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Background: Reaching meaningful interoperability between proprietary health care systems is a ubiquitous task in medical informatics, where communication servers are traditionally used for referring and transforming data from the source to target systems. The Mirth Connect Server, an open-source communication server, offers, in addition to the exchange functionality, functions for simultaneous manipulation of data. The standard Fast Healthcare Interoperability Resources (FHIR) has recently become increasingly prevalent in national health care systems. FHIR specifies its own standardized mechanisms for transforming data structures using StructureMaps and the FHIR mapping language (FML)., Objective: In this study, a generic approach is developed, which allows for the application of declarative mapping rules defined using FML in an exchangeable manner. A transformation engine is required to execute the mapping rules., Methods: FHIR natively defines resources to support the conversion of instance data, such as an FHIR StructureMap. This resource encodes all information required to transform data from a source system to a target system. In our approach, this information is defined in an implementation-independent manner using FML. Once the mapping has been defined, executable Mirth channels are automatically generated from the resources containing the mapping in JavaScript format. These channels can then be deployed to the Mirth Connect Server., Results: The resulting tool is called FML2Mirth, a Java-based transformer that derives Mirth channels from detailed declarative mapping rules based on the underlying StructureMaps. Implementation of the translate functionality is provided by the integration of a terminology server, and to achieve conformity with existing profiles, validation via the FHIR validator is built in. The system was evaluated for its practical use by transforming Labordatenträger version 2 (LDTv.2) laboratory results into Medical Information Object (Medizinisches Informationsobjekt) laboratory reports in accordance with the National Association of Statutory Health Insurance Physicians' specifications and into the HL7 (Health Level Seven) Europe Laboratory Report. The system could generate complex structures, but LDTv.2 lacks some information to fully comply with the specification., Conclusions: The tool for the auto-generation of Mirth channels was successfully presented. Our tests reveal the feasibility of using the complex structures of the mapping language in combination with a terminology server to transform instance data. Although the Mirth Server and the FHIR are well established in medical informatics, the combination offers space for more research, especially with regard to FML. Simultaneously, it can be stated that the mapping language still has implementation-related shortcomings that can be compensated by Mirth Connect as a base technology., (© Jesse Kruse, Joshua Wiedekopf, Ann-Kristin Kock-Schoppenhauer, Andrea Essenwanger, Josef Ingenerf, Hannes Ulrich. Originally published in JMIR Medical Informatics (https://medinform.jmir.org).)

Laboratory information systems need to adapt to new demands created by the COVID-19 pandemic, which has set up new normals like containment measures and social distancing. Some of these have negatively impacted the pre- and postanalytical phases of laboratory testing. Here, we present an intriguing finding related to the generation of the accession number/specimen number on the investigation module of a hospital management information system and its impact on the dissemination of reports resulting in the wrong release of reports on a female patient amidst the background of COVID-19 containment measures. We analyze the situation that led to this false reporting and the importance of the proper customization of information software in laboratories along with a robust postanalytical framework of laboratory work culture to avert such untoward incidents. This introspection has made us realize that COVID-19 has been a scientific, medical, and social challenge. We need to redefine our priorities in the days to come because SARS-CoV-2 is here to stay., (© American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care., Competing Interests: Potential conflict of interest None declared., (Croatian Society of Medical Biochemistry and Laboratory Medicine.)

Background: A well-functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management., Objectives: To assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a 'similar articles' search in PubMed., Selection Criteria: Randomised and non-randomised trials, controlled before-after studies and time-series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems., Data Collection and Analysis: Two authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence., Main Results: We included six studies: four cluster randomised trials and two controlled before-after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality. In terms of data quality, a web-based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper-based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper-based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence). A hand-held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper-based system (moderate-certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper-based system (very low certainty evidence). We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper-based system (very low certainty evidence). High-intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low-intensity brief text messaging (low-certainty evidence). We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper-based stock notification (very low certainty evidence). We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence)., Authors' Conclusions: The review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data-informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision-making, to inform robust intervention design and evaluation methods., (Copyright © 2020 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

