The ideal laboratory information system.

CONTEXT: Laboratory information systems (LIS) are critical components of the operation of clinical laboratories. However, the functionalities of LIS have lagged significantly behind the capacities of current hardware and software technologies, while the complexity of the information produced by clinical laboratories has been increasing over time and will soon undergo rapid expansion with the use of new, high-throughput and high-dimensionality laboratory tests. In the broadest sense, LIS are essential to manage the flow of information between health care providers, patients, and laboratories and should be designed to optimize not only laboratory operations but also personalized clinical care. OBJECTIVES: To list suggestions for designing LIS with the goal of optimizing the operation of clinical laboratories while improving clinical care by intelligent management of laboratory information. DATA SOURCES: Literature review, interviews with laboratory users, and personal experience and opinion. CONCLUSIONS: Laboratory information systems can improve laboratory operations and improve patient care. Specific suggestions for improving the function of LIS are listed under the following sections: (1) Information Security, (2) Test Ordering, (3) Specimen Collection, Accessioning, and Processing, (4) Analytic Phase, (5) Result Entry and Validation, (6) Result Reporting, (7) Notification Management, (8) Data Mining and Cross-sectional Reports, (9) Method Validation, (10) Quality Management, (11) Administrative and Financial Issues, and (12) Other Operational Issues.

Previously undetected metabolic syndromes and infectious diseases among psychiatric inpatients.

OBJECTIVE: This study identified previously undetected metabolic and infectious disease among persons with serious mental illness who were admitted to psychiatric inpatient units. METHODS: Observational-naturalistic methods were used to simulate universal screening in order to document evidence of undetected disease among 588 adult psychiatric patients. Data were obtained from medical records and laboratory tests. RESULTS: Laboratory results showed that 10% of patients had HIV, 32% had hepatitis B, and 21% had hepatitis C. Glucose levels were elevated in 7%, and total cholesterol levels were elevated in 22%. Nearly 60% had body mass indices above 25. The treatment team missed a considerable proportion of infectious disease (95% of hepatitis B cases, 50% of hepatitis C cases, and 21% of HIV cases) and metabolic disorders (89% of cases with elevated total cholesterol levels and 97% of cases with elevated triglyceride levels). By contrast, only 18% of cases with elevated glucose levels were missed. CONCLUSIONS: This study demonstrated very high prevalence of both metabolic disorders and infectious diseases in a psychiatric inpatient population.

2008 ACLPS panel discussion on resident education in clinical pathology.

A curriculum in clinical pathology (CP) was developed under the auspices of the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) in 2006. At the 2008 ACLPS meeting in Philadelphia, PA, a panel was convened to address the current challenges in resident education and how to overcome them. Current challenges include the heterogeneity of the discipline (which requires analytical, medical, and managerial knowledge), the diverse repertoire of clinical laboratory testing, and the need to better integrate the resident into the work flow of the laboratory, especially with respect to clinical consultation. Recommendations of the panel include the incorporation of active learning, clinical consultation, and competency assessment into CP resident training. A summary of the panel discussion is presented herein.

Conveying the importance of the preanalytical phase.

Preanalytical issues do not readily lend themselves to systematic teaching and the approach to teaching must be modified for each of the populations who require such education. The populations to be educated include patients, nurses, medical students and physicians. The different approaches that we have tried, and continue to use are described.

Effect of disease complications on hospital costs.

BACKGROUND: To test the hypothesis that complications increase the use of resources in managing patients in hospitals, we examined the costs of managing patients with the same disease with and without complications. METHODS: We used a database developed by the University HealthSystems Consortium that contains the costs of managing more than 1 million patients in 60 University hospitals. We created a simplified database of the costs of 457 445 patients in 111-paired diagnosis-related groups (DRGs) that were classified as either having or not having complications and/or comorbidities. Costs were calculated from the ratio of costs to charges within the individual hospitals. RESULTS: The median costs of managing patients with complications were higher than those for managing patients without complications, confirming the appropriateness of the dual classification. Notably, these extra costs were largely incurred through increased length of stay. Of note, the cost per day for DRGs with complications and/or comorbidities was most often less than that for the corresponding uncomplicated conditions. Although accommodation costs generally were the largest single component of total costs for both complicated and uncomplicated conditions, in only 31 DRGs (15 with complications, 16 without) did they account for more than one-half the total costs. Laboratory and drug costs were higher for complicated conditions, but as a proportion of total costs were comparable for complicated and uncomplicated conditions. CONCLUSIONS: Complications in patients are associated with increased hospital costs, although the costs per day of hospitalization are often less than in patients without such complications.

Comparative costs of treating adults and children within selected diagnosis-related groups.

BACKGROUND: There have been no large-scale analyses of resource utilization comparing the overall costs to treat pediatric patients vs adult patients. Likewise, there have been no studies evaluating the costs of the various components of hospitalization (e.g., accommodation, laboratory, radiology, and drugs) among adult and pediatric populations. METHODS: To study the effect of age on the costs of treating patients, we have evaluated 43 conditions with matching diagnosis-related groups (DRGs) for children and adults. Using a database developed by the University HealthSystems Consortium, we examined the major non-physician components of hospital costs, including accommodation, surgery, pharmacy, radiology, and laboratory for 1,346,028 patient admissions to 60 University hospitals. These costs were derived from the ratio of costs to charges based on the Centers for Medicare and Medicaid Services PPS UB-2 cost reports. RESULTS: The total non-physician cost of treating adults was generally greater than that for children within paired DRGs. Some of this difference may be attributable to the overall longer stay of adults in hospital. For conditions that were nominally the same, radiology, laboratory, and drug costs, especially tended to be higher for adults than for children. This was most marked when the costs were evaluated on a per diem basis. There tended to be greater variability in the costs of treating children than adults within the paired DRGs, as evidenced by greater differences between the median and mean costs. CONCLUSIONS: Among University hospitals, the costs of managing children are typically less than for adults with the same nominal condition. In these hospitals, there tends to be less use of laboratory, radiology, and pharmacy services for children than for adults.