 Okay, a pleasant morning, a pleasant afternoon, a pleasant evening to everyone, whatever time you're watching this asynchronous video. So I just want to greet you a good day to everybody. So for this discussion, we will be discussing your laboratory information system. So this is already the third topic on your syllabus. So we're actually nearing the end of the prelim coverage. So hopefully you'll be listening to our discussion for today. So laboratory informatics again, good morning to everybody. Okay, so before I proceed, let me just check if my recording, my audio and also my camera are all working well. So let's get started. So for this morning, we're going to talk about laboratory information system. So some of these topics are actually are going to be review for you guys, especially for those of you who still remember your HIS. So your health information system for medical laboratory science was actually a primer already of this discussion that we're going to have for today. Although the discussion for today is merely a review, a reiteration of the importance of laboratory information system. When it comes to the clinical chemistry section. So if you are following with me, this is not found on your BESHA, but I would want you to proceed to your to your Henrys. Okay, if you already have a copy of your Henrys, you can actually find this in Chapter 11 and I am currently and will be starting at page 132. Okay, page 132. So laboratory information system that is our topic for today. So let's get started and let's move to the next slide. So laboratory information laboratory information system. Simply your information system refers to the empirically refers empirically to the hardware, the software and also the connectivity design to perform data management function. So as you all know, basic when it comes to your computer, you have your software, you have your hardware. But most importantly, you also have the connectivity in which this hardware and software are integrated with one another that allow us to perform data management function. So when we say data management function, we're not just merely talking about curating or storing a particular set of data in the laboratory, but also how we manage them. So as you all as you all know, and hopefully all of you still remember when it comes to data management, we also pertain onto how we were able to use up the data that we gathered so that it would benefit the laboratory or the hospital in general. Like for example, I collected data about the satisfaction of your patients, then I would be able to know what to improve and what to retain when it comes to the services. So in your laboratory information system, we're actually focusing the use of information system in the laboratory. So most of the time, okay, most of the time, the laboratory information system are commonly used in the communication of different analyzers. So sir, what do you mean by communication with different analyzer? Take for example, I am the medical technologist, I'll be putting in my specimen into the machine and my way of giving commands to the analyzers are through your laboratory information system. At the very same time, the manner on how my analyzer will also communicate to me the result that they were able to gather or that we're able to measure is also through the laboratory information system. So all the data, okay, now all the data, all the information that has been measured and that has been retrieved, okay, from a particular patient can all be curated and all stored into the information system, more specifically in your cloud, okay, in your cloud. So please do remember that laboratory information system nowadays plays a very important role when it comes to increasing the efficiency and effectiveness of your laboratory. First and foremost, it is because a lot of the manpower are no longer focused on retrieving your results, no longer focused writing down your results or writing down a lot of the things in the laboratory. Instead, they are now focused on improving the service in the laboratory rather than spending hours, hundreds of hours on paperwork. Okay, that's one of the good things about laboratory information system. It did increase the efficiency in the laboratory and increase efficiency in the laboratory would also mean improvement when it comes to our turnaround plan. So having said that now, okay, your laboratory information system is our way of communicating to the analyzer and the way of analyzers communicating to us. Well, that was just the beginning of laboratory information system, okay, that was just the beginning of your laboratory information system. So before, it's just merely into commanding your machine and your machine giving out the measurement or the result that they were able to take. But now, your laboratory information system now encompass not only your laboratory, but your whole hospital. That's why we also have your hospital information system in which from patient registration to your billing up until to your accounting, even your inventories, even your electronic medical records, your EMRs are all now integrated in your hospital information system. So there's a cloud, okay, there is a cloud now that will integrate, that will connect all of the different systems in the hospital, specifically your laboratory, for example, your pharmacy, your billing, your admissions, okay, your discharge. So all of the aspects in the laboratory, all the aspects in the hospital, to you be general, are now connected with the cloud, okay, they are now connected with the cloud. So I cannot overemphasize the importance here of connectivity, okay, because of that connectivity, all of the data