Laboratory Manual | Computer Information

DEFINITION and employee data. An HIS is often linked to other digital information
systems (e.g., laboratory information system).
 Data – are raw facts that have no meaning until grouped together or
 Community Health Information Network (CHIN) – is a network of
organized.
computers in a community or city that shares information on patients.
 Information – is data organized and grouped to increase a user’s Hospitals, reference laboratories, physician offices, pharmacies, health
knowledge. insurance companies, etc. can have access to patient information.
 Personal Computer (PC) – also referred to as a microcomputer or desktop  Malware – is malicious software that can damage computers and includes
computer, is a stand-alone computer that contains a central processing unit viruses, Trojans, spyware, etc.
(CPU), monitor, hard drive, etc., and can be used for processing data.
 Informatics – the science of information, the practice of processing
 Operating System (OS) – is a computer program that controls the basic information, and the development of information systems.
operation of a computer and allows other software to interact with the
computer hardware (e.g., Windows Vista, UNIX, and Mac OS). GENERAL COMPUTER INFORMATION
 Server – a computer with a large amount of memory and storage capacity
DIGITAL DATA
that stores data accessed by other computers, called clients or workstations.
Programs (applications) can also be stored on servers.  Computers process and store data with numbers.
 Mainframe – a large-capacity computer designed to support many users at  Binary (base 2): computers use a series of 0’s (zeroes) and 1’s (ones); 0 is
once with little or no down time. The term can have different meanings, but off and 1 is on.
today it often refers to computers compatible with the IBM System/360  Bit: A 0 or 1
series of computers.  A Byte is a series of 8 bits. It takes one byte to represent one character.
 Supercomputers – are computers that, at the time of their production, are There are 2s, or 256, combinations of bytes. Storage capacity is measured
on the forefront of processing speed. They contain hundreds of CPUs. in kilobytes (KB), 1024 bytes; megabytes (MB), 1024 kilobytes; or gigabytes
 Local Area Network (LAN) – is a collection of hardware, including printers (GB), 1024 megabytes.
and PCs, or clients connected to at least one server through cables
(hardwired) or via a wireless network. The PCs are able to send data and COMPUTER HARDWARE
share files with others on the network.  The CPU contains millions of transistors and performs mathematical and
 Intranet – a network of computers and other hardware that is not accessible logical operations. The speed of the CPU is measured in clock speed, or
to anyone outside that organization or office. gigahertz (GHz), which is the number of cycles per second. Cache memory
 Wide Area Network (WAN) – is a computer network over a large is the location of data being processed by the CPU and is located on the
geographic area that crosses metropolitan or national boundaries. CPU. Cache memory is the fastest memory on a computer, but it is also the
 Computerized Provider Order Entry (CPOE) – is a method of digital entry most expensive. Modern computers have dual or quad processors.
of instructions for the diagnosis and treatment of patients by a medical  Memory modules are the locations where random access memory (RAM)
practitioner. is stored. RAM contains data waiting to be processed or that has recently
 Electronic Health Record (EHR) or Electronic Medical Record (EMR) – been processed by the CPU. RAM requires continuous electricity to be
is a digital patient record that can include demographics, test results, maintained; any data in RAM is lost when the computer loses power.
medical history and examination, images, etc. EHRs can be accessed via Modern computers generally have 2-4 GB of RAM.
computer over a network.  The motherboard is a circuit board connecting the other components of the
 Hospital Information System (HIS) – is a powerful computer system that computer. The CPU, memory modules, and other circuit boards are plugged
includes hardware and software responsible for storing patient, business, into the motherboard. When the power is turned on, the motherboard
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Laboratory Manual | Computer Information
distributes power to the integrated circuits and moves data through the hard drives with much larger storage capacity. Hard drives allow random
components. The electronic pathway for the movement of data is referred to accessing of data, meaning the computer can directly read or write to any
as the databus. location on the disk.
 Input devices: A number of devices can input data into a computer.  Floppy disks also use magnetized particles, as do hard drives. Floppy disks
o Keyboard are portable, but they have a much smaller storage capacity. They have
o Pointing device (e.g., mouse and touch-sensitive pad) is used with a generally been replaced by other storage devices.
graphical user interface (GUI).  Tape drives, or streamers, read and write data to a magnetic tape. Data
o Bar code reader or scanner reads printed bar codes, a series of are stored sequentially, meaning the data can only be accessed in an
parallel lines that represent letters or numbers. Bar codes are used to ordered sequence. They are generally used to back up large amounts of
identify patients and patient samples. data and typically have a storage capacity of 4-20 GB. Sequential storage is
an effective use of space, but it takes longer to access the data compared to
Output devices
accessing data on a hard drive.
