Can you imagine any healthcare professional practicing quality care today without the use of informatics? Medical informatics, as defined by the American Medical Informatics Association (AMIA) is, ‘the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.’[1] AMIA has delineated core medical informatics competencies for use in the education and assessment of those practicing in the discipline. The AMIA competencies apply generally across all health informatics professions, while the Association of Public Health Laboratories (APHL) competencies include laboratory specific competencies[2]. Although some laboratory professionals in roles, such as a LIS Analyst, may utilize the AMIA competencies below frequently in their daily practice, other laboratorians may use the competencies less frequently in their practice.
- Fundamental scientific skills in the areas of problem analysis, solution production, articulation of the rationale, innovation, collaborative work; education, dissemination and discussion; and professional perspective acquisition.
- Scope and breadth of the discipline, including fundamental knowledge about biomedical data and information; prerequisite knowledge and skills in biology, health, population health and research problems; and procedural knowledge and skills for problem solving, analysis, and clinical decision-making using informatics-based methods.
- Theory and methodology such as theory application; understanding the types of medical data; application of frameworks used in informatics; knowledge representation; and use of methods and processes for different informatics contexts.
- Technological approaches in procedural knowledge and skills; fundamental knowledge; and prerequisite knowledge and skills.
- Human and social context principles like prerequisite knowledge of social, cognitive, decision science; Fundamental knowledge in human centered design, study design, human factors engineering, informed consent and HIPAA, research and biotechnology, public health and instrumentation; along with procedural knowledge in understanding challenges and limitations of technologies; assessment of informatics problems across organization, people, and societal systems across the biomedical spectrum.
Laboratory informatics, one of the specialty areas of medical informatics, is at the heart of the laboratory’s role to improve patient care by generating and communicating quality information to the healthcare team. The Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) developed core informatics competencies which are applicable to all clinical laboratory professionals[3]. Informatics competencies are listed for each subcompetency at the beginner, competent, proficient, and expert practicing professional levels. Laboratory professionals are trained to be error-free in producing clinically actionable results, as laboratory medicine is a quality-based process. Therefore, laboratory professionals demonstrate many AMIA and most APHL competencies.
Laboratory professionals understand the impacts of pre-analytical testing variables, analytical testing and post-analytical reporting, including how informatics tools such as the laboratory information system (LIS) can highlight process issues throughout the testing phases and how information technology can improve workflow efficiencies. Laboratory and informatics fundamental competencies include understanding how information is generated about the patient via laboratory analysis and identification of both quality data and data with quality issues.
In particular, laboratory reports generated from the analysis of patient specimens communicate results, often with reference ranges and interpretations, in guiding the healthcare team in providing personalized and precision medicine for each patient. Information generated by the laboratory team is increasingly accessible to patients through patient portals and more recently via mobile device applications or “apps.” It will be more important than ever for electronic laboratory reports to be clear and understandable to avoid interpretation errors as they are communicated in more formats to more consumers.
In addition, laboratory informatics needs to be included in medical laboratory science curricula so students can become competent in laboratory informatics basics and recognize its application in their daily laboratory practice as they grow in their informatics proficiency. New and current employees often train on LIS and automation systems when implemented, but daily practice needs may dictate additional competencies such as identification of errors in patient data, or issues within the information systems. As informatics proficiencies increase, laboratorians may grow into roles such as LIS Analysts which perform expert level competencies. Such expertise may include LOINC and SNOMED CT mapping, setting up HL7 interfaces, building new tests or updating existing test menu items, and developing reports on over- and under-utilization of test orders.
Middleware, diagnostics, automation, and LIS vendors have expanded product offerings with capabilities and features such as autoverification, delta checks, and rules to assist laboratory professionals in their daily practice. Laboratory informatics is a tool which enables laboratory professionals to achieve four key goals:
- Reduce errors. Informatics rules, such as delta checks, alert of significant differences between current and previous patient results. Such alerts may be an indicator of patient identification errors or specimen contamination. Laboratory professionals regularly use quality control decision making tools such as Levy Jennings Charts or proficiency testing to ensure testing systems are in control.