coming from all parts of the hospital are now integrated to one another. And having said that, since they are all integrated into one cloud, they can also exchange information. So take for example, there's an information that we need coming from the pharmacy. We will now be able to communicate with the pharmacy department, to the radiology department, cardiology department, any department that you can think of, we are now connected to them through the laboratory information system. So it's just like a cloud, it's just like a cloud that underneath it are all the different systems that works together for the increased efficiency when it comes to patient care in the hospital. And having said that now, okay, having said that now, in your screen, these are the different functionalities, okay, the different systems that you usually see in the hospital. So this is no longer just in the laboratory, but in general, these are common healthcare enterprise information systems that are being used. So we have here your ADT or your admission discharge and transfer. So its functionality, it runs the entire patient care workflow. So if the patient is to be admitted, if they are to be discharged or if they are going to be transferred from one room to another from an intensive care unit to a regular room. All the patient care workflow are integrated in your ADT. So from registration of the patient up until the bed tracking and discharge, we are able now to monitor that. We are able to monitor that. More similarly, when we are able to watch movies physically, you can actually choose a seat, you can choose a seat and then you can track which chair is still available. In the hospital, that's also the same thing. We're able to determine if there are full capacity already, how many beds are still vacant, how many patients can still accommodate. So it makes the life of a lot of people in the hospital much easier. In addition to that, you also have your electronic clinical information system or your CIS. Your CIS on the other hand contains now, contains the patient information from all the inpatient and outpatient systems in an enterprise and is used for reviewing patient data. So if you're a fan of grace anatomy, you'll now see them using their laptop or using their iPods, okay? Using their iPods in checking the laboratory result. These are now the charts that we consider. So before, we do have your physical, your paper-made chart. Now we actually have your CIS or your clinical information system where all of the records, all of the information of your patient with regards to their management, with regards to their diagnosis, with regards to all the things that they have, okay, are all integrated here, okay? A much similar aspect of your CIS is your EMR. I'll skip the LIS first, okay? Your EMR, your electronic medical record is a chronologically ordered paperless chart that summarizes the clinical history and the diagnostic test results that has been made from the patient. So your CIS, okay? Your CIS, this contains all information of your patient, like more of the demographics, okay? More of the demographics. And then your EMR, these are now health-related aspects of your patient. So these are the initial diagnosis, the clinical history, and also your diagnostic test result that has been made to your patient. So if you can remember in your HIS before, there are different types of data that are being taken from our patient and being incorporated to your LIS. So their allergies, their medical history, okay? So all of those records are all integrated in your EMR. And the good thing about this is that before if you're going paperless, of course, if you do have your paperless, you still have to go to the nursing station that you'll be able to get the chart of your patient, but now it can even be sent to you electronically, okay? Of course, we still maintain confidentiality of your data. So aside from that, we also have here, okay? Let's go back one point upward. So you also have here your laboratory information system. So your LIS is an electronic data processing and information management function that functions necessarily for laboratory operation. So later on, we'll be talking about the laboratory information system function and also the information flow when it comes to the laboratory because that is our main concern for today. So just like what I was discussing in the beginning of our meeting, okay? Your LIS, your laboratory information system allows us to not only communicate with the outside system of the laboratory, but most importantly, it allows a seamless communication within the laboratory, okay? Within the laboratory. Later on, I'll be showing you a video on how well if a laboratory is fully automated with laboratory information system, it would work wonders in the laboratory. Now, finally, we also have here your EDW or your Enterprise Data Warehouse. Your Enterprise Data Warehouse on the other hand is also similar to your CIS except that the information is utilized for research through using databases and data analysis tools to uncover hidden patterns and relationship in the data. And right now, okay, this is a booming study and field of research which we call data mining. So data mining, okay? Data mining is actually a dry laboratory, a dry experiment to be considered now in most field of research. So what is laboratory? What do we mean by Enterprise Data Warehouse? Your Enterprise Data Warehouse, I don't know if some of my students from HHS still remember this, but this is the time where all of the things, all of the, I was not able to handle your lecture pala, okay? So it was the second year right now. So when it comes to your Enterprise Data