PubMed Health⌕ Search

PubMed · 12562228

Six-year trends in laboratory computer availability.

Abstract

CONTEXT: Failure of a clinical laboratory computer system can disrupt work flow and charge capture and affect patient care. The first comprehensive survey of computer downtime was conducted in 1995 and demonstrated significant interinstitutional variation in system availability. Despite numerous changes in the laboratory and computer industries since 1995, no follow-up study has been reported. OBJECTIVES: To quantify current laboratory computer availability and compare it with 1995 performance. DESIGN: Ninety-seven laboratories prospectively recorded the frequency and duration of computer downtime during 30 days in 2001. Results were compared with 1995 survey data. RESULTS: For the median facility, the number of downtime episodes decreased from 8 events per 30 days during 1995 to 3 events per 30 days during 2001 (P <.01). The frequency of unscheduled downtime also improved, from a median of 2 to 0.5 events per 30 days (P <.01). Reduced downtime events were paralleled by reduced cumulative downtime (14.3 vs 4.0 hours per 30 days; P <.01). Improvements were not restricted to the median facility; laboratories performing in the bottom quartile in 2001 recorded substantially less downtime than laboratories in the bottom quartile in 1995. When the comparison was restricted to the 37 institutions that participated in both the 1995 and 2001 surveys, a significant reduction in overall downtime and unscheduled downtime events was still evident (P <.01). More recent installation of vendor software patches was associated with a reduced frequency of downtime events in the 2001 data set. CONCLUSION: Laboratory computer downtime was less frequent in 2001 than in 1995; industry performance appears to be improving.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Paul Valenstein, Molly Walsh. 2003. Six-year trends in laboratory computer availability.. https://doi.org/10.5858/2003-127-157-sytilc

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Enhancement of claims data to improve risk adjustment of hospital mortality.

CONTEXT: Comparisons of risk-adjusted hospital performance often are important components of public reports, pay-for-performance programs, and quality improvement initiatives. Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality. OBJECTIVE: To assess the effect on risk-adjusted hospital mortality rates of adding present on admission codes and numerical laboratory data to administrative claims data. DESIGN, SETTING, AND PATIENTS: Comparison of risk-adjustment equations for inpatient mortality from July 2000 through June 2003 derived by sequentially adding increasingly difficult-to-obtain clinical data to an administrative database of 188 Pennsylvania hospitals. Patients were hospitalized for acute myocardial infarction, congestive heart failure, cerebrovascular accident, gastrointestinal tract hemorrhage, or pneumonia or underwent an abdominal aortic aneurysm repair, coronary artery bypass graft surgery, or craniotomy. MAIN OUTCOME MEASURES: C statistics as a measure of the discriminatory power of alternative risk-adjustment models (administrative, present on admission, laboratory, and clinical for each of the 5 conditions and 3 procedures). RESULTS: The mean (SD) c statistic for the administrative model was 0.79 (0.02). Adding present on admission codes and numerical laboratory data collected at the time of admission resulted in substantially improved risk-adjustment equations (mean [SD] c statistic of 0.84 [0.01] and 0.86 [0.01], respectively). Modest additional improvements were obtained by adding more complex and expensive to collect clinical data such as vital signs, blood culture results, key clinical findings, and composite scores abstracted from patients' medical records (mean [SD] c statistic of 0.88 [0.01]). CONCLUSIONS: This study supports the value of adding present on admission codes and numerical laboratory values to administrative databases. Secondary abstraction of difficult-to-obtain key clinical findings adds little to the predictive power of risk-adjustment equations.

Clinical Laboratory Information Systems↗

Definition of an XML markup language for clinical laboratory procedures and comparison with generic XML markup.

BACKGROUND: Clinical laboratory procedure manuals are typically maintained as word processor files and are inefficient to store and search, require substantial effort for review and updating, and integrate poorly with other laboratory information. Electronic document management systems could improve procedure management and utility. As a first step toward building such systems, we have developed a prototype electronic format for laboratory procedures using Extensible Markup Language (XML). METHODS: Representative laboratory procedures were analyzed to identify document structure and data elements. This information was used to create a markup vocabulary, CLP-ML, expressed as an XML Document Type Definition (DTD). To determine whether this markup provided advantages over generic markup, we compared procedures structured with CLP-ML or with the vocabulary of the Health Level Seven, Inc. (HL7) Clinical Document Architecture (CDA) narrative block. RESULTS: CLP-ML includes 124 XML tags and supports a variety of procedure types across different laboratory sections. When compared with a general-purpose markup vocabulary (CDA narrative block), CLP-ML documents were easier to edit and read, less complex structurally, and simpler to traverse for searching and retrieval. CONCLUSION: In combination with appropriate software, CLP-ML is designed to support electronic authoring, reviewing, distributing, and searching of clinical laboratory procedures from a central repository, decreasing procedure maintenance effort and increasing the utility of procedure information. A standard electronic procedure format could also allow laboratories and vendors to share procedures and procedure layouts, minimizing duplicative word processor editing. Our results suggest that laboratory-specific markup such as CLP-ML will provide greater benefit for such systems than generic markup.

Clinical Laboratory Information Systems↗