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GlimsLaboratory Information System

GlimsGeneral Laboratory

Information Management System

S.A. MIPS N.V.Industriepark Zwijnaarde 3A9052 GentBelgium

MIPS France S.a.r.l.15, Place de la Nation75011 ParisFrance

MIPS GmbHBorsigstrae 2221465 Reinbek bei HamburgDeutschland

Http://www.mips.be

MIPS IbericaCalle Orense 34, 8a Planta28020 MadridEspaa

MIPSExperts in Healthcare IT


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Automating your laboratory is an impor-

tant factor for success in todays com-

petitive world. GLIMS takes advantage

of and inherits many years of experience

from MIPSYS. In the competitive market

of Laboratory Information Systems,

GLIMS offers you even more - its graphi-

cal user interface, sample tracking, GLP

compliance and relational databases, to

name but a few of its advantages.

From the start, MIPS' policy has been to

develop its products in close cooperation

with key people in the clinical pathology

business. Advice from experts in hospi-

tal and ambulatory environments, and

also in academic centers has resulted in

a very user-friendly product, offering sig-

nificant improvements in operational

management and reduction in staff

costs.

The latest technologies are used, includ-

ing:

A relational Database Management

System, open to external query via

ODBC

An Object-Oriented development ap-

proach

Client/Server & Multitier application

partitioning

Internet / Intranet communication

Multiple user interfaces (Teletype,

Graphical, World Wide Web)

The product's flexibility is truly excep-

tional, allowing the user to completely

define the layout and content of screens

and reports. It also incorporates a labo-

ratory oriented expert system to imple-

ment diagnostic support rules or reflex

testing. In multilingual sites or distrib-

uted networks, each user can log into

the system in his/her own language and

consult the tailor-made generated re-

ports.

Direct access to all functions is imple-

mented by means of a user-specific tool-

bar. Users have multiple search possi-

bilities to obtain results for a patient, or

for a prescribing physician, for in-

stance Analyzers are bi-directionallyconnected, allowing centralized control

Introduction and highlights


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and cost savings. Dedicated technical

modules are available for all special labo-

ratory departments, including microbiol-

ogy, transfusion management, pathol-

ogy. Billing and accounting modules

are kept up-to-date with fast-changing

legislation.

GLIMS has a unified communication

model for external applications improv-

ing robustness and increasing GLIMS'

flexibility for integration into a larger in-

formation Network. Support is provided

for quality assurance functions (ISO/

GLP).

Users identify themselves when logging

in. They must provide a log-in name and

a password. GLIMS hides the menu op-

tions to access those functions prohib-

ited to any user.

GLIMS plays a vital role in implementing

Good Laboratory Practice and is a key

tool for your laboratory in achieving itsgoals on quality. An internal audit trail

imposes extra demands on software de-

velopments. GLIMS also has Standard

Operation Procedures (SOP) to ensure

the validity and traceability of data on

the internal, routine and daily operation

laboratory procedures. Thus it is possi-

ble at any time to show, monitor and

record the various procedures to which

data or laboratory activities have been

subjected from start to finish (of the

work).

GLIMS also performs audits. For exam-

ple, all result modifications and status

changes are automatically logged. The

report of any individual result is also

logged. All billing operations are logged

and traceable.

Procedures

GLIMS offers a unified model for the de-

scription of all technical laboratory ac-

tivities, including sampling, preprocess-

ing, observation and derivation. The

model allows combining basic activity

descriptors into an elegant representa-

tion of complex procedures.

Introduction and highlights


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The figure above is an example of an

action diagram, leading to an assess-

ment of Low Density Lipoproteins in a

clinical laboratory.

GLIMS is highly flexible because it can

looselyconnect administrative, technical

and financial configurations. Properties

are attributes of the analyses requested.

They can be assessed through one or

several alternative methods or proce-

dures. System commands available in-

clude the selection of specific tests, pan-

els of tests, specific samples of method-

ologies which can either be explicitly re-

quested at order entry, or automatically

using reflex test triggers.