Warehouse, all of the data coming from all systems in the hospital are all integrated to one another. And here, we are able to apply, if you are familiar with data science, we're able now to come up with rationalization and conclusion based on the information from our patient. Take for example, I'll give you one. So take for example, most of your patients who are coming in the laboratory, take for example, a particular local, most of them has increased population of teenage pregnancy. So you would see that pattern in the hospital. You would see that pattern on your data. Now there's an increasing number of teenage pregnancy. And with that information, you can now, you are now able to see that most probably in this particular locale, there are no reproductive health bill seminars or protocols or even seminar or education that is being given to the population. That's why there's an increasing number of teenage pregnancy. And the very same thing when it comes to your, when it comes to your, in a particular urban residence, there's an increased number, especially right now, most probably right now in the time of pandemic where all of us are working from home. So there will be an increase, increase cases of health related problems with regards to your weight, when it comes to your weight, when it comes to your stress, when it comes to your mental health. Because again, there's a particular pattern and that's the beauty when it comes to data mining and that is the beauty when it comes to data science. All those data that are gathered around, you're able to come up with a conclusion. You're able to come up with a visual that would explain a particular phenomenon. A particular phenomenon in the, not only in the laboratory, but in the community in general. And finally, we also have here your billing systems. So when it comes to your billing system, it receives information on charges and or test performed to calculate charges to your patient insurance. I know that if you notice, we do not maintain a particular list of things that have been done from your patient. We don't have a list like that. Instead, all the things that are being done to your patient is being charged to their account. It's more like a baggage counter if you would say, or the cashier. You take all you need and then before you leave, they'll scan them all so that you would know how much you'd pay. Similarly in the laboratory, all the things that is to be done to your patient will be done, will be performed and then before the patient is discharged or transferred, they would have to pay for the bills that they were able to incur during their stay in the hospital. So these are the usual laboratory information system. Actually, hospital information system if you may because it's not just focused on the laboratory. Now, if we're going to narrow it down to the laboratory, what are the usual steps in the laboratory that would require your laboratory information system? Perhaps most of you would think, since I was mentioning about communication with your analyzers, it would be focused more on the analysis of your results and perhaps you can also think of the releasing of the results. But in reality, all the parts of your clinical laboratory workflow are involved, are involving your laboratory information system now. So from the pre-analysis, the analysis, post-analysis and even the management afterwards, they are all integrated through your laboratory information system. Now, even patient registration is already done through the laboratory information system. So gone are the days that we have to fill out lengthy papers. So right now, you will just have to fill out or be interviewed for their patient registration even test ordering. Test ordering is like ordering using your shopping, your lazada, your food panda, your grab. You just simply type or simply click on the test that you would want, especially if you're a doctor. You just simply request that and it will be performed to your patient. Aside from that, you can also have customized requisitions especially for outreach clients, for outreach client. Aside from that, it would also allow you to have the phlebotomy draw list so you would know what are the different tests. You would know who are the different patient that you need to collect samples with. You already have a bar coded collection labels and alicote labels. So sure what do you mean by collection labels and alicote labels? So collection labels, this are, take for example, I extracted blood from a patient. The tube that I have is the collection tube itself. But when I move to the laboratory, I need to alicote it. Why do we call it alicote? Remember in clinical chemistry, we separate the plasma or the serum immediately from the red blood cell so that we can prevent any further metabolism of the RBC. So once you remove your serum or your plasma, you transfer it into a different test tube and that in itself now is already your alicote. So you also need to have a proper labels for your alicote that would correspond to the labels that are found on your main collection tube. Okay? To your main collection tube. So aside from your pre-analysis, as you can see, we can say that the pre-analytical, when it comes to the patient preparation, patient registration, patient identification and even in your patient or your specimen collection, it is being governed by your laboratory information system. More so, when it comes to your analysis, your instrument work list, so it is your laboratory information system serve as the interface and allow us to automatically download or upload information into the machine or out of the machine. So we also have your manual work list, manual