Laboratory services form an integral part of medical care in the decision-making of physicians, including those working at ambulatory care centers. Information exchange is essential between ambulatory care centers and laboratories. Inevitable errors have always existed in the exchange of such information on paper, which can be to some extent avoided by developing appropriate computer-based interfaces. Therefore, this review aimed to examine studies conducted to determine the effect of electronic communication between ambulatory care centers and laboratories. This systematic review was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were searched in the PubMed, Embase, Cochrane, and Web of Science, and those written in English and published between 2000 and February 2019 with full texts available were selected. From a total of 3898 papers retrieved from the studied databases, 24 papers were eligible for entering this study after removing similar and nonrelated studies. Electronic exchanges between ambulatory care centers and laboratories can have numerous benefits in terms of financial, organizational, and quality. This evidence for the value of electronic communications is an important factor contributing to its local investment and adoption., (© American Society for Clinical Pathology 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

EPIC Systems Corporation provides a widely used electronic medical record. Beaker Anatomic Pathology is a newly developed laboratory information system (LIS) that has been implemented at a small number of academic pathology departments. Pathologist opinions of EPIC Beaker AP have not been well described in the literature. A 37-question survey was administered to pathologists and pathology trainees to assess overall satisfaction and efficiency of report generation using Beaker AP. Data about experience in pathology, signout responsibilities, Beaker AP usage, and the legacy LIS was also collected. Seventy-four pathologists (51 faculty, 23 residents) responded to the survey (overall response rate 29.7%). Overall pathologist satisfaction with Beaker AP showed high inter-institutional variability; institutions with legacy LISs with a graphical interface had a generally neutral to negative assessment of Beaker AP. The majority of respondents disagreed with the statement "Beaker AP is easy to use and designed for my needs". Pathologists felt that Beaker AP was useful for reviewing clinical information and billing; areas of weakness included searching for prior cases and grossing efficiency. Overall, pathologists had a neutral opinion of whether generating and signing out a complete report was faster in Beaker AP, with marked inter-institutional variation. This variability was likely due to a combination of the efficacy of the legacy LIS, familiarity with Beaker AP at the time of the survey, and institution-specific optimization efforts.

Introduction:   To support African veterinary laboratory services, the Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise puts in place an operational system called "SILAB for Africa" (SILABFA); this is a web application used by a laboratory information management system to support laboratory diagnostic activities and to meet the needs of various African countries. SILABFA was designed to collect and manage all necessary information on samples, tests, and test results. Methods:   The system involves the entry of sample data on arrival, the tracking of samples through the various sections of the laboratory, and the collection of test results. It automates the generation of test reports and monitors outbreaks through data interrogation functions and eliminates multiple registrations of the same data on paper records. SILABFA is currently installed in Namibia, Botswana, Zambia, Zimbabwe, Tanzania, Uganda, Kenya, Ethiopia, and Cameroon, and installation in Senegal and Ivory Coast is planned for the next few months. After some years of SILABFA usage, it was natural to want to utilize more and more data collected in a homogeneous and consistent way for epidemiological purposes and to cover informative debts toward ministries and other organizations. Conclusion:   To improve the availability of good, detailed, and reliable data, as the epidemiological information, SILABFA has been linked to the local animal identification, registration, and traceability system and other relevant national information systems.

Rationale, Aims, and Objectives: Laboratory information sub-systems play an important role in diagnosis and treatment of patients. This study aimed to determine functional requirements of users and assess the existence of these requirements in the laboratory information system., Method: This descriptive cross-sectional study was conducted in 2016 in two phases. The first phase was done through three stages. First, based on an unsystematic review of related literature, an outline of functional laboratory information system requirements was identified. In the second stage, these requirements were identified in group meetings in the form of a semi-structured questionnaire and given to experts. Then, modified Delphi technique was used to reach agreement on each item. Then, based on experts' comments, the final version of the questionnaire was presented including 61 closed-ended items using Likert scale and an open-ended item. It was surveyed by 50 experts using Delphi technique. Responses were scored, and the requirements whose mean final score was 3 and above were finally confirmed. In the second phase, based on the confirmed requirements, a checklist comprising 68 requirements was prepared and adopted hospital information systems were evaluated through researcher observation. Data were analysed using descriptive statistics., Results: The final list of functional laboratory information system requirements was prepared with 68 items. The results of the evaluation revealed that confirmed requirements existed in 58.8% of hospital information systems., Conclusion: Laboratory information system requirements were designed with 68 items. Evaluation results showed that the systems were moderate in terms of compliance with the requirements., (© 2018 John Wiley & Sons, Ltd.)

