PubMed · 16548391
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Heidi Learn. 2006. Web-based programs work for the lab manager.. https://pubmed.ncbi.nlm.nih.gov/16548391/
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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.
OBJECTIVES: To assess the usability of an emerging POE system, OM/Lab, for the computer-supported ordering of laboratory tests. We were more specifically interested in the relation of the usability problems detected in the user testing sessions with the order behaviour in terms of efficiency and errors in ordering. METHODS: A cognitive walkthrough of the OM/Lab system was conducted by two analysts using four real-life scenarios for ordering laboratory tests, which were reviewed for comprehensiveness by an expert clinician. Thereafter, the OM/Lab system was evaluated on its usability in testing sessions with seven potential end-users of the system performing these same four scenarios. The results of these end-user testing sessions were used to analyze the effect of usability flaws on the quality of ordering in terms of omissions, errors in orders and cancelled orders. RESULTS: The analyses revealed a total of 33 usability problems, of which 25 problems were revealed both by the cognitive walkthrough and in the end-user sessions. These 25 usability problems indeed led to inefficient order behaviour, omissions and errors in orders and even to cancelled orders. DISCUSSION: Our results revealed that the OM/Lab system suffered from a high number of usability flaws. The interface design flaws were, among other things, related to misallocation of buttons on the screen, incomprehensibility of button labels and feedback containing no relevant information to the user about the cause of errors made and consequences of a user's action. Additionally, our user test session results indicated that the OM/Lab system also suffered from user interaction problems of a more socio-technical nature. These sessions revealed, among other things, that the more specific action sequences to be executed within the ordering model of the OM/Lab system did not correspond to the daily working routines of end-users and that the grouping of laboratory tests within clusters did not match the paper-based order forms. The seemingly negative effects of these usability flaws on the quality of ordering and the inefficiency of work processes during the pilot implementation finally lead to withdrawal of the OM/Lab system from clinical practice. Though the system implementation failed, our usability study brought research on (re)designing and evaluating clinical computer applications at a higher status in our institution. It is now recognized that usability evaluation studies that will support good quality of clinical practice are highly important.
Considerable attention has been focused on definition and enhancement of the analytical quality in laboratory testing over the past decades. Advances in laboratory technology and computer informatics have allowed a major sense of confidence with the analytical phase and more efforts should now be focused on extra-analytical areas of improvement, that should further strengthen the link between cost effectiveness and clinical outcome. Deduction and implementation of common reference intervals, to be possibly shared by a regional network of clinical laboratories, appear so far a crucial step to increase efficiency and harmonization. With the experience gained from External Quality Control exercises and with the consensus of several contributory laboratories, this process is underway in Italy. Quality performances resulting from widespread implementation of common reference intervals and longitudinal comparison of patient's data, will allow clinical laboratories to accomplish with a major transferability, amplifying health benefits and meeting increasing health systems demand.