results entry. You can choose whether to manually enter the work list. When we say work list, you can manually select the different tests to be performed and you can also manually retrieve the results or you can simply choose the automated way. So automated results entry via an interface. So what do we mean by this? So once at the particular machine measure a particular analyte, it will automatically be forward to your laboratory information system and it is now ready to be printed. It allows easier validation of your results. So whether that is manual or automatic release, it will allow us to have a better and a faster validation when it comes to your results. And most importantly, when it comes to laboratory information system, you can also have a better way on analyzing your quality control specifically your intra-laboratory quality control. So in the laboratory, in the laboratory in your CLIN Chem One, you will be performing manual preparation of your quality control table together with the identification of the different errors or rules that have been violated according to West Guard. So in a laboratory information system, it is automatically be generated by your machine. The only thing that you would do then would be to read it and to interpret it. Even the errors, they would be able to flag the errors already. You'd be able to know which one are errors, which one are not. Which one are errors, which one are not. So that's the good thing about your laboratory information system. Aside from that, it would also allow us to even control your post-analytical seamlessly. So from the requisition-based patient reports whether that is a final or a partial result, we'll be able to release that to your doctors immediately. And most importantly, you have a cumulative patient report. You have a cumulative patient report. So delta checking would be easier through the help of your laboratory information system. Aside from that, you can easily correct reports. If you're a doctor, you can easily create a result inquiry. So during my time, we would experience doctors who are already in the laboratory really waiting for the results. So they won't leave your side not until you give them a result. So sometimes that's the case when our doctors but they don't know what's going on and they don't know what's going on. But sometimes they think that their measurement of your samples are that easy. That's why they would wait there. They would wait there. And it's really a lot of pressure for medical technologists for those times. So aside from that, of course, you also have your electronic reporting to external interfaces. So interfaces, rather, interfaces so you can you can communicate it to the billing so that they would know what are the tests that have been performed from your patient. And of course, when it comes to your management here, you have your pending and incomplete list. You're able to know what is the turnaround time from the request of the test up until the release of the result work load statistics. You're able to know what are the agents that you need to order more frequently. You also have your ad hoc report or report writer. So you're able to report all what do you call this? Incident reports. Incident reports in the laboratory. And finally, your CIS and instrument integrity monitoring tool. So when we say instrument integrity we're also able to lock the or limit the access of people to the information of your patients or anyone from the laboratory. So hopefully this was able to give you I was able to give you a picture of how laboratory information system works in the laboratory. So let's go to the information flow. So usually this is the common information flow in the laboratory. So you have your patient registration on your order test ordering order test, you can use it in the collection sample when you receive a sample, when you ran a sample, your review result, your release report, and even when you report now your results. So let's go through this information flow one by one and I'm just going to discuss the important things about this information flow as indicated in your Henry's. So when it comes to your patient registration or identification always remember this people of the Philippines patient registration is always and forever be would be the most critical step in any workflow. So if you misidentify a patient, if you misidentify a person that would completely mess up your system. Now either would completely mess up your system. So right now when it comes to patient registration and newer technology that is being applied is your radio frequency identification or your RFID. So similarly if you already have traveled using your RFIDs niba you don't have to interact with anyone anymore when you are doing your tolfi. So there is a system there are specialised camera that are able to identify your car. So similarly when it comes to your patient registration and identification usually the RFID are in the form of your ID bands. We're able to monitor your patient. We're able to monitor and identify your patient in the laboratory. More so when it comes to the laboratory information system we already have what we call your smart label. So buti pa yung label smart. So we have your smart label. So in your smart label it actually have three components. First is a human readable information. So up until this day even though we use bar code we can use QR code like the name of the patient the time of collection the time in date who is the phlebotomist who collected the date of birth of your patient so that we can still counter check it with our system. So okay aside from that you also have your bar code so if the human readable information