Pathology has a large role to play in the proper development, implementation, and optimization of clinical decision support (CDS). CDS training must be supported by an educational foundation in clinical and pathology informatics. Educational opportunities are currently limited, but expanding, in the pathology residency space with Pathology Informatics Essentials for Residents. The use of an educational version of electronic clinical systems is an important educational tool to support the needed outcomes-driven and exercise-based informatics and CDS training. With the multidisciplinary nature of informatics, it is advantageous to include laboratory professionals in the training exercises as appropriate., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Emerging applications of machine learning and artificial intelligence offer the opportunity to discover new clinical knowledge through secondary exploration of existing patient medical records. This new knowledge may in turn offer a foundation to build new types of clinical decision support (CDS) that provide patient-specific insights and guidance across a wide range of clinical questions and settings. This article will provide an overview of these emerging approaches to CDS, discussing both existing technologies as well as challenges that health systems and informaticists will need to address to allow these emerging approaches to reach their full potential., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Clinical decision support tools that involve improving test utilization should be jointly overseen by a laboratory stewardship committee and the hospital informatics team. The roles of these groups vary by institution and may overlap. This is a team effort and collaboration is a must. The effectiveness of these efforts in an institution depends on the receptiveness of leadership and providers, as well as the effectiveness of the associated committees. Examples of the challenges and successes of laboratory stewardship interventions that have been operationalized at the Cleveland Clinic that use clinical decision support tools, as well as associated literature, are reviewed., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Clinical laboratories for in vitro diagnostics are facing pressure to preserve cost control while providing better services through new initiatives. Laboratory automation is a partial answer to this problem, having come a long way from the early days of clinical laboratory testing. The journey and implementation of automation in the Singapore General Hospital's Clinical Biochemistry Laboratory has allowed for sustained performance in the light of increasing workload and service commitments amid an evolving healthcare environment. Key to realising predicted outcomes is the optimisation of workflow processes, reduction of errors, and spatial placement of specimen reception and analytical areas. This paper gives an overview of our experience with automation in the clinical laboratory and its subsequent impact on service standards., (Copyright: © Singapore Medical Association.)

This study aimed to develop and test a research model that examined 7effective factors on the effectiveness of laboratory information system (LIS) through strategic planning. This research was carried out on total laboratory staff, information technology staff, and laboratory managers in Shiraz (a city in the south of Iran) teaching hospitals by structural equation modeling approach in 2015. The results revealed that there was no significant positive relationship between decisions based on cost-benefit analysis and LIS functionality with LIS effectiveness, but there was a significant positive relationship between other factors and LIS effectiveness. As expected, high levels of strategic information system planning result in increasing LIS effectiveness. The results also showed that the relationship between cost-benefit analysis, LIS functionality, end-user involvement, and information technology-business alignment with strategic information system planning was significant and positive.

Background: Recent U.S. government regulations incentivize implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR to their laboratory information system (LIS). Reported long-term benefits include increased efficiency and improved quality and safety. In order to successfully implement an interfaced EHR-LIS, institutions must plan years in advance and anticipate the impact of an integrated system. It can be challenging to fully understand the technical, workflow and resource aspects and adequately prepare for a potentially protracted system implementation and the subsequent stabilization., Objectives: We describe the top ten challenges that we encountered in our clinical laboratories following the implementation of an interfaced EHR-LIS and offer suggestions on how to overcome these challenges., Methods: This study was performed at a 777-bed, tertiary care center which recently implemented an interfaced EHR-LIS. Challenges were recorded during EHR-LIS implementation and stabilization and the authors describe the top ten., Results: Our top ten challenges were selection and harmonization of test codes, detailed training for providers on test ordering, communication with EHR provider champions during the build process, fluid orders and collections, supporting specialized workflows, sufficient reports and metrics, increased volume of inpatient venipunctures, adequate resources during stabilization, unanticipated changes to laboratory workflow and ordering specimens for anatomic pathology. A few suggestions to overcome these challenges include regular meetings with clinical champions, advanced considerations of reports and metrics that will be needed, adequate training of laboratory staff on new workflows in the EHR and defining all tests including anatomic pathology in the LIS., Conclusion: EHR-LIS implementations have many challenges requiring institutions to adapt and develop new infrastructures. This article should be helpful to other institutions facing or undergoing a similar endeavor., (Copyright © 2017 Elsevier B.V. All rights reserved.)