- Manage knowledge and information. Automated inventory control systems provide just in time ordering to aid laboratories in managing their operational supply needs. Rules can also aid in canceling duplicate orders, prevent unnecessary test ordering (such as overutilization of testing), manage reflex orders, or otherwise guide providers to use appropriate clinical guidelines, which may reduce underutilization of testing. Reports for administrative and regulatory tasks, turn-around times, test utilization reports, optimization of resources, and metrics communicating the value of laboratory data to others all help with knowledge and test management.
More and more, laboratory professionals are interacting with their information technology teams for building new tests, transitioning to a new LIS, building reports for monitoring quality metrics within the laboratory such as costs or volumes for reference lab testing or inventory tracking, as well as building reports for assessing quality metrics outside the laboratory such as blood product utilization rates, or test ordering patterns by physician. Smaller laboratory settings may require laboratory professionals to create their own reports or use external vendor informatics tools.
- Make Decisions. Laboratory data have been reported to be involved in over 70% of clinical decision making. Laboratory results are peppered throughout clinical quality measures (CQMs) reported by hospitals and physicians as indicators of quality patient care. Computer generated reminders ensure providers follow clinical practice guidelines with test ordering such as Hepatitis C Virus (HCV) testing in baby boomers, and Hepatitis B Surface Antigen (HBSAg) testing as part of prenatal testing.
- Communicate more effectively. Informatics tools such as autovalidation, standardized report comments, interpretive report comments, and timely reminders for patient testing needed to comply with clinical best practices are ways informatics aids in better communication of laboratory data. Opportunities for lab professionals to communicate test results with patients directly is expected to increase as patients manage more of their health. Patient education resources about the different types of testing and results are being incorporated into patient portals with their results.
The value of laboratory data will be a significant factor as healthcare is transitioning from a fee for service market to a value-based care market with accountable care organizations (ACO). Informatics will be a critical enabler of generating even more value from laboratory data for internal laboratory process improvements, as well as across the care continuum to enhance access to the right information at the right time and in the right format for all health professionals and patients.
In the 2003 National Academies Press report entitled “Health Professions Education – A Bridge to Quality”[4], the committee recognized the importance of utilizing informatics by including it as a core competency that all clinicians should possess, regardless of their discipline, to meet the needs of the 21st-century health system. Utilizing laboratory informatics is vital in the laboratory’s role of providing and communicating laboratory information for the delivery of quality, safe patient care. Informatics’ pervasiveness across health exemplifies the need for laboratory profession to become competent, proficient and expert in the informatics to propel health into the 21st century.
[1] Casimir A Kulikowski, Edward H Shortliffe, Leanne M Currie, Peter L Elkin, Lawrence E Hunter, Todd R Johnson, Ira J Kalet, Leslie A Lenert, Mark A Musen, Judy G Ozbolt, Jack W Smith, Peter Z Tarczy-Hornoch, Jeffrey J Williamson; AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline, Journal of the American Medical Informatics Association, Volume 19, Issue 6, 1 November 2012, Pages 931–938, https://doi.org/10.1136/amiajnl-2012-001053
[2] Ned-Sykes, Renee & Johnson, Catherine & C Ridderhof, John & Perlman, Eva & Pollock, Anne & Deboy, John. (2015). Competency Guidelines for Public Health Laboratory Professionals: CDC and the Association of Public Health Laboratories. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002). 64. 1-81. https://www.cdc.gov/mmwr/pdf/other/su6401.pdf
[3] Ned-Sykes, Renee & Johnson, Catherine & C Ridderhof, John & Perlman, Eva & Pollock, Anne & Deboy, John. (2015). Competency Guidelines for Public Health Laboratory Professionals: CDC and the Association of Public Health Laboratories. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002). 64. 1-81. https://www.cdc.gov/mmwr/pdf/other/su6401.pdf
[4] INSTITUTE OF MEDICINE (U.S.). (2003). Health Professions Education: A Bridge to Quality. Washington, D.C., National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK221528/