 Monitor  USB flash drives contain a universal serial bus (USB) connector and a
o Resolution is measured in the number of pixels (picture elements) and flash memory chip (circuit). Because of their compact size, large storage
the dot pitch. A pixel is the smallest piece of information in an image. It capacity, and ease of use, these storage devices are widely used.
is composed of three dots: red, green, and blue. A monitor with a  Compact discs (CDs) and DVDs (digital versatile discs or digital video
resolution of 1024 X 768 has 1024 columns and 768 rows of pixels. Dot discs) are optical storage devices. Data are stored as either “pits” or
pitch refers to the distance between dots of light of the same color. The “grounds” on the disks in thin closely spaced tracks. A laser is used to read
smaller the dot pitch and the greater the number of pixels, the better is the data on the disks. DVDs have tracks that are much closer together and,
the image. therefore, they have greater storage capacity.
o Liquid crystal display (LCD) monitors have become the industry
Cables
standard. They take up less space, are lighter, and use less electricity
than the older cathode ray tube (CRT) monitors.  Are used to connect external components (peripherals) to the computer via
 Printers the motherboard.
o InkJet printers spray ink onto paper.  Serial cables move one bit of data at a time. Serial cables are no longer
o Laser jet printers use the precision of a laser to position dots on a commonly used; they have been replaced by USB cables.
drum with magnetized toner. The particles are fixed to the paper with  Parallel cables move one byte of data at a time. Parallel cables had been
heat. LaserJet printers are faster but more expensive to purchase used to connect printers and laboratory instruments to a computer. Parallel
compared to inkjet printers. Generally, however, the cost per page is connections have generally been replaced by USB connections, which are
less for a laser jet printer. much faster and use thinner cables.
o Plotters are vector graphic printing devices that print line art by moving  USB cables are commonly used to connect peripherals. They allow multiple
a pen over the surface of paper. They are used for large technical devices to be connected through a single port; allow plug and play (hot
drawings (architectural) and computer-aided designs. swapping), where a device can be removed without restarting the computer;
Storage devices and provide power to low-consumption devices.
 IEEE 1394 interface (i.e., Firewire, Apple Inc.) is a high-speed serial
 Hard drives use magnetized microscopic particles embedded in a surface. connection commonly used to connect digital cameras and audio/visual
Data are added and retrieved using a read/write head. Hard drives can be components to a computer.
internal or external. Disk arrays are a series of linked, generally external,
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Laboratory Manual | Computer Information
ELECTRONIC COMMUNICATION o Hypertext markup language (HTML) and extensive markup language
(XML) are standard languages used for Web pages. Web browsers
 The internet is a worldwide network of computers. read the text (i.e., HTML code) and display the information.
 Transmission control protocol (TCP) is the protocol computers use to  Search engines use spiders or bots (short for robots) to retrieve information
exchange data on the Internet. It allows electronic mail (e-mail) and the found in Web pages and create a searchable database.
content of Web sites to be sent electronically. TCP divides messages and
 Telemedicine is the use of technology to send healthcare-related
files into smaller pieces called segments.
information (e.g., patient test results) for clinical diagnosis and treatment.
 Internet protocol (IP) address is a unique address that electronic devices
(e.g., computers and printers) use in order to communicate with each other LABORATORY INFORMATION SYSTEMS
on a computer network.
A. A laboratory information system (LIS) is a computer network of hardware
 Bandwidth refers to the rate data are transferred; it is usually measured in
and software for receiving, processing, and storing laboratory data and
kilobits/second (Kbps).
information. It can interface with laboratory instruments to transfer data into
o A broadband connection is one that transfers a lot of digital data at
patient records, evaluate quality control data, and store preventive
once or when multiple pieces of data are sent simultaneously.
maintenance records. In addition, an LIS can interface with an HIS,
Computers need a network interface card (NIC) to connect to a
pathology information system, and other information systems.
broadband cable. Examples of cable connections include:
B. Components of an LIS:
o Ethernet cable (1 gigabit/second)
1. The LIS software user interface determines how the user will interact
o Coaxial cable (10 megabits/second)
with the system. It will have specific screens for entering data, sending
o Fiber optic cable (600 megabits/second)
reports, reporting results, etc. The software will have features such as
o A dial-up connection over a telephone line is a narrowband connection
security, access control, file maintenance, etc.
(56 Kbps). A modem converts the computer’s digital signal to analog.