In this report, we describe 2 instances in which expert use of an electronic health record (EHR) system interfaced to an external clinical laboratory information system led to unintended consequences wherein 2 patients failed to have laboratory tests drawn in a timely manner. In both events, user actions combined with the lack of an acknowledgment message describing the order cancellation from the external clinical system were the root causes. In 1 case, rapid, near-simultaneous order entry was the culprit; in the second, astute order management by a clinician, unaware of the lack of proper 2-way interface messaging from the external clinical system, led to the confusion. Although testing had shown that the laboratory system would cancel duplicate laboratory orders, it was thought that duplicate alerting in the new order entry system would prevent such events., (© The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described., Aims: We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts., Design: A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI., Method: The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service., Results: 28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function., Conclusion: The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care., (© The Author 2017. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Preanalytical errors have previously been shown to contribute a significant proportion of errors in laboratory processes and contribute to a number of patient safety risks. Accreditation against ISO 15189:2012 requires that laboratory Quality Management Systems consider the impact of preanalytical processes in areas such as the identification and control of non-conformances, continual improvement, internal audit and quality indicators. Previous studies have shown that there is a wide variation in the definition, repertoire and collection methods for preanalytical quality indicators. The International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety has defined a number of quality indicators for the preanalytical stage, and the adoption of harmonized definitions will support interlaboratory comparisons and continual improvement. There are a variety of data collection methods, including audit, manual recording processes, incident reporting mechanisms and laboratory information systems. Quality management processes such as benchmarking, statistical process control, Pareto analysis and failure mode and effect analysis can be used to review data and should be incorporated into clinical governance mechanisms. In this paper, The Association for Clinical Biochemistry and Laboratory Medicine PreAnalytical Specialist Interest Group review the various data collection methods available. Our recommendation is the use of the laboratory information management systems as a recording mechanism for preanalytical errors as this provides the easiest and most standardized mechanism of data capture.

Background: The linkage of high-quality biosamples with detailed data from medical examinations, questionnaires and interviews offers great opportunities for research. This is particularly true for large-scale prospective epidemiological studies with long observation periods, like the German National Cohort (GNC)., Aim: The modalities of collecting, processing and storing biosamples of high quality and with a high throughput, as well as ethical aspects are described using the GNC as an example., Material and Methods: For the GNC, 200,000 randomly selected adults will be recruited by 18 study centres and will be followed up for 20-30 years. In addition to the extensive basic examination protocol, followed by reassessment examinations and follow-up questionnaires, the biorepository is a cornerstone of the GNC., Results: The GNC biorepository will comprise more than 20 million aliquots of plasma, serum, erythrocytes, lymphocytes, urine, saliva, nasal swabs and stool. Preanalytics and aliquoting are performed locally in the study centres and are highly standardised and extensively automated. All samples are stored at - 80 and - 180 °C, respectively. A laboratory information system documents all processing steps and storage locations. Access to data and biosamples will be granted to researchers within and outside Germany after completion of the baseline recruitment (i.e. from 2018 onwards)., Discussion: Experience with already existing epidemiological biobanks shows impressive results, especially with regard to genetic research, as well as post-genomics (e.g. transcriptomics, metabolomics, epigenomics). Previous success stories explain the strongly increased demand for data and biosamples from the population. Thus the GNC will provide an important resource for biomedical research in the future.

The paper presents the results of the development and implementation of an expert system that automatically generates doctors' letters based on the results of laboratory tests. Medical knowledge is expressed using a first order predictate logic based language. The system was implemented and evaluated in the Helix laboratory service.

Health information technology (IT) may improve patient safety and quality, but the application of new technology in health care may also increase patient safety hazards. The complexity of organizations, work practices and physical environments within the healthcare sector impacts the development and application of health IT. Clinical simulation can be used to evaluate technology in differing clinical contexts, throughout the software development life cycle in nursing informatics. Clinical simulation may be conducted in a range of settings varying from simulation laboratories to simulation in real settings. Clinical simulation supports involvement of context in pre-implementation design and evaluation of health IT involving real end-users as they use technology in realistic environments performing realistic tasks. The inclusion of clinical context is a powerful element of clinical simulation and enables visualization of technology in connection with clinical context without endangering patients.

