Standard Guide for Selection of a Clinical Laboratory Information Management System

SCOPE
1.1 This guide covers the selection, purchase, use, enhancement, and updating of computer technology supplied by a vendor as a complete system in the clinical laboratory. The purpose of the guide is to assist hospitals, clinics, and independent laboratories through the entire automation project in order to minimize the risks and maximize the benefits. It provides a process that may be used by the medical institution to carry out laboratory information projects in a rational and orderly manner. It also includes checklists of items to be considered at each stage of planning to help guard against the unpleasant consequences of oversights. It includes planning and design aids to assist in carrying out the project. In addition, there is information (see Section 18) about enhancement and updates after the system is purchased.
Note 1—The term "stat," as used in this guide is the abbreviation for the Latin word statim, which means immediately.
1.2 This guide is not concerned with digital or computer electronics used only within instrumentation. Rather, it deals with the application of information systems to a large segment of the laboratory operation, and generally is concerned with how Information and Communications Technology (ICT) can be used to enhance the interaction of the laboratory with the rest of the institution, improve workflow in the laboratory, and help keep records. Such systems will normally include segments for patient biographical information, test ordering, specimen collection, workstations worklists, test result entry, result verification, patient result reporting, management reports, archiving, and other special functions.
1.3 The major topics are found in the following sections:  SectionProject Leader and Project Team 4Project Definition 5General5.1Self-Examination 5.2Unfulfilled Goals 5.3Alternatives 5.4Selection of Option5.5Laboratory Definition 5.6Functional Requirements 6General 6.1Admission-Discharge-Transfer6.2Test Ordering 6.3Specimen Pickup6.4Allocation6.5Test Performance 6.6Reports6.7Archival Storage 6.8Vendor Survey 7Refinement of Functional Requirements8General 8.1Priorities 8.2Preliminary Vendor Contact 8.3Site Visit 8.4Approvals 9Requests for Proposals10Evaluation of Vendor Proposals 11General 11.1Evaluation of Cost 11.2Warranty 11.3Maintenance 11.4Hardware 11.5Software 11.6Backup System 11.7Interfaces 11.8Training 11.9Acceptance11.10Evaluation of Vendors 11.11Selection of Vendor 12Purchase 13Installation 14Site preparation 14.1Delivery 14.2Installation 14.3Startup 14.4Training15Acceptance 16Records and Evaluations 17General17.1Documentation of Normal Operations17.2Documentation of Maintenance17.3Evaluation of System Performance17.4Enhancements and Updating 18
1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

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Publication Date
09-Jan-2002
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NOTICE: This standard has either been superseded and replaced by a new version or discontinued.
Contact ASTM International (www.astm.org) for the latest information.
e1
Designation: E 792 – 95 An American National Standard
Standard Guide for
Selection of a Clinical Laboratory Information Management
System
This standard is issued under the fixed designation E 792; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
e NOTE—Specification E 1633 was added editorially to 2.1 and 6.2.2 upon its approval.
1. Scope
Self-Examination 5.2
Unfulfilled Goals 5.3
1.1 This guide covers the selection, purchase, use, enhance-
Alternatives 5.4
ment, and updating of computer technology supplied by a
Selection of Option 5.5
Laboratory Definition 5.6
vendor as a complete system in the clinical laboratory. The
Functional Requirements 6
purpose of the guide is to assist hospitals, clinics, and inde-
General 6.1
pendent laboratories through the entire automation project in
Admission-Discharge-Transfer 6.2
Test Ordering 6.3
order to minimize the risks and maximize the benefits. It
Specimen Pickup 6.4
provides a plan-of-attack that may be used by the medical
Allocation 6.5
institution to carry out computer automation projects in a Test Performance 6.6
Reports 6.7
rational and orderly manner. It also includes checklists of items
Archival Storage 6.8
to be considered at each stage of planning to help guard against
Vendor Survey 7
the unpleasant consequences of oversights. It includes planning Refinement of Functional Requirements 8
General 8.1
and design aids to assist in carrying out the project. In addition,
Priorities 8.2
there is information (see Section 18) about enhancement and
Preliminary Vendor Contact 8.3
updates after the system is purchased. Site Visit 8.4
Approvals 9
NOTE 1—The term “stat,” as used in this guide is the abbreviation for
Requests for Proposals 10
Evaluation of Vendor Proposals 11
the Latin word statim, which means immediately.
General 11.1
1.2 This guide is not concerned with digital or computer
Evaluation of Cost 11.2
Warranty 11.3
electronics used only within instrumentation. Rather, it deals
Maintenance 11.4
with the application of computers to a large segment of the
Hardware 11.5
laboratory operation, and generally is concerned with how
Software 11.6
Backup System 11.7
computer technology can be used to enhance the interaction of
Interfaces 11.8
the laboratory with the rest of the institution, improve work-
Training 11.9
flow in the laboratory, and help keep records. Such systems
Acceptance 11.10
Evaluation of Vendors 11.11
will normally include segments for patient biographical infor-
Selection of Vendor 12
mation, test ordering, specimen collection, workstations
Purchase 13
worklists, test result entry, result verification, patient result
Installation 14
Site preparation 14.1
reporting, management reports, archiving, and other special
Delivery 14.2
functions.