Order entry

Linking orders to patients is effected ei-

ther with or without communication to

hospital information systems. When a

patient identification code is entered,

GLIMS queries all connected systems,

which support the code format. Patient

data input is stored locally to ensureavailability in the event of a HIS commu-

nication problem.

Tests and specimen are requested either

individually or in profiles/panels. GLIMS

uses aliases, or abbreviations, to define

the current set of tests performed in the

laboratory. Sample lists can be re-

quested to obtain a summary of the

available tests and profiles. Different

configurable screen-windowed order

forms can be displayed graphically on

screen to visually guide the order entry

process. Duplicate requests are auto-

matically detected.

Using its configuration data, GLIMS de-

cides which procedures to use and what

information or specimens are still re-

quired to fulfill an order. They are re-

quested (and, optionally, logged in)

automatically.

GLIMS is able to detect a possible reuse

Order entry


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of a specimen or a result, which may

have been delivered earlier for the same

patient. If applicable, you can decide

whether or not to reuse the previous re-

sult or specimen, by creating a link with

the new order.

If GLIMS determines that some or all of

the required specimen for the requested

tests are missing, the specimen records

are kept in a special mode to ensure

scheduling of specimen collection. Sub-

sequently, sample collection lists can be

generated to be taken along during sam-

ple collection.

GLIMS will provide printed labels, con-

taining information about the specimen,

the patient and the tests to be per-

formed, as configured by the database

manager. Specimen numbers are as-

signed using a site-configurable format.

GLIMS enables definition of sample pre-

processing (centrifugation, aliquoting,

etc.). Consequently, work lists can sum-

marize preprocessing work as well as

sampling or test requests. Chained ac-

tions will automatically be synchronized

to wait until all requisites, including ali-

quots or preprocessed materials, are

available.

Work lists

Work lists can be used for manual result

entry or for review of instrument data.

Special attention was given to offer

maximum flexibility and to consider the

user's wishes.

Samples are sequenced, with sorting

controlled by work list specific criteria

such as urgency or test priority. This

sequencing may also be driven by a

dedicated tray layout, determining the

relative positions of quality control sam-

ples among patient samples.

The work list can include user-selected

demographics or test results from the

GLIMS database. Results requiring spe-

cial attention are highlighted. Different

types can be predefined as templates, to

determine layout, selection and sort cri-

teria, as well as the relative position of

quality control samples among patient

samples. Pop-up menus provide easy

Result acquisition


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access to information related to the fo-

cused result.

Work list forms are organized in rows

and columns, corresponding to orders

and tests, respectively. Their appearance

on screen matches the printed sheet for

easy result entry by lab technicians.

The succession of print-outs and sorting

is also parameterized (by department,

priorities, emergencies, etc.). There is

full control over successive versions,

sorting etc.

The number of work lists is virtually

unlimited.

Successive work list versions are stored

on disk.

Instrument interfacing

GLIMS supports direct communication

with any instrument (supporting host

query if applicable), over either a serial

or a TCP/IP connection.

Among the many benefits are multiple

instrument monitoring from any general-

purpose workstation, standardized pro-

cedures for quality control and direct ac-

cess to historical patient data for valida-

tion purposes.

Communication via dedicated high prior-

ity processes, capable of stand-alone

operation in the event of server downing

is also supported.

Manual result entry

In the absence of an instrument link, re-sults can be typed in a spreadsheet-like

grid interface, with rows corresponding

to specimen and columns corresponding

to properties. The grid size is unlimited,

as it can scroll both horizontally and ver-

tically. The size of the result itself is also

unlimited, as the grid cells can also be

Result acquisition


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scrolled (the result may be numerical or

free text of unlimited length). From the

result context in the grid cells, any result

method can be activated.

Numerical results can be entered in dif-

ferent units; GLIMS automatically con-

verts to the applicable base unit prior to

performing any checks. Exponential no-

tation is accepted, as are comparatives

(less or greater than).