Highly customizable laboratory information systems help to address great variations in laboratory workflows, typical in Pathology. Often, however, built-in customization tools are not sufficient to add all of the desired functionality and improve systems interoperability. Emerging technologies and advances in medicine often create a void in functionality that we call a functionality gap. These gaps have distinct characteristics—a persuasive need to change the way a pathology group operates, the general availability of technology to address the missing functionality, the absence of this technology from your laboratory information system, and inability of built-in customization tools to address it. We emphasize the pervasive nature of these gaps, the role of pathology informatics in closing them, and suggest methods on how to achieve that. We found that a large number of the papers in the Journal of Pathology Informatics are concerned with these functionality gaps, and an even larger proportion of electronic posters and abstracts presented at the Pathology Informatics Summit conference each year deal directly with these unmet needs in pathology practice. A rapid, continuous, and sustainable approach to closing these gaps is critical for Pathology to provide the highest quality of care, adopt new technologies, and meet regulatory and financial challenges. The key element of successfully addressing functionality gaps is gap ownership—the ability to control the entire pathology information infrastructure with access to complementary systems and components. In addition, software developers with detailed domain expertise, equipped with right tools and methodology can effectively address these needs as they emerge.

Optimizing pathologist workflow can be difficult because it is affected by many variables. Surgical pathologists must complete many tasks that culminate in a final pathology report. Several software systems can be used to enhance/improve pathologist workflow. These include voice recognition software, pre-sign-out quality assurance, image utilization, and computerized provider order entry. Recent changes in the diagnostic coding and the more prominent role of centralized electronic health records represent potential areas for increased ways to enhance/improve the workflow for surgical pathologists. Additional unforeseen changes to the pathologist workflow may accompany the introduction of whole-slide imaging technology to the routine diagnostic work., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Laboratory information systems (LISs) supply mission-critical capabilities for the vast array of information-processing needs of modern laboratories. LIS architectures include mainframe, client-server, and thin client configurations. The LIS database software manages a laboratory's data. LIS dictionaries are database tables that a laboratory uses to tailor an LIS to the unique needs of that laboratory. Anatomic pathology LIS (APLIS) functions play key roles throughout the pathology workflow, and laboratories rely on LIS management reports to monitor operations. This article describes the structure and functions of APLISs, with emphasis on their roles in laboratory operations and their relevance to pathologists., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The practice of surgical pathology is under constant pressure to deliver the highest quality of service, reduce errors, increase throughput, and decrease turnaround time while at the same time dealing with an aging workforce, increasing financial constraints, and economic uncertainty. Although not able to implement total laboratory automation, great progress continues to be made in workstation automation in all areas of the pathology laboratory. This report highlights the benefits and challenges of pathology automation, reviews middleware and its use to facilitate automation, and reviews the progress so far in the anatomic pathology laboratory., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The single most important element to consider when evaluating clinical information systems for a practice is workflow. Workflow can be broadly defined as an orchestrated and repeatable pattern of business activity enabled by the systematic organization of resources into processes that transform materials, provide services, or process information., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The main mission of a laboratory information system (LIS) is to manage workflow and deliver accurate results for clinical management. Successful selection and implementation of an anatomic pathology LIS is not complete unless it is complemented by specialized information technology support and maintenance. LIS is required to remain continuously operational with minimal or no downtime and the LIS team has to ensure that all operations are compliant with the mandated rules and regulations., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Bar coding and specimen tracking are intricately linked to pathology workflow and efficiency. In the pathology laboratory, bar coding facilitates many laboratory practices, including specimen tracking, automation, and quality management. Data obtained from bar coding can be used to identify, locate, standardize, and audit specimens to achieve maximal laboratory efficiency and patient safety. Variables that need to be considered when implementing and maintaining a bar coding and tracking system include assets to be labeled, bar code symbologies, hardware, software, workflow, and laboratory and information technology infrastructure as well as interoperability with the laboratory information system. This article addresses these issues, primarily focusing on surgical pathology., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Some laboratories or laboratory sections have unique needs that traditional anatomic and clinical pathology systems may not address. A specialized laboratory information system (LIS), which is designed to perform a limited number of functions, may perform well in areas where a traditional LIS falls short. Opportunities for specialized LISs continue to evolve with the introduction of new testing methodologies. These systems may take many forms, including stand-alone architecture, a module integrated with an existing LIS, a separate vendor-supplied module, and customized software. This article addresses the concepts underlying specialized LISs, their characteristics, and in what settings they are found., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Since 2010, CDC has provided resources from the Prevention and Public Health Fund of the Affordable Care Act to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to assist with implementation of electronic laboratory reporting (ELR)* from clinical and public health laboratories to public health agencies. To update information from a previous report about the progress in implementing ELR in the United States, CDC examined regular communications between the agency and the 57 health departments during 2012-2014. The results indicated that, as of July 2014, 67% of the approximately 20 million laboratory reports received annually for notifiable conditions were received electronically, compared with 62% in July 2013. These electronic reports were received by 55 of the 57 jurisdictions and came from 3,269 (up from nearly 2,900 in July 2013) of approximately 10,600 reporting laboratories. The proportion of laboratory reports received electronically varied by jurisdiction. In 2014, compared with 2013, the number of jurisdictions receiving >75% of laboratory reports electronically was higher (21 versus 14), and the number of jurisdictions receiving <25% of reports electronically was lower (seven versus nine). National implementation of ELR continues to increase and appears it might reach 80% of total laboratory report volume by 2016.