Installation 14.3
1.3 The major topics are found in the following sections:
Start-up 14.4
Training 15
Section
Acceptance 16
Project Leader and Project Team 4
Records and Evaluations 17
Project Definition 5
General 17.1
General 5.1
Documentation of Normal Operations 17.2
Documentation of Maintenance 17.3
Evaluation of System Performance 17.4
Enhancements and Updating 18
This guide is under the jurisdiction of ASTM Committee E-31 on Healthcare
Informatics and is the direct responsibility of Subcommittee E31.13on Clinical 1.4 This standard does not purport to address all of the
Laboratory Systems. This guide was prepared in cooperation with the College of
safety concerns, if any, associated with its use. It is the
American Pathologists.
Current edition approved Jan. 15, 1995. Published March 1995. Originally
published as E 792 – 81. Last previous edition E 792 – 94.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
E 792
responsibility of the user of this standard to establish appro- ANS/IEEE 983-85 Software Quality Assurance Plans Guide
priate safety and health practices and determine the applica-
ANS/IEEE 1002-87 Taxonomy for Software Engineering
bility of regulatory limitations prior to use.
Standards
ANS/IEEE 1008-86 Software Unit Testing
2. Referenced Documents
ANS/IEEE 1012-86 Software Verification and Validation
2.1 ASTM Standards:
Plans
E 622 Guide for Developing Computerized Systems
ANS/IEEE 1016-87 Software Design Descriptions
E 623 Guide for Developing Functional Requirements for
ANS/IEEE 1058.1-87 Software Project Management Plans
Computerized Systems
ANS/IEEE 1063-87 Software User Documentation
E 624 Guide for Developing Implementation Designs for
ANS/IEEE 1074-8x Software Life Cycle Processes
Computerized Systems
IEEE EMBS Standards
E 625 Guide for Training Users of Computerized Systems
2.3 ISO Information Systems Engineering Standards:
E 626 Guide for Evaluating Computerized Systems
ISO 6592 Information Processing—Guidelines for the
E 627 Guide for Documenting Computerized Systems
Documentation of Computer-Based Application Systems
E 730 Guide for Developing Functional Designs for Com-
ISO 9127 Information Processing—User Documentation
puterized Systems
and Cover Information for Consumer Software Packages
E 731 Guide for Selection and Acquisition of Commercially
2 ISO 9294 Information Processing—Guidelines for the Man-
Available Computerized Systems
agement of Software Documentation
E 919 Specification for Software Documentation for a
2 2.4 Other ISO Information Systems Related Standards:
Computerized System
HL-7, Health Industry Level Interface Standards, v 2.2
E 1013 Terminology Relating to Computerized Systems
2.5 ANSI Standards:
E 1029 Guide for Documentation of Clinical Laboratory
ANS X3.88-1981 Computer Program Abstracts
Computer Systems
ANS X3.172-1990 Dictionary for Information Systems
E 1113 Guide for Project Definition for Computerized Sys-
tems ANS X3-TR-6-82 Guide for Technical Documentation of
E 1238 Specification for Transferring Clinical Observations Computer Projects
Between Independent Computer Systems
ANS X3-TR-89 Documentation of Consumer Software
E 1239 Guide for Description for Reservation/ Packages
Registration—Admission, Discharge, Transfer (R-ADT)
ANS X11.1 The MUMPS Programming Language
Systems for Automated Patient Care Information Systems
2.6 Federal and DoD Standards:
E 1246 Practice for Reporting Reliability of Clinical Labo-
FIPSPUB 38-76 Documentation of Computer Programs and
ratory Computer Systems
Automated Data Systems
E 1381 Specification for Low-Level Protocol to Transfer
FIPSPUB 120-87 The MUMPS Programming Language
Messages Between Clinical Laboratory Instruments and
FIPSPUB 64-79 Documentation of Computer Programs
Computer Systems
and Automated Data Systems for the Initiation Phase
E 1384 Guide for Description for Content and Structure of
DoD Stand 7935 Documentation of Computer Programs
an Automated Primary Record of Care
and Automated Data Systems
E 1394 Specification for Transferring Information Between
DoD Std 2167A Defense System Software Development
Clinical Instruments and Computer Systems
DoD Std 2168 Software Quality Assurance Requirements
E 1466 Specification for the Use of Bar Codes on Specimen
2.7 NIST Standard:
Tubes in the Clinical Laboratory
NBS Handbook 118 The MUMPS Programming Language
E 1633 Specification for Coded Values Used in the
Computed-Based Patient Record
3. Significance and Use
2.2 IEEE Standards:
3.1 The decision to computerize a clinical laboratory is an
2.2.1 IEEE Computer Society Standards:
extremely critical one, and needs to be approached with utmost
ANS/IEEE 610.2-87 Computer Application Terminology
care. There are numerous examples where such attempts have
ANS/IEEE 610.12 Glossary of Software Engineering Ter-
met with financial and operational failure, as well as many
minology
successful projects that have improved laboratory and hospital
ANS/IEEE 730-84 Software Quality Assurance Plans
operation. A key factor in most of the failures is poor planning
ANS/IEEE 828-83 Software Configuration Management
or bad administrative design decisions at some point in the
Plans
ANS/IEEE 829-83 Software Test Documentation
ANS/IEEE 830-84 Software Requirements Specification
Available from American National Standards Institute, 11 W. 42nd St., 13th
Floor, New York, NY 10036.