is for the human the bar code is actually for the computers for your machines they're able to read the labels using your bar code and aside at the same time it also have an integrated circuit or IC chip with memory on the bar code. So later on when you go to the I'll show you a video later on of the full implementation of an automated laboratory. So you'll be able to see why integrated circuit chip is also important in the smart label. Okay. So moving forward aside from the patient registration just like what I was mentioning in your test orders okay you're able to select test electronically and it's being sent to the LIS so take for example the doctor is in the 11th floor in the laboratories in the ground floor so they will be they will be able to select the test that they would need you just be able to select the different test that they would require for their patient to be requested and then once your patient went to the laboratory it's now saying okay it is now saying and then the phlebotomies will just be collecting the sample for your patient I hope we're clear with that and speaking of sample collection and labeling we're not gonna talk about automated sample collection here because up until this day medical technologies humans okay are still collecting blood from our patient but right now usually we do not we no longer write or we no longer personally the test tubes why? because we already are using your printed label so as you can see here this is an example of your smart label so you have here the medical record number the name the other ID okay for identification what is the tube type so this is an SS tube a yellow tube the collection the collection date and time you have the test okay what is the test that is um what is the test for this particular sample and you also have the accession number so here as you can see people this is an example of the smart label um as a person me I would be able to still identify the tube the sample my machine can also identify the tube and the sample so simple okay but um why is it important because it's a counter checking for our medical technologies and also for your machine okay so um as you can see automation would actually cause less human interaction when it comes to your sample and the reason for that is um lesser human interaction or lesser human interference when it comes to your when it comes to your um samples your agents would actually limit um errors in the laboratory okay so now um once you are able to collect your sample we're now ready to perform the test so in performing your test this can also be done um either um semi-automated or fully automated so when I say semi-automated this are uni-directional analyzer communication so meaning to say um the input of a particular test is manual so for example me I would have to um manually select every single test that I need for this machine to run but the good thing about this is that um the the reporting of results will be automatic okay the reporting of results will be automatic so once that the machine was able to record a particular measurement it will now be sending the results to the LIS and we can now review it we can now double check it delta check it before releasing to our physicians or to our patients okay that is the uni-directional most of the laboratory here in the Philippines are actually doing uni-directional even though um we have an automated machine it's still the medtech that chooses and monitor the test that are being um selected for the um being selected for the um for the specimens in the laboratory on the other hand we also have the bi-directional analyzer communication so here both your the input of the test and the reporting of the results are all accommodated so meaning to say um we simply scan the barcode like this one the one that um I showed you a while back so once you scan this the machine will already be able to read and will be able to be programmed that it would need to um it would need to measure your um take for example your protein okay your blood urea nitrogen your protein and even your amylase in the sample so your patient now okay your patient sample will be able to identify or rather your machine would be able to identify what type of test will be performed in this particular okay in this um particular specimen okay so that is the two methods or two um communication that comes to um we have your unidirectional and also your bi-directional analyzer communication okay communication so having said that now let's go to the releasing of your results okay so in the releasing of your result if before we do have the paper medical records now we simply have your electronic um health record or your E or electronic medical record or your E MR okay so in the releasing of your result it is now online releasing it is faster and somehow secure as well okay it is also secure sir what do you mean by integrated panic values okay so in the laboratory we have this thing called um panic value okay so what are panic value panic value are certain levels of analyze highly abnormally high or abnormally low levels that would alert the medical technologist that once we um once we are able to measure or record a particular value and is considered to be a panic value we need to immediately report it to the doctor so usually take for example um the turnaround time would take four hours but upon measuring it okay in the first two hours the patient's result um is extremely high okay for example your potassium so there's hyperkalemia and increased potassium would cause your heart to be parallel your muscles to be parallelized one of the muscles there would be your heart and that and that would cause the cessation