The impact of laboratory information systems on the efficient management of laboratories.

Abstract

The computerisation of hospitals knows its roots to the pioneering work carried out in the laboratory and laboratory information systems (LIS) were the first to take root. Thus, LIS have been with us for a few decades and their functions within the laboratory are well understood. They form part of the infrastructure of a good modern laboratory. Technological advances have produced several other IT systems in the hospital environment and LIS is an essential component of an integrated hospital information system. These systems allow for improved patient care. Apart from facilitating and performing some of the basic function of laboratories, LIS have an inherent capacity to assist management. This management role is perhaps a little less understood or utilised. This study explored the impact of these systems on the efficient management of laboratories and how they can improve the management process. Another important question this study examined was the impact that the introduction of LIS and the pneumatic tube system had on the turnaround time of laboratory investigations. This is a continuation on Camilleri's (2007) work on turnaround time and a comparison of his findings to the current situation. The project also measured the turnaround time of several analytes in different laboratory disciplines. To achieve these aims, one quantitative and two qualitative studies were carried out. The quantitative part involved the measurements of turnaround time. These were carried out using a tool developed for this study which utilised report generation software and the data from the LIS. The results generated a set of benchmarks for both analytical and therapeutic turnaround times. The new data also allowed for a 'before and after' analysis of turnaround time between the old and the new hospitals. This was a recommendation in Camilleri's (2007) thesis and it allows for measuring the impact of the LIS and the pneumatic tube system on laboratory turnaround time. The results show that for urgent (stat) samples, there was no change in analytical time but there was a great improvement in therapeutic turnaround time. This establishes that there was a positive impact on turnaround time with the implementation of a LIS and pneumatic tube system. The study also showed that there is still room for further improvement. Two qualitative studies were carried, one to tap into the knowledge base of IT experts on LIS and management issues, and the other to gather the perception of laboratory clients on improvement in the service the laboratory provides. LIS aids laboratory management in performing several managerial functions. It allows for the control function to be calried by providing audit information about laboratory operations. The availability of factual and up to date information allows managers to perform the other functions of decision taking, planning and organising. LIS allows for the automation of certain processes such as authorisation of results and these make the system more efficient. Other efficiency gains are obtained by the LIS allowing for the automation of certain processes such as rule-based decision taking and the use of bar-codes. Having a single data repository provides for other efficiency gains, such as data gathering for reports and research. LIS and other IT systems can also help other management areas such as in finance and resource management. LIS provides benefits to clinicians as it allows for the availability of laboratory results to other hospital systems. It is therefore important for hospital management so that the hospital can provide services such as clinical decision support systems and others that provide an improved clinical service and increase patient safety. The study recommended that a formal communication structure should be set up between the laboratory and clinical area. The interdepartmental committee would discuss issues such as turnaround time and its continuous improvement. Another recommendation was for laboratory management to assist hospital IT management to expedite the roll-out of the ordering software in the hospital.