Healthcare is always a top priority within any collection of individuals, whether it is the workforce, schools, churches, communities, states, countries etc. This is because mortality rates are directly affected by the level of healthcare available, and effective productivity is dependent on good health and high mortality rates.
Developed nations tend to invest large sums of money into healthcare, in order to prevent most ailments before they become epidemics, however, due to lack of emphasis on the importance of healthcare, African nations suffer from low mortality rates caused by lack of proper laboratory procedures and equipment, to test and accurately diagnose problems ahead of time.
Even though we are now in a highly advanced technological era, Nigerian hospitals still conduct tests, data collection, and calculations manually, leaving a huge opening for errors which could lead to wrong diagnosis and in turn, wrong treatment.
As we humans become ever increasingly dependent on computer technology in our daily lives, it then would be appropriate to utilize technological solutions to problems conventional methods prove inefficient at.
These problems can be solved with the use of a properly configured software system to manage all administrative tasks in the laboratories.
The most effective use of technology to solve to these issues would be carried out using open source software popularly known as a Laboratory Information System (L.I.M.S).
The model of this work seeks to provide an application which will enable vital functionalities such as proper documentation and storage of patient information, patient specimen/sample tracking, and most important, patient test results.
In the light of the above, the proposed system applies the web application development approach in its information architecture and processing, however this system will run on a local machine as opposed to running on a remote server over the internet. Consequently at completion of this work, the end product should be a Laboratory information management system which handles activities in the lab from the entry of a patient to the laboratory to the generating of a test result or Laboratory report.
BACKGROUND OF STUDY
The study for the development of the laboratory information management system uses a medical laboratory facility: Bakor Medical laboratory as its case study.
Investigations indicate that the following steps or procedures are undertaken in the process of getting tested in the medical laboratory.
On entry into the laboratory a document known as the Patient Investigation form. This form holds information such as the Patients name, age sex, on filling this form the patient is then billed.
The patient Investigation form is then transferred to a second laboratory attendant who then uses the information retrieved from the aforementioned form to fill the laboratory request book.
STATEMENT OF THE PROBLEM
In recent times, due to increase in population, there is constant pressure on providers of various services to provide innovative methods of dispensing a sizable amount of services to great amount of people in the shortest possible time. Consequently, organizations are constantly resorting to technological solutions to meet up with the ever increasing demand for quality and speedy service delivery and with virtually everything in our day to day lives being technologically driven, should there not be a scenario where paper documentation is completely annihilated from medical laboratories?, where a system is adopted in which patient records and data are properly stored such as to enable features such as patient/visitor history tracker, where a returning patients history can aid the laboratory in deducing what type of test a visitor would request for, statistical reports generation where useful statistical information is inferred based on test results e.g whether or not there is an increase or decrease of new HIV infections, should there not be a software/application where other stakeholders in the health-care delivery processes such as doctors and pharmacists have access to laboratory generated information to aid in their health-care administration?, should the retrieval of patient test records be slow and cumbersome?, why must results be entered directly on the result document, therefore a backup copy is unavailable. Questions such as these will serve as a guide to the development of a robust system than manages various tasks in the medical laboratory.
1.3 RESEARCH QUESTIONS
Based on the statement of the problems above the research question for this study are:
How will the development of a laboratory information management System greatly increase the laboratory’s efficiency?
OBJECTIVE OF STUDY
To design a robust Laboratory information System that will efficiently aid in the running of the laboratory facility
To hold and provide timely information about each visitor to the laboratory
To reduce the need to hire staff through the proper application of technological solutions therefore cutting cost.
With a proper functioning and comprehensively designed application, Laboratory tasks such the following can be achieved:
A LIMS can automate the management of samples. An organization can configure its analytical parameters and calculations into the LIMS before implementing the software in the laboratory. After sample registration, the system can print barcodes which it can scan at the end of the analysis when loading results into the LIMS. The system can check the completed results, automatically validating those which comply with specifications; and reporting (but not validating) out-of-specification results. A LIMS may release or retain lots and batches, according to a laboratory’s specifications and calculations.
