David Chou

Unit-independent reporting of laboratory test results

Abstract A variety of laboratory measurement units, assay systems, and reference values are presently being used in different clinical environments. There is therefore a challenge in provision of tools for presentation of laboratory data in harmonized forms that reduce the information load and reinforce clinical perception of test results. This paper describes the use of standard deviation (SD) units and logarithmic time graphical displays to improve presentation of laboratory test results. The SD concept employs strength of the change from normality as a diagnostic indicator, and the logarithmic time scale enables long-term overview of patient results. The suggested format is expected to promote effective transfer of test result information between laboratories, clinicians and hospitals.

Comment: Applications of robotics in the clinical laboratory.

The implementation of a robotic workstation in the clinical laboratory involves considerations and compromises common to any instrument design and development activity. The trade-off between speed and flexibility not only affects the way the instrument interacts with human operators and other devices (the ‘real-world interface’), but also places limitations on the adaptation of chemistries to the given instrument. Mechanical optimization for speed and reproducibility places restrictions on the imprecision of consumables. Attempts to adapt a robot to a constrained system may entail compromises that either degrades the theoretically-attainable quality of results, or requires human interaction to compensate for physical or mechanical limitations. The general considerations of function and workflow, programming and support, and reliability place practical limits on the implementation of robotic workstations in the clinical laboratory.

Infrastructure and Security

Publisher Summary Infrastructure refers to those resources and items required to successfully support and operate information systems. Security refers to policies, procedures, software, and hardware designed to insure that data in information systems are protected against accidental or inappropriate destruction, alteration, or access. Properly supported, infrastructure competency allows an organization to maintain agility in responding to strategic directives and tactical changes. Infrastructure and security together provide the day-to-day operational support for the hardware and software, thus forming a critical component of the organization. Proper management of security requires attention to infrastructure and information system designs, as well as the organization adhering to strict and appropriate personnel practices. Both infrastructure and security are among the many invisible processes and resources required to implement and sustain a successful clinical computing system. Some resources, such as a data center, must be available prior to implementation of these systems; many other resources, such as those supporting security, should be available prior to implementation, but are often deferred until problems occur. Most infrastructure requirements continue and expand after the system is in use. Although organizations can purchase services through outside contracted vendors, those developing skills in their own personnel can use resources more cost effectively, saving as much as 25–40%, particularly in areas such as disaster management. In the longer term, the use of contracted services can result in the loss of skills necessary for making strategic decisions, putting into question whether the estimated savings of contracting can be achieved.

Chapter 4 – Infrastructure

Infrastructure refers to those resources and items required to successfully support and operate information systems. These items include, but are not limited to, security, networks, computers and closely associated hardware, their operation and management, data centers, and desktop computers. In many cases, these items may be purchased as services from a vendor, or are a part of services supported by groups within an organization. Infrastructure items often require large capital and operational expenditures, lengthy lead times, and highly technical skills. The internal versus the acquisition of these services from commercial suppliers is usually decided by economic tradeoffs and availability of local skills. Infrastructure also refers to hardware and software for the use and management of information systems. These include software to manage identity management (users and their passwords), logins (such as single sign-on or SSO), anti-virus software, firewalls, and software for remote access. Infrastructure plays a large role in supporting the security of information systems to protect data against accidental or inappropriate destruction, alteration, or access.

Importing Laboratory Data

You have just completed a patient history and physical exam. You determine that the patient needs laboratory tests to rule out secondary hypertension. You pull out and fill out paper requisition forms for basic blood work. You send the patient to the laboratory phlebotomist servicing the practice with a requisition for a basic seven-test chemistry profile (CHEM7) and a complete blood count (CBC). The patient goes home with filled-out request form and instructions for a 24-hour urine collection for metanephrine and is asked to return when he has completed the collection. You receive the results for the CHEM7 and CBC next morning. The patient returns to the laboratory satellite one week later with the 24-hour urine, but leaves the request forms at home. The phlebotomist calls your office for instructions on how to handle the urine jug while the patient is waiting. After 15 minutes with an angry patient, the phlebotomist receives a copy of the requisition faxed by your office. The metanephrine is ordered and results arrive two days later. You hunt down the laboratory results received a week earlier from the stack of paper on your desk and compare them with the metanephrine results.