of your heart um to beat so your patient would die so and they can resolve the condition of your patient immediately so when it comes to the integrated panic value these are the moment where your system your laboratory information system would send signal or what which we call in the laboratory your flags okay so take for example there's an abnormally high we would see a flag okay that would prompt us that this particular analyte is abnormal okay either abnormally high or abnormally low that is what we call your flagings okay so those are your warning signs in the laboratory so once that is also integrated in your LIS it will be able to prompt you it can the machine can alarm and it can prompt the medical technologist to rerun the test or to report the results immediately now speaking of reporting so remember that when it comes to your electronic data we already have electronic data repository so just like what we were talking about um your electronic data your electronic um what do you call this again your enterprise data warehouse okay your enterprise data warehouse in which all of the data are collated to one another and we're able to come up with an interpretation on how this particular data are the way they are okay and finally of course you also have your electronic medical record in which telemedicine is being um utilized telemedicine is very widely used now in this time of pandemic this would actually help us okay this would actually help us um to better the service or to improve the service when it comes to um reporting and also your consultation in the laboratory so now I'll show you a video I hope so I'll show you a video of how beautiful a fully automated laboratory would be um and when I say fully automated from their from the receiving of their sample once they receive the sample and up until the release of the results um you would see the automation that is in here okay so let's watch this video we're not watching Avengers and it will automatically sort okay the machine will be the one to sort um your specimen you know so it's entering um in a conveyor um conveyor belt so it also has a automatic service it automatically separates some plasma a balloon um the package when this stopper this is now after the centrifugation um the removal of your stopper or your um top so why they are doing this stopper perhaps some of you are wondering um will the tubes be lost no they don't be lost because we have the fire field system and they are um I think we're trying to do the so they are trying to leave the tubes okay okay where the some point from the rather tube will be transcribed to the called tubes okay there you go get your projectives go back as per um so I told you to leave it and now sample transfer it's about when you can expect to expect some many can see by even even my even my but for I didn't that much I got friends now this is this is you will now re-sup it for you your sample was was part of this list okay okay so that was your um so that was an example of a fully automated um laboratory from the sorting of the samples up until the sorting of the samples after being run in the laboratory so in St. Luke's um St. Luke's BGC in St. Luke's Global okay global city they do have this so when we went there um they would just put all the specimens collected on a conveyor conveyor belt and then it will now start to scan and it will start to deliver the different samples into the specific sections in the laboratory and it was actually quite amazing watching it actually to happen so imagine the amount of science the amount of robotics um that is in there that's why in the future if you have plans you can also you can also pursue biomedical engineering um as your postgraduate um programs okay but finally as to to end this discussion for today um let's also talk about bioinformatics so bioinformatics um studies how information is stored in biological systems specifically um our genetic code so um with the help of bioinformatics we're able to organize data from a molecular level to a macromolecular level with a large part of focus being on DNA RNA and protein sequences sequences so here um right now um the dawn of omics um as they as they call it okay um omics genomics proteinomics metabolomics so all of those omics now um to gain popularity okay and we're able to somehow um understand all this data using bioinformatics so in general bioinformatics is like a translator of all of the um all of the nucleotide sequences that we're able to gather from a DNA take for example you sequence a particular DNA for you to be able to understand that you need to compare that into a bioinformatics machine so you have to compare that to different biobanks okay so take for example um this particular variant of a bacteria or a virus you compare it to the one that is recorded in the biobank so that you would know if it is a similar variant or a similar virus or a new or a novel virus already okay so that's the use of bioinformatics okay in the laboratory and with the help of laboratory information system we're also able to integrate this um bioinformatics in the laboratory so I hope I'm clear and hopefully you did learn something new today about your um laboratory information system you appreciated the beauty of the automation in the lab and most importantly we're also able to have an introduction of bioinformatics do not worry because um on your succeeding semester you will be having your molecular diagnostics and bioinformatics will be discussed there further but for now that's it for me so that's it for our discussion for today so thank you so much for listening and I'll see you one hour next discussion I'll see you on our next video goodbye