Once results come available for the lab’s clients or owners, they can extract them in PDF, XML or spreadsheet files from the LIMS interface. (Note that moving insufficient data to a spreadsheet may lose the traceability of changes).
One may configure a LIMS for use by an unlimited number of users. Each user owns an interface, protected by security mechanisms such as a login and a password. Users may have customized interfaces. A laboratory manager might have full access to all of a LIMS’ functions, whereas technicians might have access only to functionality needed for their individual work-tasks.
ADMINISTRATIVE TASKS AUTOMATION
As of 2009 LIMS implementations can manage laboratory sampling, consumables sampling schedule and financial (invoices).
SCOPE OF STUDY
Bakor Medical centre has various departments and sections based on the issue at hand to be dealt with; however this study focuses mainly on the lab processes, including data collection and management.
This study takes the patient from the moment of entry into the medical centre, filling forms, up till the moment the test is taken, from that point onwards the study will focus on the methods used by the laboratory attendant to collect and store data, through recording of findings and submission of results
This study will also concentrate on data backup and retrieval methods and will highlight potential errors and problems that could be encountered if the entire process was carried out manually instead of using a well configured computer application.
SIGNIFICANCE OF STUDY
The Computer based Laboratory information management System is quite desirable as it will benefit the laboratory in the area of repetitive task automation. It will serve as an assistant to the medical laboratory scientist. It will also benefit patients as they will be able to retrieve record from previous visits to the laboratory.
LIMITATIONS OF STUDY
The limitations of this study include:
Inability to obtain actual test result document, as this goes against medical ethics for a third party to view Laboratory specimen or test results.
Unavailability of qualified laboratory scientist at the study locations to properly explain terms and laboratory procedures.
From tasting urine to microscopy to molecular testing, the sophistication of diagnostic techniques has come a long way and continues to develop at breakneck speed. The history of the laboratory is the story of medicine’s evolution from empirical to experimental techniques and proves that the clinical lab is the true source of medical authority.
Three distinct periods in the history of medicine are associated with three different places and therefore different methods of determining diagnosis: From the middle ages to the 18th century, bedside medicine was prevalent; then between 1794 and 1848 came hospital medicine; and from that time forward, laboratory medicine has served as medicine’s lodestar. The laboratory’s contribution to modern medicine has only recently been recognized by historians as something more than the addition of another resource to medical science and is now being appreciated as the seat of medicine, where clinicians account for what they observe in their patients.
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The first medical diagnoses made by humans were based on what ancient physicians could observe with their eyes and ears, which sometimes also included the examination of human specimens. The ancient Greeks attributed all disease to disorders of bodily fluids called humors, and during the late medieval period, doctors routinely performed uroscopy. Later, the microscope revealed not only the cellular structure of human tissue, but also the organisms that cause disease. More sophisticated diagnostic tools and techniques – such as the thermometer for measuring temperature and the stethoscope for measuring heart rate – were not in widespread use until the end of the 19th century. The clinical laboratory would not become a standard fixture of medicine until the beginning of the 20th century.
Ancient diagnostic methods
In ancient Egypt and Mesopotamia, the earliest physicians made diagnoses and recommended treatments based primarily on observation of clinical symptoms. Palpation and auscultation were also used. Physicians were able to describe dysfunctions of the digestive tract, heart and circulation, the liver and spleen, and menstrual disturbances; unfortunately, this empiric medicine was reserved for royalty and the wealthy.
Other less-than-scientific methods of diagnosis used in treating the middle and lower classes included divination through ritual sacrifice to predict the outcome of illness. Usually a sheep would be killed before the statue of a god. Its liver was examined for malformations or peculiarities; the shape of the lobes and the orientation of the common duct were then used to predict the fate of the patient.
Ancient physicians also began the practice of examining patient specimens. The oldest known test on body fluids was done on urine in ancient times (before 400 BC). Urine was poured on the ground and observed to see whether it attracted insects. If it did, patients were diagnosed with boils.
