THE ESSENTIAL ROLE OF MEDITECH'S LIS IN IMPROVING PATIENT SAFETY
By John Saulenas, MT (ASCP)
Hard to believe that a 1999 report on medical errors issued by the Institute of Medicine (IOM)
still has the health care industry's attention focused on patient safety; continuing to reduce the
startling number of medication errors that result in patient death. This issue has also put the
spotlight on medical laboratories because of the crucial role labs play in medical decision
making.
Up to 80 percent of the information that physicians rely upon for important medical decisions
comes from the laboratory, according to the Joint Commission on Accreditation of Health Care
Organizations (JCAHO). Information from the lab also constitutes an estimated 80 percent to 90
percent of the data in the typical electronic medical record (EMR). Thus, the lab's ability to
produce accurate results will substantially affect a hospital's error rate.
Experts have suggested numerous ways to keep the lab's error rate to a minimum-better education
and training, increased study of the cause of errors and incentive structures that encourage error
reporting. These strategies, however, are aimed at getting employees to perform more reliably, who
will inevitably make mistakes, no matter how careful or highly trained.
It's no mystery, then, why many view information technology (IT) as the most direct change a
lab can make to reduce errors and create safer conditions for patients. IT replaces fallible,
inconsistently performing human staff with precise, dependable and highly productive systems and
processes when implemented correctly.
MEDITECH”s Laboratory Information System (LIS) interfaces with the pre-analytical, analytical
and post-analytical phases of laboratory testing. An intriguing use of the LIS is that it can aid
quality management teams to look at ordering patterns and test efficacy.
Pre-analytical Phase
A recent study indicated that most errors in the venous blood testing process are pre-analytical,
i.e. they occur before the sample reaches the laboratory1. Unlike the laboratory analysis, the
pre-analytical phase involves several error-prone manual tasks not easily avoided. The study also
demonstrated that only 22% of staff uses the patient's wrist band for identification and 98% of
staff label the tubes after blood collection and most of the time outside the patient's room.
MEDITECH's LIS has always helped reduced the number of pre-analytical errors by the use of bar
code labels and readers. Such a system of labels and readers, tied to the LIS, can identify the
wristband on the patient to the laboratory requisition-thus, matching patients to tests, and can
also match tests to the required specimen containers to help ensure the tests are performed
properly. The sample is transported to the laboratory for analysis where the worksheet, also
generated by the LIS, will ensure that the tests ordered on that sample are preformed. All this
can be planned so that turn-around-times (TAT) can be measured. If need be, the data can serve as
a basis for improving TAT. MEDITECH has recently introduced the Proof Positive Solution which
resolves the following issues and increases Patient Safety:
- Streamlining the phlebotomist's workflow by providing one tool with locations requiring
draws
- Providing a centralized list of patients, their locations, and necessary time of draw
- Ensuring positive identification of the patient by scanning the patient's bar coded
wristband
- Providing collection instructions, amount of specimen, and tube type presented to the user
upon verification of the patient
Analytical Phase
During the analytical phase, where few errors generally occur, the MEDITECH LIS is still
increasingly useful. The MEDITECH LIS features a very robust Quality Control Program. The system
will flag controls which have failed and will prompt the technologist/technician for corrective
action. This feature ensures the accuracy and quality of the patient's test values.
MEDITECH's LIS provides a solution to one of the biggest challenges that laboratories are faced
with today, the shortage of qualified lab technologists and increasing testing volumes. Thus, labs
are looking for ways to bridge the gap to do more with less. The answer is MEDITECH's Autorelease
feature. This is a feature that has been available for a very long time but few clients have taken
advantage of it. Any test result that falls within normal parameters-as defined by the lab-is
automatically validated and released. This frees technologists from the manual, time-consuming
task of reviewing each result. Instead, they can focus their energy and attention on results that
require tech review. Thus laboratories are able to streamline their processes while maintaining
the highest quality standard.
Post-analytical Phase
The MEDITECH LIS has had an impact on the post-analytical phase ever since it was first
introduced to the lab. Now, information is transmitted faster and more accurately, with a
concomitant reduction in errors. The more rapid TAT has led to better patient care, fewer lost
reports and perhaps more attention paid to the report as it arrives in a more timely fashion.
Clinicians who are motivated to make a diagnosis quickly should not have to wait for test
results. It could be said that the longer it takes to receive a report, the less likely it is to
be useful, particularly in the ED or OR. MEDITECH and its ally partner Forward Advantage recently
co-developed a new technology to address the growing need to be able to transmit lab results from
the MEDITECH LIS to physician practice management systems. This new technology called Data Express
works in the following way: First, a special interface bundle is set up between MEDITECH and Data
Express, and data is sent from MEDITECH to Data Express via HL7 format. From there, the data is
converted into a standard format and sent off to the physicians' practices based on the profile
of the practices' information systems. This allows physicians to have up to the minute important
clinical information to make informed decisions. This allows physicians to provide improved
quality care and at the same time ensure patient safety.
All this comes at a time when the median age of the laboratory worker nears 50 and fewer people
are going into a laboratory career. From this we draw two inferences: 1) the lab is going to be
increasingly short-handed and 2) as the entire population ages, more work is going to be asked of
the lab. Thankfully, the MEDITECH LIS is able to provide solutions to the ever changing challenges
faced by today's laboratories and help ensure patient safety.
For more information about our MEDITECH practice and how VCS can help your organization, please
call us at 610-444-1233 or visit our website at
www.getvitalized.com
1Clin Chim Acta 2008 May; 391 (1-2): 91-7. Epub 2008 Feb 21. Wallin O, Soderberg J,
Van Guelpen B, Stenlund H, Grankvist K, Brulin C.