Clinical laboratory information systems produce improvements in the quality of information, reduce service costs, and diminish wait times for results, among other things. In the construction process of this information system, the National Institute of Health (NIH) of Peru has developed and implemented a web-based application to communicate to health personnel (laboratory workers, epidemiologists, health strategy managers, physicians, etc.) the results of laboratory tests performed at the Peruvian NIH or in the laboratories of the National Network of Public Health Laboratories which is called NETLAB. This article presents the experience of implementing NETLAB, its current situation, perspectives of its use, and its contribution to the prevention and control of diseases in Peru.

The paper presents the results of semiautomatic mapping of Russian laboratory terms to LOINC. Two clinics (A and B) and a laboratory service participated in the project. We were able to map 86% (Clinic A) and 87% (Clinic B) of laboratory terms. The required effort was reasonable and the price of mapping and maintenance was considered as relatively low. We established LOINC as a canonical coding method for a laboratory data exchange. This provided semantic interoperability for the data exchange process.

A clinical study requires massive amounts of of lab test data, especially for rare diseases. Before creating a protocol, the hypothesis if the protocol will work with enough amount of patients' dataset has to be proved. However, a single facility, such as a university hospital, often faces a lack of number of patients for specific target diseases. Even if collecting datasets from several facilities, there is no active master table that can merge lab test results between the facility datasets. Therefore, the authors develop a unified lab test result master. Because test master standards such as JLAC10 and LOINC are provided from a viewpoint of academic classification of laboratory medicine, the classification does not fit clinical classification, which doctors understand with a mind-set of establishing a clinical study protocol. The authors establish a method to unify masters using an active lab test result master from two university hospitals.

The interpretation of laboratory results is a critical part of the clinical decision making process. The proper understanding of many clinical conditions depends on the identification of evidences in the laboratory reports. If the classic tabular presentation of laboratory results has demonstrated its efficiency since many years, the increase number of potential results, the increased complexity of cases and the time shortage to analyses cases raise the question of finding more efficient ways of displaying these results to clinicians. The presentation layer becomes even more crucial when it comes to small-sized interactive displays. In this work, we discuss three alternative graphical representations of laboratory results adapted to handheld devices.

A large clinical care and research organization in Haiti required an electronic medical record system (EMR) to serve the needs of its 30 interlinked clinical programs. After assessing available open source software, the local team designed and implemented a modular proprietary EMR that is improving data quality and patient care. Despite the many benefits of existing open source medical record systems, clinical centers with complex workflow patterns--even those in resource-limited settings--should consider developing sustainable, local systems that fit their care model.

Laboratory test results in primary care are flagged as 'abnormal' when they fall outside a population-based Reference Interval (RI), typically generating many alerts with a low specificity. In order to decrease alert frequency while retaining clinical relevance, we developed a method to assess dynamic, patient-tailored RIs based on mixed-effects linear regression models. Potassium test results from primary care were used as proof-of-concept test bed. Clinical relevance was assessed via a survey administered to general practitioners (GPs). Overall, the dynamic, patient-tailored method and the combination of both methods flagged 20% and 36% fewer values as abnormal than the population-based method. Nineteen out of 43 invited GPs (44%) completed the survey. The population-based method yielded a better sensitivity than the patient-tailored and the combined methods (0.51 vs 0.41 and 0.38, respectively) but a lower PPV (0.66 vs 0.67 and 0.76, respectively). We conclude that a combination of population-based and patient-tailored RIs can improve the detection of abnormal laboratory results. We suggest that lab values outside both RIs be flagged with high priority in clinical practice.

