ primary care physicians found the expectations of care beyondÂ the scope of their knowledge.The physicians will be wellÂ served with a LIS, which helps to provide interpretations toÂ ordering physicians that are specific to patientsâ needs andÂ conditions.