EDITORIAL

Laboratory Computers- The Unfulfilled Promise

0 When computers entered the laboratory a couple of decades ago, the future looked bright indeed. The early hopes and expectations were soon tempered, following a number of spectacular failures. The industry went into a more realistic building phase, creating systems to deal with the voluminous data each laboratory produced and the logistical complexities involved in op- erating a clinical laboratory. These systems became more and more successful. Indeed, it became difficult to survive without some form of computer help. But the systems were focused more and more inward toward the needs of the laboratory. The laboratory’s raison d’etre was largely ignored as the need for process control and billing consumed everyone’s energies. There were some attempts to get the results out of the laboratory to the physicians who needed them. A few laboratories even gave some thought to designing readable cu- mulative summaries. Most clinicians took what they were given, thinking that this was the best the laboratory could do. But almost no one, least of all the software vendors and certainly not the hardware peddlers, asked the simple questions, “What information do the clinicians need? How can we best pro- vide it?” One suspects a few laboratories attempted to address these ques- tions, only to be beaten into submission by the vendors or to be told that it is ( 6 too expensive.”

Witness the outcome: Laboratory reports that are unreadable, filled with irrelevant data or meaningless abbreviations. On-line systems that are so primitive as to be embarrassing. Physicians frustrated that they still cannot easily find, read, or interpret the data. It may not be hyperbolic to suggest that the situation is appalling, especially since there are simple, widely avail- able database systems that can manipulate information on inexpensive PC ’ s for $500, while laboratories spend $500,000 and up and are still unable to get the appropriate report in an acceptable format to the right physician at the time it is needed. The result is that the reporting function of many laboratory systems is anachronistic. When will laboratories, pathologists, and computer vendors begin to understand that their role is to present patient data to physi- cians in the most convenient way foi them to integrate and interpret it?

Our laboratory recently selected a new computer system widely recog- nized as one of the Cadillacs of the industry, if not a Maserati. The laboratory technologists love it, and the billing department thinks it’s the best thing since

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61 2 PEDIATRIC PATHOLOGY: EDITORIAL

sliced bread. It is only the clinicians and pathologists who find it barely marginal-a mere cut above the old handwritten single type report. There are a few dozen options on how tests can be billed, but a scant two on how a test result may be reported. And we are to blame. We have not demanded more. We have devalued the value of the laboratory result. There have been a few faint voices raised in protest, attempting to point out what should and could be done (Ref. 1).

It is time for us to spend as much effort in presenting our data as we do in producing it or charging for it.

REFERENCE

Kciynroncl S. F'hvsician-orientrtl data processing. JAMA 1975;234:83-85

Denis R. Benjamin Seattle

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