Quality control

One of the prime objectives of laborato-

ries is to ensure that laboratory quality-

control practices are adequate to achieve

satisfactory analytical quality.

GLIMS provides internal and external

quality control. Internal quality control

(IQC) checks whether test results on

quality control materials are reproduci-

ble.

External quality control (which may be

enforced by law) checks whether differ-

ent laboratories produce comparable re-

sults on the same material. In this case,

the control samples may not even be

recognizable as such. IQC is based on

the regular scheduling of analyses on

quality control specimens. This schedul-

ing can be defined by the LIMS, but this

is not mandatory.

Beside simple accuracy control and

trend checking, GLIMS supports the QC

algorithms of Westgard and Trigg. Qual-

ity control specimen can be scheduled

automatically at predefined positions

among routine specimen. Alternatively,

unsolicited QC results sent by any con-

nected instrument are also processed. In

any case, quality control results must be

stored to perform the quality control

function. The usual norm validation may

Quality control


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have to be disabledfor IQC samples.

Violation of quality control checks puts

the associated result output channel in

Unreliable status, until it is manually

reset. Patient results obtained from an

unreliable channel are marked as such.

Result validation

Method-specific normal range checks

according to sex, age, menstrual cycle

and MISPL (see further) rules are avail-

able. If so configured at the test level,

each result may have to pass a series of

automated checks: for format, accuracy

and precision, channel trend, range, and

shift (delta checks).

All check definitions allow to specify

how the result must be treated if an

alarm is signaled. Severity levels can be

assigned, comments can be associated

and MISPL trigger code can be launched

to add comments or schedule reflex test-

ing. GLIMS also supports two explicit

validation levels: technical and biologi-

cal. Configuration allows specification of

the result severity level, below which the

respective validation procedures are per-

formed automatically.

Reporting

GLIMS features cumulative reports with

configurable content, layout and condi-

tions for output. Different test types

shown on the reports can be organized

hierarchically. Report models can be set

up for each individual correspondent or

group of correspondents, if required. Re-

ports support variable formats: plain

text, HTML, MS Word reports, HL7,

HPRIM, LDT, Medidoc, HealthOne, Edi-

fact, Medar messages, etc.

At order entry, reports are automatically

scheduled according to the issuers pref-

erences. As results become available,

scheduled reports are automatically

marked for output by dedicated back-

ground tasks.

Because of direct contact with the phy-

sician prescribing the test, report gen-

eration is a particularly important part of

GLIMS. The report generator makes it

possible to build up personalized reports

for each physician. Each physician may

Result validation


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obtain reports in the preferred layout, in

his/her own language, with one or more

recapitulative result columns, and with

results expressed in units to which he /

she is accustomed. These and other

physician preferences are stored in the

physician database.

Report retrieval is driven by user search

specifications. Search keys are order

number, an external reference number,

patient name or physician name. For in-

dividual tests, GLIMS keeps track of a

result's availability and reporting status.

This feature can be used to prevent the

report generator from redundant report-

ing. (i.e. by not printing out a report if

all test results are not available).

MISPL

The MIPS Site Programming Language

is an easy to use, object-oriented pro-

gramming language available to end-

users. Site personnel maintain programs

written in MISPL. It is a single configura-

tion language for use throughout the

application.

At application startup time, MISPL reads

the complete scheme information and

hence is able to compile and run site-

specific programs. Many built-in func-

tions are available.

Applications include filtering, statistics,

calculations, diagnostic support rules,

Reporting


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reporting, test method selection, label

definition, result derivation

The MISPL builder is a user-friendly tool

which allows browsing through the

GLIMS database and offers all available

information and functions. While wan-

dering through the database structure,

the corresponding documentation is up-

dated on the fly in a help window.

Microbiology

One of the main differences here lies in

the fact that frequently the lab is pro-

vided with a material and a question

'See what you can find'.

Since the procedures to be carried out

and the results to be stored are not

known beforehand, the Microbiology LIS

subsystem should be very flexible in its

data model and user interface.

