Tracking a White Blood Count from Order to Result

A clinician requests (orders) that a laboratory perform a white blood count on a blood sample from a patient in one of several ways. The clinician writes the order on paper, gives a verbal order to a nurse, or enters the order directly into a computer system. A LIMS may receive this order in one of several ways: directly, if the LIMS provides an order-entry component that either the clinician uses directly or the nurse or ward clerk uses on her behalf; indirectly, if a paper order form accompanies the specimen; or electronically, from an order-entry system embedded in another information system (such a point-of-care system as discussed in Chapter 6).

We will trace the most automated path in which the LIMS receives the order electronically. The received order sets up a specimen-tracking process that is a central LIMS function. The LIMS (or a point-of-care system) controls a printer, which is often located in the clinical area from which the order originated. The printer generates a bar-coded label. A phlebotomist attaches the label to a "purple top'' vial (containing magnesium citrate or ethylenediaminetetraacetic acid [EDTA] to prevent the blood from coagulating). The phlebotomist draws the blood after checking carefully that the identification on the labeled tube matches the patient, and sends the sample to the laboratory. Oftentimes, the labeled specimen is transported by pneumatic chute from clinical areas, such as the emergency department, or by express overnight delivery to the laboratory. A technician in the laboratory scans the barcode of the specimen with an optical scanner, which is connected to the LIMS. If the laboratory has an automated analyzer for blood counts, the technician simply places the vial into the specimen carousel of the analyzer. The analyzer recognizes the bar code, communicates with the LIMS over an internal laboratory network to determine which tests were ordered for the specimen, runs the tests, and transmits the results to the LIMS. Other types of specimens may require preparation, such as centrifuga-tion, before being placed into the carousel of an automatic analyzer, but the information processing and communication between the analyzer and the LIMS are otherwise identical. For tests that are done by hand, the LIMS provides user-interfaces into which medical technologists register specimens and enter intermediate and final results of tests.

Depending on the laboratory and the needs of its clinical customers, the LIMS may deliver the results as paper reports, via Web-browser interfaces, or by e-mail. A LIMS typically offers all of these options. A LIMS invariably has an outbound computer-to-computer interface that can transmit results to other clinical information and public health information systems. Although our example is of a clinical test, the process is identical for environmental tests ordered by sanitarians, water quality technicians, or outbreak investigators.

The vast majority of laboratory work in the United States is highly automated in the fashion just described. With the exception of tests done in the field or in office practices, LIMSs track and manage the analytic results of most laboratory tests performed in the United States. LIMSs are designed to make test results available to clinicians and other information systems soon after they are performed. LIMSs are highly reliable and operate in real time. LIMSs are developed within the laboratory by information technology staff, purchased from commercial vendors, or a combination of both.

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