The Sancti Spíritus Provincial Medical Genetics Network has been using the Salgen IT platform since 2009 for health care, administrative and research activities concerning pregnant mothers and newborns. The network uses the national Infomed backbone to provide real-time connection between community-based polyclinics in primary health care and the Provincial Medical Genetics Reference Center. The platform has records for 23,025 pregnant women and sequential clinical data on genetic risk assessment in early pregnancy, first trimester ultrasound, sickle cell anemia screening, alpha-fetoprotein levels, cytogenetic antenatal diagnosis, second trimester ultrasound, delivery and newborn characteristics, neonatal metabolic screening, and infant clinical assessment. The system makes health care results immediately available and provides health alerts to enable timely preventive care for pregnant women. It also provides guidelines for processes and practices, and streamlines administrative and monitoring activities through statistical reports. The database generates indicators for assessing fetal growth and applies international standards for antenatal ultrasound quality control. Salgen provides a new source of information for medical research and knowledge management, and its use in this case fulfills Cuba's criteria for an integrated health services network.

Background: Lost, delayed or incorrect laboratory results are associated with delays in initiating treatment. Delays in treatment for Multi-Drug Resistant Tuberculosis (MDR-TB) can worsen patient outcomes and increase transmission. The objective of this study was to evaluate the impact of a laboratory information system in reducing delays and the time for MDR-TB patients to culture convert (stop transmitting)., Setting: 78 primary Health Centers (HCs) in Lima, Peru. Participants lived within the catchment area of participating HCs and had at least one MDR-TB risk factor. The study design was a cluster randomized controlled trial with baseline data. The intervention was the e-Chasqui web-based laboratory information system. Main outcome measures were: times to communicate a result; to start or change a patient's treatment; and for that patient to culture convert., Results: 1671 patients were enrolled. Intervention HCs took significantly less time to receive drug susceptibility test (DST) (median 11 vs. 17 days, Hazard Ratio 0.67 [0.62-0.72]) and culture (5 vs. 8 days, 0.68 [0.65-0.72]) results. The time to treatment was not significantly different, but patients in intervention HCs took 16 days (20%) less time to culture convert (p = 0.047)., Conclusions: The eChasqui system reduced the time to communicate results between laboratories and HCs and time to culture conversion. It is now used in over 259 HCs covering 4.1 million people. This is the first randomized controlled trial of a laboratory information system in a developing country for any disease and the only study worldwide to show clinical impact of such a system., Trial Registration: ClinicalTrials.gov NCT01201941.

The purpose of this paper is to discuss the Saudi experience in implementing Electronic Lab Information Exchange (ELIE) within healthcare organizations in Saudi Arabia. This paper reviews the benefits, challenges and achievements that Saudi Arabia has gone through over the last five years in implementing ELIE. Data sources included academic literature, websites, and informant interviews. Results show that various Saudi healthcare organizations are participating in ELIE and improvements in laboratory department workflow and patient care have been reported. Future work includes projects to be implemented in different laboratories within the Kingdom to link the various laboratory information systems to Electronic Health Records. Various challenges stand in the way of implementing ELIE including weakness of the information infrastructure, staff resistance, recruiting qualified staff to develop and implement ELIE, producing clear policy and procedures to ensure staff compliance with the data entry, ensuring the privacy and integrity of patient data, and the lack of awareness on the importance of ELIE.

Often researchers find it difficult to interpret and correlate the results obtained from several experiments thus the development of a system that would allow storage, display and data analysis would be very useful. A web based interface is presented that allows people from a laboratory to submit the collected data and to compare results within different experiments. The interface was designed to be user-friendly and to be a basis of a flexible tool for performing analysis in an intuitive manner.

MultiplexBCT is a molecular-based diagnostic test for rapid identification of microorganisms in positive blood cultures. A MultiplexBCT Android tablet computer application is being developed as an accessory to the diagnostic test. The aim of the application is to facility the end user's workflow by supporting data entry and communication of the MultiplexBCT test results in a hospital environment. This paper reports the results and benefit of a participatory heuristic evaluation conducted on the MultiplexBCT application. The design is an extension of heuristic evaluation that includes end users as work-domain experts to complement usability experts for inspection of a user interface. The user interface assessment identified 86 heuristic violations, which consisted of both product- and domain-related issues. These results will be used to guide further development of the MultiplexBCT application to ensure that the system will fully support the workflow of the end users when using the MultiplexBCT diagnostic test.