It should be able to suggest procedures

to be undertaken through evaluating the

current specimen data, but should allow

storage of any related or intermediate

result entered by the analyst. All relevant

data should be stored in a way that per-

mits fast and easy retrieval of result for

daily result operation, previous patient

results, statistical and epidemiological

reports,

A table of antibiotics is present, contain-

ing mnemonic, name, reporting order (if

any), medical comments and result type

(RRRResistant, IIIIntermediate, SSSSensible or free

text). Antibiotic thresholds assist in the

calculation of the RIS code starting from

a diameter.

Antibiotic panels group antibiotics to be

tested by default, given a certain combi-

nation of organism group and sample

material.

Results of macroscopic evaluation, mi-

croscopic evaluation, presence of red or

white blood cells, etc. are entered as op-

tional results and treated as output of

the initial. This output can, and probably

will, automatically trigger further test

requests. At any time, the analyst can

decide to add extra tests or results to

the specimen being studied.

MISPL expressions allow fine-tuning for

selection criteria such as patient age,

patient location, test requestor, etc. At

Microbiology


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run time, the analyst can decide to sup-

press or add antibiotics for a specific

specimen. Intermediary reports can be

sent to inform the test requester of the

current status. Such intermediary results

may be "Negative after ... days' incuba-

tion", "Suspicion of...", etc. The data

model also offers the possibility of easy

database query for statistical or epidemi-

ological purposes.

HighlightsHighlightsHighlightsHighlights

Explicit support for all microbiology-

related data (isolation, carriers, isola-

tion tests, carrier tests, etc.)

Normalized, relational data model

Seamless integration with other

Glims modules

Multiple specimens per order

User-definable specimen information

(method, location, etc.)

Fast patient history retrieval

Dedicated result entry screens

Expert system support (e.g. for anti-

biogram filtering)

User-definable alarms and flags on

isolation, specimen and patient level

Transfusion Management

The blood transfusion management has

three constituent parts. The first part

handles the determination and storage

of blood groups, rhesus pheno types,

irregular antibody screening, typing and

the specification of antigens and anti-

bodies.

The requests for any of the above men-

tioned tests can be linked to previous

results, sex, age, previous transfusions,

etc. in order to decide whether to pro-

ceed or discontinue the request.

Based upon the data acquired, addi-

tional criteria can be specified.

to derive a valid result from sub-tests

Microbiology


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to check consistency of independ-

ently obtained results as e.g. the

blood group which can be derived

from the serum part and the erythro-

cytes part;

to check consistency of the current

result with respect to the previous

result;

to check the reusability of previous

results with respect to the blood

group, rhesus, phenotype, etc.

to effect conditional request

(avoiding unnecessary requests by

taking into account sex, age, etc.)

to store the blood group, rhesus and

screening information in a person

oriented table;

to store absence or presence of anti-

gens and antibodies like duffy, lewis,

etc.

The second part is the management of

the blood bag database, which allows

obtaining an overview of the current

blood bag supply with respect to the

different manipulations to which the

blood bags are submitted during the

transfusion process. These manipula-

tions include:

data entry for new blood bags is per-

formed manually or via barcodes.

This allows storing data on proper-

ties like blood group, rhesus and

pheno types, antigens for blood

types or even the authology and the

corresponding person if specified.

There is provision for self-transfusion

product data storage.

queries for an up-to-date overview of

stored blood bags or of (urgent)

blood product requests;

marking blood bags as discontinued

or expired, so that these blood bags

will no longer be used in further

transfusions;

blood requests can be marked as dis-

continued to indicate that those par-

ticular requests need to be cancelled;

generation of order advice lists at

any time to obtain an up-to-date

overview of the total number of

transfusion-ready blood bags;

Finally, the third part offers a complete

trace on blood bags during transfusion.

