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GETTING THE MOST OUT OF YOUR (OLD) EXISTING LIS Dennis Winsten In today's era of intense competition for already tight budgets, like it or not, many laboratories will be unable to justify and obtain the large capital allocations required for major laboratory information system (LIS) upgrades or replacement. They will have to make do with their (however antiquated) existing LIS. Nevertheless, the laboratory will be expected to meet increasing demands for service, quality, and productivity. The existing LIS will be expected to support high levels of quality assurance, provide rapid response times, support additional terminals and user access (including remote access), provide timely and comprehensive reporting, offer useful and timely management data and, of course, be compliant with an ever increasing set of standards and regulations. It's as challenging and risky as the "Perils of Pauline" (for you younger folks, Pauline was the one always being tied to the railroad tracks just ahead of the 5:02 train, that is). Fortunately, despite budgetary constraints, there are a number of things that the laboratory can do to get more out of and thus extend the life of its current laboratory information system. Moreover, these enhancements are possible with minimal expense using, in some instances, equipment and software already available on premises. These actions fall into several general categories:
- PC download/PC tools; e.g., spreadsheets, database queries, Fax cards, etc.
- System utilization audit/inservice re-education
- Inter-operability of manual and automated procedures
- Access capacity expansion
- Supplemental software; e.g., ad hoc query/report generator
- Remote "value-added" network services; e.g., Compuserve, America Online, Prodigy, etc.
Let's consider each of these categories and discuss the opportunities of each. PC DOWNLOAD/PC TOOLS Virtually every laboratory has at least one personal computer (PC) on premises. Very often the PC is under-utilized, being used at periodic intervals for quality control processing or small spreadsheet analysis. There is a wealth of generally available, easy-to-use software for PC's which, when coupled with access to data extracted from the LIS, can be powerful tools for the laboratory manager. Spreadsheet programs such as Lotus(tm), Excel(tm), Quattro Pro(tm), and others can be used to process downloaded files and to produce valuable management and even clinically-oriented reports. Word Processing programs (e.g., WordPerfect(tm), Microsoft Word(tm), etc.) can support procedure manual maintenance and various text/report processing. Graphics/Publishing software (e.g., Harvard Graphics(tm), Freelance(tm), etc.) can assist in preparing educational and presentation materials. Low cost seminars on advanced usage of most of the common PC software packages are offered relatively frequently in many geographic locations. Check for those offered in your area. The investment in attending such a seminar can pay dividends many-fold. Useful advanced techniques include:
- Use of "macros" to automate repetitive tasks
- Creation of "templates" for data importing
- Use of import/export commands for data interchange
"Computer Dialog" frequently offers some examples of PC applications developed using standard PC software tools. The authors are usually willing to discuss their applications. Call them, if you need more information. A number of examples are cited below in Suggested Reading. SYSTEM UTILIZATION/AUDIT Many laboratories are not taking full advantage of the capabilities of the laboratory information system they already have. The reason for this is that during the stress and intensity of LIS installation many subtleties are bypassed in favor of "getting the installation completed." There may be extended functions or improved features that have been added by the vendor since installation and, of which, the laboratory staff may be unaware. Unfortunately, few users retrospectively examine their LIS operations and even fewer LIS vendors offer "follow-up" inservice training to help labs make the best use of the system. Further, once caught up in LIS operations, little attention is given to improving the integration of manual and automated procedures. Requesting your LIS vendor to conduct an onsite audit will almost assuredly result in more effective/efficient use of the LIS. INTER-OPERABILITY OF MANUAL & AUTOMATED PROCEDURES While improved utilization of the LIS, as noted above, can enhance operations, even greater results may be achieved by examining the "interface" between the automated and manual procedures. An internally performed or externally provided manual/automated workflow analysis will usually result in elimination of "bottlenecks," improved workflow, and better "meshing" of LIS and manual operations. ACCESS CAPACITY EXPANSION Many older, existing LIS have reached their capacity to add terminals and/or instrument interfaces. There are several alternative approaches of moderate cost to provide expanded accessibility. These approaches include the use of:
- Data Switch. Cost: Approximately $25,000; Vendors include: Micom, Gandalf, AT&T
- Port Sharer. Cost: Approximately $15,000; Vendors include: ??
- Local Area Network Card. Cost: Approximately $10,000 plus $250 per connected device
The "best" approach will depend on your particular system configuration and extent of access capacity needed. Your vendor or network consultants can assist if needed. SUPPLEMENTAL SOFTWARE Ad hoc query/report generators are commonly offered as part of, or in conjunction with, LIS vendor software. Although relatively costly ($25,000 - $75,000+), such software can substantially enhance the availability of management information, operating statistics, and special reports. Acquiring an ad hoc query/report generator may serve to provide these reports which would not otherwise be possible with just the existing LIS software. REMOTE SERVICES Commercial Value-Added Networks (e.g., Compuserve, America Online, Prodigy, etc.) can offer a range of services which can be of use to the laboratory. Services can include nationwide electronic mail, user shared interest forum, "real-time" forum conferences, bulletin boards, reference sources, access to various databases including an number of healthcare databases, rapid access to the latest in fast-breaking legislative/regulatory news and/or issues. Further, such services offer services for users' personal lives too; e.g., travel planning, stock market, news, weather, sports, hobbies and games (just what every busy laboratorian needs!). SUMMARY In summary, the lack of a large budget for information systems should not prevent laboratories from getting as much as possible from existing systems investments. Your consideration of the possibilities available can pay large dividends with relatively little expenditure. SUGGESTED READING Glickman, M.L. "Networking: A Means Not An End," Proceedings of HIMSS Healthcare
Conference, June 1992. Resnick, R. "Exploring The Online World," Home Office Computing, February 1993. Scheele, K. "Evaluating LIS Turnaround Times with Lotus 123," Computer Dialog, MLO,
September 1989. Smith, M., Sephel, G., Woodward, S., Duncan, D. "Templates For Generating Levey-Jennings and Westgard QC Charts," Computer Dialog, MLO, December 1992. Wilkenson, I. "Hypertext For The Laboratorian," Computer Dialog, MLO, January 1993. Winsten, D. "Post-Installation Follow-Up Training Can Enhance System Utilization,"
Consultant's Corner, 3M LIS Focus, Spring 1991. |
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