William Coughlin, chair of the Laboratory Information Systems and Medical Informatics Division of the American Association for Clinical Chemistry (AACC of Washington, D.C.) and marketing manager, Chemistry Division/ Central Lab, Global Marketing for Dade Behring (Deerfield, Ill.) provides a status report on IT in the clinical lab.

IT impacts every corner of the hospital environment. This is just as apparent and necessary within the lab as it is in other clinical, administrative and financial operations. The benefits include increased productivity, improved access to patient data and enhanced patient care.


Q. How is information generated in the lab being used throughout the healthcare enterprise? What is the justification for IT in the lab?

A. About 60 percent of the data in the electronic health record (EHR) is generated in the laboratory, and laboratory results are a component of 80 percent of physicians' diagnoses. As a consequence, the clinical laboratory of today resembles a continuous-flow manufacturing operation. Automation is crucial, and IT is an essential component of automation. Before making that investment; however, laboratories and hospitals need to understand the work processes that go into generating the information required to guide and enhance patient care. Hospitals can optimize performance by tapping into consulting services offered by vendors. These services are used to analyze bottlenecks and improve processes in order to reach the Six Sigma quality levels. The goal is to optimize processes before automating them.

Today, it can be a tortuous route from the patient's arm to the clinician's mind. The journey begins at the LIS, is passed on to an analyzer, then migrates back to the LIS and HIS and concludes at the medical record. IT offers the capability to better organizing information to enhance clinical interpretation and physician efficiency. The laboratory information is traveling one of several parallel paths to the EHR, where results need to be available simultaneously throughout the healthcare enterprise. The goal is a living, dynamically updated presentation of the patient's health information.


Q. What is the current state of IT in the lab?

A. IT in the lab is in a state of transition. It's moving from a pre-analytical focus, such as ensuring that the correct patient information is associated with each test order, toward post-analytical data management. Today, labs are developing post-analytical IT solutions to increase productivity, better share information with clinicians, and, ultimately, improve patient care. For example, IT solutions can link analyzers with laboratory information systems (LIS) to expedite verification and transmission of results.


Q. How is IT used in the lab?

A. IT can be deployed in the lab for multiple purposes - IT can facilitate internal checks such as comparing current results with previous results to check for potential errors or substantial changes in a patient's condition. This can improve clinical care and enhance labor efficiency.

Vendors are initiating use of IT to monitor the condition of analyzers real-time and this can help maximize the efficiency and quality of laboratory instruments' performance.


Q. What infrastructure is needed to facilitate information management?

A. Hospital laboratories require good interoperability among their various components. This includes: instruments, analyzers, information systems and middleware that often integrates results from several instruments for better analysis and correlation of patient data. Optimization of interoperability necessitates message form and content standardization. The federal government is promoting Consolidated Health Informatics (CHI), a set of standards for messaging, communication and information transfer for its hospitals and healthcare institutions. Adopting these standards is an important step toward promoting the interoperability of data among all segments of the healthcare enterprise. At its 2004 National Meeting, AACC will be presenting an afternoon-long workshop on this government initiative. The industry needs to complete the interoperability framework and adopt standards so that data flow is completed as efficiently as possible.