The transfusion trace includes the re-

questof blood products, the selectionof

Transfusion management


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blood bags based on a predefined com-

patibility system, the physical or elec-

tronic (Type and Screen) compatibility

check, the checkout of blood bags, gen-

eration of a transfusion form and the

completion of a blood bag trace by the

transfusion data and a possible transfu-

sion reaction. In some exceptional cases,during the life cycle of the blood bag, it

may be returned to stock, or discarded

because of accident or expiry.

These situations are also supported in

GLIMS. Finally, this module allows re-

porting with respect to the transfused

blood bags.

Anatomic pathology

The anatomic pathology module is fully

integrated in GLIMS and supports the

processing of material examinations.

The module is suited for biopsy, cytol-

ogy as well as autopsy.

Most of the results in a material exami-

nation are textual descriptions, but can

be more structured as well. E.g. for the

conclusion, a simple text might do,

whereas the body contains more specific

and varied text results. All these results

are gathered in the material examination

on which the pathologist is working. For

each material exam GLIMS offers a com-

pact overview of its results, the possibil-

ity to manipulate the examination until a

finished state and to produce reports for

it.

The anatomic pathology module also

supports image results which can con-

tain both microscopic and macroscopic

images. With the appropriate editing

software installed, these images can be

edited and stored from the GLIMS appli-

cation. Thanks to the MS Word report-

ing functionality in GLIMS, the anatomic

pathology module also allows to include

both macroscopic and microscopic im-

ages on reports. These reports can also

contain very long texts as for example

an autopsy report.

The anatomic pathology module also

offers support for different coding stan-

dards, like SNOMED, ADICAP, ICD-9/10

etc. The seamless integration of this

module in GLIMS provides access to all

related chemical and microbiological in-

formation.

Anatomic pathology


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The anatomic pathology module of

GLIMS is highly flexible thanks to its

possibility to configure personalized

schemes for material examinations and

the possibility to configure reusable

texts and information blocks. In the

mean time, you have an overview of

each material examination, you can eas-

ily fill in the results and you can follow

up the evolution of the material exami-nation. This module will give you both a

detailed and compact solution for anat-

omic pathology.

Billing

GLIMS provides an extensive billing

module. Since GLIMS is an international

product, it needs to cope with the billing

peculiarities in all supported environ-

ments.

Clinical lab billing is usually highly regu-

lated and consequently country depend-

ant. Local legislation specifies billing

rules, price levels, documents to be pro-

duced, etc. Private clinical labs typically

have to deal with invoicing for patients,

physicians and insurance companies,

while hospital labs usually send billing

information to the hospital information

system which performs the actual in-

voicing. Industrial or commercial labs

should be able to create invoices for is-

suers, object suppliers, veterinarians,

animal owners, etc. In these cases spe-

cific negotiated price lists are used in-

stead of official price lists. Billing might

also be different for orders where a labo-

ratory is operating as a sub-contractor.

In Germany, Laborgemeinschaften per-

form routine tests for physicians: these

tests are billed directly to the physician.

In France, pharmacies interfere in thebilling process. The VAT regime is also

country and environment depending.

From the outset, the GLIMS billing mod-

ule was designed to cope simultane-

ously with all these different require-

ments. The result is a general-purpose

billing engine that sets new standards in

flexibility. Billing involves two major

steps: tariffication and invoicing. Tariffi-

cation is the actual price and debt calcu-

lation while invoicing includes every-

thing from generating electronic and pa-

per invoices to payment follow-up.

Billing


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The GLIMS billing engine supports the

tariffication for all the various lab ser-

vices (both sampling and testing; as

well as microbiology and blood transfu-

sion activities). It can be configured for

both individual or grouped billing.

Payment agreements, policies and price

lists as concepts, laboratories have great

flexibility in configuring which parties

(e.g. test requester, veterinarian, health

care insurance company or specimen

supplier) are involved in the billing proc-

ess, which billing codes to use, and at

which price. Several payers can be in-

volved in a single order and customer

specific price lists can be established.

The billing engine also takes care of

multi-firm/multi-lab environments and

sub-contracting. The definition of billing

rules supports the implementation of

test combination prohibited by specific

national reimbursement schemes. VAT,

additional charges (for urgent samples

or those analyzed at night, etc.).