The ancient Greeks also saw the value in examining body fluids to predict disease. At around 300 BC, Hippocrates promoted the use of the mind and senses as diagnostic tools, a principle that played a large part in his reputation as the “Father of Medicine.” The central Hippocratic doctrine of humoral pathology attributed all disease to disorders of fluids of the body. To obtain a clear picture of disease, Hippocrates advocated a diagnostic protocol that included tasting the patient’s urine, listening to the lungs, and observing skin color and other outward appearances. Beyond that, the physician was to “understand the patient as an individual.” Hippocrates related the appearance of bubbles on the surface of urine specimens to kidney disease and chronic illness. He also related certain urine sediments and blood and pus in urine to disease. The first description of hematuria or the presence of blood in urine, by Rufus of Ephesus surfaced at around AD 50 and was attributed to the failure of kidneys to function properly in filtering the blood.
Later (c. AD 180), Galen (AD 131-201), who is recognized as the founder of experimental physiology, created a system of pathology that combined Hippocrates’ humoral theories with the Pythagorean theory, which held that the four elements (earth, air, fire, and water), corresponded to various combinations of the physiologic qualifies of dry, cold, hot, and moist. These combinations of physiologic characteristics corresponded roughly to the four humors of the human body: hot moist = blood; hot dry = yellow bile; cold moist = phlegm; and cold dry = black bile. Galen was known for explaining everything in light of his theory and for having an explanation for everything. He also described diabetes as “diarrhea of urine” and noted the normal relationship between fluid intake and urine volume. His unwavering belief in his own infallibility appealed to complacency and reverence for authority. That dogmatism essentially brought innovation and discovery in European medicine to a standstill for nearly 14 centuries. Anything relating to anatomy, physiology, and disease was simply referred back to Galen as the final authority from whom there could be no appeal.
In medieval Europe, early Christians believed that disease was either punishment for sin or the result of witchcraft or possession. Diagnosis was superfluous. The basic therapy was prayer, penitence, and invocation of saints. Lay medicine based diagnosis on symptoms, examination, pulse, palpitation, percussion, and inspection of excreta and sometimes semen. Diagnosis by “water casting” (uroscopy) was practiced, and the urine flask became the emblem of medieval medicine. By AD 900, Isaac Judaeus, a Jewish physician and philosopher, had devised guidelines for the use of urine as a diagnostic aid; and under the Jerusalem Code of 1090, failure to examine the urine exposed a physician to public beatings. Patients carried their urine to physicians in decorative flasks cradled in wicker baskets, and because urine could be shipped, diagnosis at long distance was common. The first book detailing the color, density, quality, and sediment found in urine was written around this time, as well. By around AD 1300, uroscopy became so widespread that it was at the point of near universality in European medicine.
Consequently, the clinical laboratory became a standard fixture of medicine at the beginning of the 20th century; it is now an integral part of the health-care delivery process and is seen as the basis for medical diagnosis.
In recent times a medical laboratory scientist (MLS), formerly known as a medical technologist (MT) or clinical laboratory scientist (CLS), functions as a medical detective, performing laboratory tests that provide physicians with information that assists them in preventing, diagnosing and treating diseases and maintaining patient wellness.
The medical laboratory scientist performs a wide variety of laboratory tests, ranging from simple dipstick urine tests to complex DNA tests that help physicians assess risk of diseases. Using test results, physicians can uncover diabetes, cancer, heart attacks, infections and many other diseases.
Medical laboratory scientists interact with physicians, nurses, pharmacists, and other members of the healthcare team to provide timely, accurate information so the patient can receive the correct medical treatment.
Medical laboratory scientists use sophisticated biomedical instruments and technology, microscopes, complex electronic equipment, computers, and methods requiring manual dexterity to perform tests on blood, body fluids, and tissue specimens. Clinical laboratory testing sections include clinical chemistry, hematology, Immunohematology (Blood Bank), immunology, microbiology and molecular diagnostics.
EFFECTS OF MEDICAL LABORATORIES
Medical Laboratories have played a pivotal role over the years. As stated above, in ancient times, physicians relied on various inaccurate means of disease diagnosis such as urine tasting, listening to the lungs etc. However with the advent and subsequent evolution of modern medical laboratory facilities, plus the discovery of the cellular nature of human tissue and the invention of the microscope, medical diagnosis made a tremendous leap from a 50-50 accuracy ratio to an 80% accuracy rating for laboratory based medical diagnosis. Therefore the use of medical laboratories has greatly increased the accuracy of diagnosis; hence the physician can administer the proper kind of treatment.