Linking interface terminologies (IT) to reference terminologies (RT) in flow of terminologies may allow health information system to be both usable and interoperable. Two French university hospitals worked independently on such a flow from the prescription of lab-test to the display of the corresponding results. The aim of this study was to evaluate the transmission of information in these two hospitals communication. An expert, supported by natural language processing tool, created the gold standard link between the 2 prescription ITs i.e. the terms that share the same meaning. A semantic pathway was defined to allow the mapping of one prescription IT to the other, through LOINC® and SNOMED®, the RT chosen by each hospital, respectively. The capacity of the semantic pathway to identify the correct links was computed. The expert found 218 links between the 2 prescription ITs (containing 580 and 374 terms that are linked to RT). The semantic pathway correctly identifies 96 of these links (44.0% [37.4-50.6]). The recall was not as good as expected, even though the semantic pathway was created in order to maximize it. Using different RT in different hospitals is not an efficient solution. The use of LOINC® seems to be preferable as a RT for prescription.

The knowledge about the quality of samples and associated clinical data in biospecimen collections is a premise of clinical research. An electronic biosample register aims to facilitate the discovery of information about biosample collections in a hospital. Moreover, it might improve scientific collaboration and research quality through a shared access to harmonized sample collection description data. The aim of this paper is to present a concept of a web-based biosample register of the existing biosample collections at the Medical University of Innsbruck. A uniform description model is built based on an analysis of the sample collection data of independent sample management systems from two departments within the hospital. An extended set of attributes of the minimum dataset used by the Swedish sample collection register (MIABIS) has been applied to all biosample collections as a common description model. The results of the analysis and the data model are presented together with a first concept of a sample collection search register.

Electronic reporting of laboratory results to public health agencies can improve public health surveillance for reportable diseases and conditions by making reporting more timely and complete. Since 2010, CDC has provided funding to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to assist with improving electronic laboratory reporting (ELR) from clinical and public health laboratories to public health agencies. As part of this agreement, CDC and state and large local health departments are collaborating to monitor ELR implementation in the United States by developing data from each jurisdiction regarding total reporting laboratories, laboratories sending ELR by disease category and message format, and the number of ELR laboratory reports compared with the total number of laboratory reports. At the end of July 2013, 54 of the 57 jurisdictions were receiving at least some laboratory reports through ELR, and approximately 62% of 20 million laboratory reports were being received electronically, compared with 54% in 2012. Continued progress will require collaboration between clinical laboratories, laboratory information management system (LIMS) vendors, and public health agencies.

Beginning in early 2011, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories launched the Laboratory Efficiencies Initiative (LEI) to help public health laboratories (PHLs) and the nation's entire PHL system achieve and maintain sustainability to continue to conduct vital services in the face of unprecedented financial and other pressures. The LEI focuses on stimulating substantial gains in laboratories' operating efficiency and cost efficiency through the adoption of proven and promising management practices. In its first year, the LEI generated a strategic plan and a number of resources that PHL directors can use toward achieving LEI goals. Additionally, the first year saw the formation of a dynamic community of practitioners committed to implementing the LEI strategic plan in coordination with state and local public health executives, program officials, foundations, and other key partners.

Objectives: Electronic laboratory reporting (ELR) reduces the time between communicable disease diagnosis and case reporting to local health departments (LHDs). However, it also imposes burdens on public health agencies, such as increases in the number of unique and duplicate case reports. We assessed how ELR affects the timeliness and accuracy of case report processing within public health agencies., Methods: Using data from May-August 2010 and January-March 2012, we assessed timeliness by calculating the time between receiving a case at the LHD and reporting the case to the state (first stage of reporting) and between submitting the report to the state and submitting it to the Centers for Disease Control and Prevention (second stage of reporting). We assessed accuracy by calculating the proportion of cases returned to the LHD for changes or additional information. We compared timeliness and accuracy for ELR and non-ELR cases., Results: ELR was associated with decreases in case processing time (median = 40 days for ELR cases vs. 52 days for non-ELR cases in 2010; median = 20 days for ELR cases vs. 25 days for non-ELR cases in 2012; both p<0.001). ELR also allowed time to reduce the backlog of unreported cases. Finally, ELR was associated with higher case reporting accuracy (in 2010, 2% of ELR case reports vs. 8% of non-ELR case reports were returned; in 2012, 2% of ELR case reports vs. 6% of non-ELR case reports were returned; both p<0.001)., Conclusion: The overall impact of increased ELR is more efficient case processing at both local and state levels.