Journal:Laboratory information system requirements to manage the COVID-19 pandemic: A report from the Belgian national reference testing center
Full article title | Laboratory information system requirements to manage the COVID-19 pandemic: A report from the Belgian national reference testing center |
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Journal | Journal of the American Medical Informatics Association |
Author(s) |
Weemaes, Matthias; Martens, Steven; Cuypers, Lize; Van Elslande, Jan; Hoet, Katrien; Welkenhuysen, Joris; Goossens, Ria; Wouters, Stijn; Houben, Els; Jeuris, Kirsten; Laenen, Lies; Bruyninckx, Katrien; Beuselinck, Kurt; André, Emmanuel; Depypere, Melissa; Desmet, Stefanie; Lagrou, Katrien; Van Ranst, Marc; Verdonck, Ann K.L.C.; Goveia, Jermaine |
Author affiliation(s) | University Hospitals Leuven, Katholieke Universiteit Leuven |
Primary contact | Email: jermaine dot goveia at uzleuven dot be |
Year published | 2020 |
Volume and issue | Ahead of print |
Article # | ocaa081 |
DOI | 10.1093/jamia/ocaa081 |
ISSN | 1527-974X |
Distribution license | Creative Commons Attribution Non-Commercial 4.0 International |
Website | https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa081/5827002 |
Download | https://academic.oup.com/jamia/advance-article-pdf/doi/10.1093/jamia/ocaa081/33421026/ocaa081.pdf (PDF) |
This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed. |
Abstract
Objective: The study sought to describe the development, implementation, and requirements of laboratory information system (LIS) functionality to manage test ordering, registration, specimen flow, and result reporting during the coronavirus disease 2019 (COVID-19) pandemic.
Materials and methods: Our large (more than 12,000,000 tests/year) academic hospital laboratory is the Belgian National Reference Center for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We have performed a moving total of more than 25,000 SARS-CoV-2 polymerase chain reaction tests in parallel to standard routine testing since the start of the outbreak. A LIS implementation team dedicated to developing tools to remove workflow bottlenecks—primarily situated in the pre- and post-analytical phases—was established early in the crisis.
Results: We outline the design, implementation, and requirements of LIS functionality related to managing increased test demand during the COVID-19 crisis, including tools for test ordering, standardized order sets integrated into a computerized physician order entry module, notifications on shipping requirements, automated triaging based on digital metadata forms, and the establishment of databases with contact details of other laboratories and primary care physicians to enable automated reporting. We also describe our approach to data mining and reporting of actionable daily summary statistics to governing bodies and other policymakers.
Conclusions: Rapidly developed, agile extendable LIS functionality and its meaningful use alleviates the administrative burden on laboratory personnel and improves turnaround time of SARS-CoV-2 testing. It will be important to maintain an environment that is conducive for the rapid adoption of meaningful LIS tools after the COVID-19 crisis.
Keywords: COVID-19, laboratory information system, health information technology implementation, computerized provider order entry, change management
Introduction
Background and significance
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has caused a pandemic with unprecedented medical and socioeconomic adversity. Second- and third-wave outbreaks are becoming a reality in several countries, at least partially, due to low herd immunity.[1] Laboratory testing to rapidly detect SARS-CoV-2 using polymerase chain reaction (PCR) is essential to guide proper patient management[2], while serological assays will soon be required to assess population immunity (e.g., antibody tests) and guide national coronavirus disease 2019 (COVID-19) pandemic policies.[1]
The increased demand for round-the-clock laboratory testing during the COVID-19 pandemic has surpassed surge capacity in many clinical laboratories, resulting in significant strain on laboratory personnel and infrastructure.[3][4] These developments are especially undesirable when laboratories already have to process a large numbers of potentially biohazardous specimens every day. Additional delays in testing directly translate into delayed clinical decision making and consequently congest emergency departments and isolation units.[3] Therefore, leveraging the capabilities of laboratory information systems (LIS) to streamline all phases of laboratory testing workflow (preanalytical, analytical, and postanalytical) has proven essential.
To our knowledge, only a single report has been published that discusses the implementation of health informatics to support clinical management of the COVID-19 pandemic through novel electronic health record (EHR) functionality.[5] COVID-19 is a laboratory diagnosis with immediate consequences in the health sector (hospitalization, patient isolation, postponing surgery, etc.). Therefore, clinical laboratories face specific challenges that require dedicated LIS functionality to ensure safe, reliable testing and acceptable turnaround times.[3] However, no literature exists on tools that leverage the LIS in order to alleviate the burden on laboratory personnel, streamline laboratory testing, improve test reporting, facilitate epidemiological and translational research, and enable data-driven policy making.
Objectives
Here, we describe the challenges faced by the Belgian National Reference Center for COVID-19 testing when demand passed allocated surge capacity during the initial phases of the COVID-19 pandemic. We used Kotter’s principles as a framework to rapidly develop and implement additional LIS functionality (Table 1).[6] We implemented tools to manage specimen and data streams, and detail functionality to improve (1) the prelaboratory phase (test ordering, specimen packaging, and shipping), (2) the preanalytical phase (specimen registration, tracking, and test prioritization [triaging]), and (3) the postanalytical phase (automated reporting and facilitating data-driven policymaking). We also briefly discuss unexpected opportunities in which the COVID-19 crisis accelerated the adoption of practices that promote the meaningful use of LIS systems.
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References
- ↑ 1.0 1.1 Hellewell, J.; Abbott, S.; Gimma, A. et al. (2020). "Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts". Lancet Global Health 8 (4): e488-e496. doi:10.1016/S2214-109X(20)30074-7. PMC PMC7097845. PMID 32119825. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097845.
- ↑ Guan, W.-J.; Ni, Z.-Y.; Hu, Y. et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". New England Journal of Medicine 382 (18): 1708–20. doi:10.1056/NEJMoa2002032. PMC PMC7092819. PMID 32109013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092819.
- ↑ 3.0 3.1 3.2 Lippi, G.; Plebani, M. (2020). "The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks". Clinical Chemistry and Laboratory Medicine 58 (7): 1063–69. doi:10.1515/cclm-2020-0240. PMID 32191623.
- ↑ Posteraro, B.; Marchetti, S.; Roman, L. et al. (2020). "Clinical microbiology laboratory adaptation to COVID-19 emergency: Experience at a large teaching hospital in Rome, Italy". Clinical Microbiology and Infection 26 (8): 1109-1111. doi:10.1016/j.cmi.2020.04.016. PMC 32330569. PMID 32330569. https://www.ncbi.nlm.nih.gov/pmc/articles/32330569.
- ↑ Reeves, J.J.; Hollandsworth, H.M.; Torriani, F.J. et al. (2020). "Rapid response to COVID-19: Health informatics support for outbreak management in an academic health system". Journal of the American Medical Informatics Association 27 (6): 853-859. doi:10.1093/jamia/ocaa037. PMC PMC7184393. PMID 32208481. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184393.
- ↑ 6.0 6.1 Kotter, J.P. (May–June 1995). "Leading Change: Why Transformation Efforts Fail". Harvard Business Review. https://hbr.org/1995/05/leading-change-why-transformation-efforts-fail-2. Retrieved 22 April 2020.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added.