The use of laboratories has also led to various discoveries, such as new strands of Viruses, bacteria, parasites and fungi. It also acts as a monitor for new strands of drug resistant bacteria.
CHALLENGES FACED BY MEDICAL LABORATORIES
The main challenges and bottle-necks encountered by medical laboratories over the years include.
Inability to preserve patient samples or specimens such as blood, sputum, stool, over a long period of time for reference purposes hence making patient to specimen matching and tracking,
Efficient information sharing and retrieval between the laboratory scientist and those administering treatment has been a problem.
MEDICAL LABORATORIES: IMPROVEMENTS AND THE FUTURE
For the efficient functioning of the diagnosis system, health-care delivery, scientific research into bacteriology and disease causing organisms, technology should be applied to automate administrative tasks, such as the visitor registration and result documentation. By making judicious use of computer software to automate and manage tasks in the laboratory there will be a dramatic increase in its efficiency.
Consequently this will greatly reduce the need to recruit and pay personnel to carry out administrative duties therefore such resources can be channeled towards more important needs of the laboratory.
TECHNOLOGY PLATFORM/PROGRAMMING LANGUAGE TO BE USED IN STUDY
The technologies to be used in the development of this Laboratory Information Management system is an open source programming language known as PHP, together with a MYSQL driven database, a solid browser based application will be developed.
PHP: PHP also known as Hypertext Pre-processor, it belongs to a class of languages known as middleware (Needham, 2006). These languages work closely with the web server to interpret the request made from the web, processes these request, interact with other programs on the server to fulfill the request and then indicates to the web server exactly what to serve to the client’s browser.
It is the leading web programming language for design of web applications. It possesses a language similar to C, Java or Pearl. Its uses include: retrieving user input and saving it in a database, retrieving information from a database and general data manipulation processes.
THE CLIENT: Simply refers to end users of an application that connect to a remote server to carry out computational processes
THE SERVER: An application known as a web server listens for requests a client makes, responds to those requests and serves out the appropriate response (Greenspan, 2002)
MYSQL: Refers to an open source relational database management system with a set of programs that access and manipulate these records. (Descartes, 2003).
It is a relational database management system (RDBMS) that runs as a server providing multi-user access to a number of databases.
APACHE WEB SERVER:
Apache is a web server notable for playing an important role in the initial growth of the world-wide web.
It is responsible for accepting Hypertext Transfer Protocol (HTTP) request from web client (web browsers) and serving the HTTP responses along with optional data content which usually are HTML pages.
These platforms are used in this research work because:
There are “open source” meaning there are free to use and develop with without having to purchase licenses or fulfill any legal obligation to the owners of the technology.
It is easy to deploy on a local machine
Its hardware requirements are minimal therefore making its installation and usage less cumbersome.
Developer tools and support services for the platform/technology are readily available at absolutely no cost.
DATA COLLECTED FOR LABORATORY TEST
Lab Investigation Form: This form is used for general patient registration and data collection. Data collected on this form include
Name of Doctor
Lab Request Book: Used to record Patients data for that day.
Lab Investigation Done
Data Collected for lab tests
Lab result book (Used for recording patients results)
Date of birth
Hospital registration Number
The use of technological solutions greatly reduces costs, increase profits, save human effort and provide better services to customers/clients
The use of an LIS (Laboratory information System) in the running of a medical laboratory facility greatly improves the documentation process; makes patients records retrieval a lot easier and faster, records are not lost and are kept safe via regular backup of the available data.
With the use of a Laboratory information system, various kinds of data deductions, surveys and reports can be easily generated for statistical purposes such as the average percentage of persons with a certain kind of disease, Genotype or blood type etc.
A properly developed Medical Laboratory information system will greatly increase productivity, increase the quality of services delivered by the facility and greatly reduce the amount of man hours put into the delivering the laboratory services
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