2. Request entry: Requests for laboratory tests to be performed can be
The computer receiving the data must then use a modem to convert the
entered through clients located in the nursing units or remote primary
analog signal back to digital.
care practitioner’s office. In the case of outpatients, requests can be
 Wi-fi, or “wireless fidelity” allows wireless access to computer networks
entered when the patient arrives at the laboratory.
via radio waves. Although distances vary, with a standard antenna distance
3. Data (results) entry.
is limited to about 100 feet.
 Electronic data interface (EDI) connections between an LIS and a
 The World Wide Web, or the Web, is a body of information (documents)
clinical instrument allow automatic transfer of patient test results to
interlinked and accessed via the Internet. Sir Tim Berners-Lee is credited
the LIS.
with creating the Web in 1989.
 Manual data entry: Laboratory scientist enters patient results at a
o Hyperlinks: A navigational element in one document links to another
client.
section of the same document or to a different document.
 Release patient results: The results are added to the LIS, but they
o Hypertext transfer protocol (HTTP) is a communication protocol for
are not released to clients outside the laboratory until the results
the transfer of information (hypertext) over a computer network.
and quality control are reviewed and verified. Alternatively, auto
o File transfer protocol (FTP) is a network protocol used for uploading
verification can be used. In this case, the computer uses a set of
documents to a Web server.
instructions to determine if the results should be released. Because
o Uniform resource locator (URL) is a string of characters that provides
the results are not held up for manual review, auto verification is
the address or location of a unique document available over the
quicker. To help with verification, reference ranges and panic
Internet.
values can be programmed into the LIS.
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Laboratory Manual | Computer Information
 Point of care testing: Portable laboratory instruments, like handheld C. Information provided by a LIS
analyzers, can connect to an LIS via a wireless connection. 1. Patient demographics
4. Data storage 2. Work lists
 Redundant arrays of independent disks (RAID): LISs are regulated 3. Data retrieval (inquiry)
by the Food and Drug Administration, and they are required to have o Generate patient results: Flag critical values, print reports if
mirrored hard drives. Data are stored on two separate hard drives requested, etc.
of the LIS server. o Perform delta checks: Results of an analyte assay are compared to
 System backup: Each day the data are to be copied to a tape, or the most recent previously performed results on the same patient.
other portable storage device, and removed from the laboratory. o Patient results can be retrieved electronically at a client or via the
5. System security: Ongoing procedures to ensure the security of patient Internet with a Web browser.
data and user profiles (usernames and passwords) to prevent 4. Reflex testing: If an initial test result is positive or outside normal
unauthorized access must be in place. Users should have access only parameters, the LIS can automatically order a second appropriate test.
to the patient information and LIS functions needed to perform their job 5. Current procedural terminology (CPT) codes: The CPT codes
(minimum necessary use). Antiviral software (e.g., McAfee and Norton) describe medical, surgical, and diagnostic services and are designed to
should be installed to protect the system from harmful malware, communicate information about medical services and procedures
especially for networks with a Windows operating system. among physicians and other healthcare professionals. CPT codes are
6. Barcoding can facilitate processing of clinical specimens. used for billing purposes and can be programmed into the LIS.
7. Interface: The LIS can be connected to clinical instruments and other 6. Quality control: An LIS can analyze quality control specimens and
information systems through an EDI. An interface is typically prepare charts and reports (e.g., Westgard rules, Levey-Jennings
bidirectional, meaning information is sent to and from the instruments charts).
and the information systems. With a unidirectional interface, analyte 7. Quality assurance can provide reports on turnaround time,
results from an instrument are sent to the LIS, but the LIS cannot send documentation of critical result reporting, and corrected reports.
requests to the instrument. So that instruments and computers used in 8. Management reports: Cost per billable test calculations, test volume,
healthcare can communicate with each other, the Health Level 7 (HL7) turnaround time, employee hours, workload data, etc.
communication standard was adopted. HL7 is an international 9. Encoding systems: Systemized Nomenclature of Medicine—
committee formed in 1987 to formulate data standards, a set of rules Clinical Terms (SNOMED—CT) is a comprehensive database of
that allow healthcare information to be shared and processed in a standardized terminology for healthcare. Once implemented, it will allow
uniform and consistent way. automatic data analysis over a wide range of clinical information
8. Manual procedures: If the computer system goes down, a contingency systems. Logical observation identifiers names and codes (LOINC) is
plan for manual procedures and forms needs to be in place. another database of universal standards for healthcare.
9. System maintenance: LISs need to be shut down (taken offline)
periodically for software upgrades and other maintenance.
Occasionally, the system will become nonresponsive (crash).
10. Disaster recovery: Every laboratory needs a plan to restore the system
after system disruption by a storm, fire, or other hardware damaging
situation.

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