Calculation is the responsibility of the

billing engine. The results of the tariffica-

tion can be communicated to a hospital

information system using standard pro-

tocols like HL7.

The GLIMS invoicing sub-module cre-

ates the billing documents sent to the

different paying organizations. GLIMS

keeps track of invoices and credit notes.

Invoices are grouped in invoice summa-

ries, if required, allowing for easier in-

voicing to large accounts. The layout of

all billing documents (e.g. certificates,

invoices, invoice summaries) is totally

user-definable. GLIMS keeps track of the

documents produced. GLIMS allows in-

voices to be communicated to a separate

accounting system.

Billing


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Support for medical and industrial

laboratories

Multiple internal accounts

Individual or grouped billing of lab

services (both sampling and testing;

including microbiology and blood

transfusion activities) by means of

internal billing codes.

Payment agreements allow definition

of different payer categories (e.g. the

prescribing Doctor, Patient, Veteri-

narian, Health Care Insurance Com-

pany, Sample supplier,etc.)

Multiple payers per order

Customer specific price lists

Configurable cummulation and ex-

ception rules

VAT calculation

S u p p l e m e n t a r y c a l c u l a t i o n

(administrative procedures, emergen-

cies, ...)

Variable document layouts (e.g. Cer-

tificates, Invoices, Invoice summa-

ries)

Communication with hospital infor-

mation and external accounting sys-

tems

Statistics

GLIMS comes with an extensive statis-

tics module covering production, micro-

biology, blood transfusion and finance.

All modules have a uniform look and

feel, though differ in some detailed as-

pects typical to the kind of statistics re-

quired. Guidance by the GLIMS statistics

wizard makes the collection and display

of the statistical data now easier than

ever.

The user can choose from a wide variety

of selection and classification options.

The statistical results can be consulted

Statistics


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and edited through different output

channels.

The data can be printed, directly be dis-

played on screen in different formats,

saved into a file for use with third party

applications like MS Excel, MS Access

or any web browser and even emailed to

one or more contact persons.


Fully integrated in GLIMS

Guidance by GLIMS statistics wizard

Uniform look and feel of all statistics

modules.

Extremely flexible selection and clas-

sification options

Open-ended: results can very easily

be loaded into 3rd-party software

Urgency monitor

The urgency monitor program shows a

continuously updated overview of ur-

gent orders that have not been entirely

completed. Depending on the time since

order creation, the order is shown in a

different color.

The user can choose from a wide range

of selection options for the orders as e.g.

the minimal urgency, maximal result

status, the issuer, the department In

addition, the display setting (colors, re-

fresh period) of the urgency monitor

can easily be customized.

Communication

MIPS places a very high priority in its

products ability to communicate with

many peripheral applications, including

analyzer control software, hospital infor-

mation systems (HIS), general practitio-

ners systems, insurance systems and

web browsers.

The standards supported include HL7,

HPRIM, LDT, ASTM and Edifact.

Urgency monitor


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The complete list is much longer since

we have a lot of connections based on

local or national standards and connec-

tions with legacy systems. GLIMS is

able to communicate with several hospi-

tal information systems simultaneously

to support laboratories servicing several

hospitals. Each hospital may have its

own identification system and an unlim-

ited number of patient identifiers can be

stored.

Available platforms

The flexibility of the MIPS products is

one of their main features and allows us

to deploy them on many different hard-

ware platforms. MIPS has no preferred

relationship whatsoever with any hard-

ware supplier and strives to maintain

this independence. Most of the server

systems sold run on Windows 2000 or

Unix (HP, Sun Solaris, IBM, etc). GLIMS

clients typically run on Windows NT or

Windows 2000 PC's. Host-based con-

figurations without clients are also pos-

sible, using terminal servers (MS Termi-

nal Server Client, Citrix, etc.) or the

GLIMS TTY interface.

Communication

Documents

Glims General En