2005 Scientific Session Abstracts
Laboratory Information Service in a Developing Nation
Joy J. Mammen, MD , (joymammen@cmcvellore.ac.in); Senior Lecturer; Sukesh C. Nair, FRCPA (Haem) , Associate Professor; Saravanan V, BSc; Medical Lab Technologist Selection Grade II; Selvakumar D., BSc; Computer Programmer; Clinical Pathology & Blood Bank, Christian Medical College, Vellore, Tamil Nadu, India
Context: This hospital is one of the largest tertiary care centers in India offering multi-specialty care and training. Our department provided about 1,168,470 results for routine blood tests in 2004 amounting to a 61% increase over the last 10 years; currently processing between 1000 – 1200 samples per day. Urinalysis samples range from 300 to 400 per day (30% increase over the same period). With increasing work-load, the main problems identified were increased turn-around-time for results, increased clerical transcription errors and a high manual slide review rate. Although we had modular automation, the need for a laboratory information system remained unaddressed. Commercially available programs were very expensive and poorly supported.
Technology: The haematology analyzers used are the Beckman CoulterLH750 and Gen*S (Beckman-Coulter, USA), Sysmex K4500 (Toa, Japan) for hematology and Clinitek500 (Bayer, Germany) for processing urine. The program was initially designed in Visual Basic ™ and Access ™ running on a Windows 2003 ™ server (Microsoft, USA). Over the last two years, issues of scalability that have arisen have been addressed by using Oracle 8i™ (Oracle, USA).
Design: The software (Online) developed locally, utilizing bar-code 3/9 for sample labeling, is designed to communicate bi-directionally with the hospital server to receive billing information and registration details from the central server and to link it up with the sample details at the laboratory using two unique identifiers – the hospital number and the laboratory number. All the data from four hematology (18/23/24 parameter output) and two urine analyzers (10 parameter output) is transferred to the laboratory server via RS232, linked to the unique identifiers. Data validation is performed using a rule based review system. The results requested for patients are transferred regularly onto the hospital intranet with flag messages alerting the clinician as to the validation status of the result. Quality monitoring using patient data in the form of moving averages is an additional feature.
Results: The mean turn-around-time for technologist validated reports improved significantly from 5.7 hrs to 2.5 hrs (p<0.01). The manual slide review rate has decreased from 39.5% to 19.8% (p<0.01). In addition, it has also enabled reduction of clerical errors, improved sample tracking, search, logging of interventions, data archive and better quality control.
Conclusion: This is the first time that this type of a program has been developed indigenously and used for this scale of operations in our country. We recommend it for hospitals in developing countries like ours where resources are limited.