Available from Health Level Seven, 900 Victors Way, Suite 122, Ann Arbor, MI
Annual Book of ASTM Standards, Vol 14.01. 48108.
3 7
Discontinued. See 1994 Annual Book of ASTM Standards, Vol 14.01. Available from Standardization Documents Order Desk, Bldg. 4 Section D, 700
Available from The Institute of Electrical and Electronics Engineers, Inc., 345 Robbins Ave., Philadelphia, PA 19111-5094, Attn: NPODS.
E. 47th St., New York, NY 10017. Available from NIST, Gaithersburg, MD 20899.
E 792
project. There are many far-reaching manifestations of auto- 4.3 The individual should be of sufficient status within the
mation that are not always fully appreciated at the early stages institution to allow effective communication with management,
of the project when key decisions are required. physicians, and others concerned with the project. The project
3.2 This is not a purchase guide. It is a description of the leader needs the cooperation of key individuals and must be
procedures a hospital laboratory should follow to most likely capable of working effectively with them. They include the
result in a productive and viable computer system that meets administrative board, the chief executive officer, the budget
the needs of the laboratory. It contains sections that may not be officer, the head of the laboratory, the head of data processing,
appropriate in all settings, and users of this guide must decide the head of the planning office, and the main users, the head of
what is important and what is not. the medical staff and the head of nursing. Since the computer
3.3 In any such project, there is obviously a technical project usually affects a wide segment of the institution, and is
component. Appropriate hardware and software must be in- sometimes disruptive of established routines, the project leader
stalled to provide necessary communications, database storage, must have the strong support of (1) someone high in the overall
processing activities, and report printing functions. There is hospital management; and (2) the laboratory director. Without
usually also a need for a strong “human orientation” that this support, the project is likely to be unsuccessful for the
includes meaningful input protocols and easily understood simple reason that necessary cooperation from the various
output displays. Besides the system’s technical considerations, segments of the hospital will not be forthcoming.
there is an organizational component to be examined. Those
4.4 If a person is recruited from outside the institution, it
changes that will be necessary in the traditional procedures
should be on a permanent and not temporary basis. The
within the laboratory or the rest of the institution should be
position in the organization and responsibility to the institution
considered during the planning of the project.
should be clearly established. If an existing member of the
3.4 The importance of getting input into the planning from
institution’s staff is selected, adequate allowance for the time
all concerned parties is stressed in this guide. These include the
demands of the project must be made. In either case, the project
institution administrators, laboratory management, laboratory
leader should report to an individual supportive of the project
staff, physicians, nurses, other laboratory customers, and com-
and high enough in the power structure to ensure cooperation
puter system vendors. Also stressed is the importance of
and support from impacted hospital units. A chain of command
thorough program review, consideration of alternatives, and
with an excessive number of links between the project leader
careful definition of expectations before a decision to utilize
and the higher management levels is unsatisfactory.
computer technology is made. Computer systems should be
4.5 The project leader should have sufficient authority to
installed in response to an operational need, not for other
call meetings, make operational and procedural decisions
reasons like institutional prestige or the necessity to use up
concerning the project, and commit planning funds.
available funds. Finally, this guide will prescribe very thorough
4.6 If the individual chosen is not well-versed in computers,
planning and documentation of criteria prior to commitment to
he or she must acquire some of that knowledge. It is important
a particular system. All too often, the decision to use the
that the project leader, while not necessarily an expert in all the
product of a particular vendor is made before the requirements
areas of specialization needed for the project, be able to
of the project are fully understood.
communicate with individuals in both the computer technology
field and the medical field.
4. Project Leader and Project Team
4.7 It is also important that a proper team be selected to
4.1 The project leader should be chosen early in the project
carry out the automation project. This team should be config-
with care since success of the project depends in large part on
ured to give representation to all concerned parties. These
this individual. It is best if the project leader is based in the
include the users of the laboratory services (test requestors,
laboratory as opposed to other hospital units. The leader must
readers of reports, etc); the laboratory personnel that perform
be well-motivated and respected by the hospital staff. This
the services; the hospital admission-discharge-transfer (ADT)
usually means the individual should be a member of the senior
and billing personnel; the hospital computer center, and the
medical staff of the clinical laboratory, or at least someone with
hospital management. The project leader may elect to include
good rapport with that staff. If not a physician, the individual
assistance from individuals with specific proven expertise from
must have sufficient knowledge of medicine and hospital
the institution.
procedure to converse with the medical staff.
4.8 It is possible for a project team to become so large and
4.2 A good candidate for the project leader is the director of
unwieldly that little can be accomplished. A core team may be
clinical laboratories, provided the individual has sufficient
selected to carry out most of the work turning to the entire body
knowledge of computers a
...

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