UNIVERSITI TEKNOLOGI MARA

A Review of Laboratory
Information Management
System (LIMS)
SYS704 : Term Paper

PREPARED BY:
MIMI NURAKMAL BINTI MUSTAPA
2013425632

LECTURER:
DR. EMMA NURAIHAN MIOR IBRAHIM

Contents
Abstract............................................................................................................................................1
1.

Introduction..............................................................................................................................1

2.

Research Background...............................................................................................................4

3.

Problems Background..............................................................................................................6

4.

Research Implications..............................................................................................................8

5.

Recommendations..................................................................................................................10

6.

Conclusion..............................................................................................................................12

Reference.......................................................................................................................................13

Abstract

Given the dynamic nature of their operations, todays public health laboratories need to be
nimble and agile. They need to cope with everchanging requirements brought about by changing
technology, increased government regulation, growing competition, expanding public health
reporting responsibilities, and greater expectations from both medical professional and the
clients. The traditional way of simply test and producing report were no longer give so much
impact in providing a better healthcare to the public. As much as the technology is growing,
diseases are also spreading rapidly and new mutate diseases can emerge in any day now. With
these reasons, public health laboratories must be able to receive a lot of test orders and manage
all the orders efficiently. From here, an extensive amount of data will be collected and without
proper information system, the data could be left unattended and underutilized whereas this data
could be analyzed further to provide useful disease reports to the physicians. Despite having a
sophisticated analyzer machine system that could only produce test result, laboratories
information system offers more laboratories management capability. An increasing awareness
among society of public health issues especially on communicable diseases give stronger reason
for an effective laboratory information system to be implemented in public health laboratories.
An interoperability ability in laboratory information system to channel reports via various
channels could help the stakeholders get the information in the first hand. This can cater the
reporting burden that government holds to disseminate harmful diseases information to public
through reliable infrastructures thus helps to provide better healthcare.

1. Introduction

Delivering the highest-quality care in a timely and efficient manner has always been paramount
for Ministry of Health of Malaysia. Not surprisingly, the premier healthcare provider has
leveraged the use of information technology (IT) for years with the implementation of Hospital
Information System (HIS) at several general hospitals. Depending on the size of the hospital,
there are three types of HIS been deployed and they are categorizing as Basic Hospital
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Information System (BHIS), Intermediate Hospital Information System (IHIS) and Total
Hospital Information System (THIS). The implementation of HIS in general hospital depicted the
on-going commitments by the Malaysia government in transforming the nation into a knowledge
based society driven by the new economy through ICT as well as realizing one of the Seven
Flagship Application under the Multimedia Super Corridor (MSC) initiatives (Hassan 2012).
To keep in pace with the MSC initiatives, National Public Health Laboratory (NPHL) of
Malaysia intends to transform their services through Information and Communication
Technology (ICT). With the mission to provide latest analytical and diagnostic services, cost
effective, timely and friendly, a reliable Laboratory Management Information System (LIMS)
can drive the success factor. Currently, beside NPHL, there are 4 others Public Health
Laboratories (PHL) which resides in Ipoh, Johor Bahru, Kota Bahru and Kota Kinabalu. These
PHL are interconnected to NPHL as the main reference laboratories.
Although each general hospital has its own laboratory or called Pathology Department, their test
environment and objective is slightly different from NPHL. Pathology Department produces
result by each patient in their own hospital whereas NPHL concern is more on the diseases itself.
This will give NPHL information on disease trends and thorough research of the characters of the
viruses can be conduct further. Pathology Department at the hospital outcome is the test result
and their objective can be accomplish in shorter period of time compare to NPHL which is
responsible to perform surveillance and disease monitoring for time to time.
The aim of this paper is to review the process of creating, building and implementing a LIS or
LIMS from others point of experience. There a many ways to build a system and each system is
unique with the own purposes and functions. The next section of this paper will give a brief
description of LIS and LISM and what are the differences between these two systems. Also will
be looking are their problems, issues and challenges of creating, building or implementing the
LIS or LIMS. Another section will discuss some of the benefits and future prospect of having
LIMS. Summary of this paper and future works will be identified at the end section of this paper.
From these data extraction, a desirable concept of LIMS can be understand to suit NPHL needs

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Laboratory Information System (LIS) vs Laboratory Information Management System

(LIMS)
An international company called Abbot Company who has build an award winning laboratory
software called STARLiMS define Laboratory Information System (LIS) as a series of computer
programs that process, store and manage data from all stages of medical processes and tests. By
putting a management word, LIS could also referred as Laboratory Information Management
System (LIMS). What is the difference between these two? Laboratory Information Systems
(LIS), exclusively serving clinical laboratories, and Laboratory Information Management
Systems (LIMS), serving analytical, manufacturing, and R&D laboratories across many
industries. LIMS software is required to be inherently more flexible as LIMS managed a wide
variety of business requirements. Physicians and lab technicians use LIS to supervise many
varieties of inpatient and outpatient medical testing, including hematology, chemistry,
immunology and microbiology. Basic LIS commonly have features that manage patient check in,
order entry, specimen processing, result entry and patient demographics.
According to Grasiani, Koch et al. (2014), a LIS tracks and stores every detail about a patient
from the minute they arrive until they leave and keeps the information stored in its database for
future reference. Cosper, A (2012) in his article wrote that the two programs differ in regulatory
requirements and workflow structure. LIS software is for hospital and typically used by
physician after making a diagnosis whilst LIMS is used in research and manufacturing labs for
pharmaceutical, chemical and food processing companies. LIMS are designed to report results
for batches of samples to the responsible parties. LIS are designed to report test results for
individual patients back to the physicians caring for them. LIMS is not a competing system to
LIS since LIMS is based more on test development than patient care. Nonetheless, traditionally,
LIMS should be able to manage samples, including receiving and tracking samples, schedule the
sample into the labs workflow, processing the sample, data storage related to analysis and
captured level of approval and compilation of sample data for reporting. Therefore, for the case
of NPHL, it is suitable to develop a LIMS as the design and functions purpose suit the NPHL
mission.

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2. Research Background

The review method for this paper consists of using various electronic database resources to
search relevant works on LIS. These include: IEEE Xplore, Emerald Insight, Elsevier, Science
Direct, ACM Digital Library and Google Scholar. Among the keywords that have been use
include Laboratory Information System, Laboratory Information Management System,
Laboratory, Implementing LIS, Requirement engineering, Agile and Methodology. At
the first stage, there are many research papers related to LIS, but only five papers were selected
on the experience of building or creating a LIS or LIMS from the very beginning. Other papers
were referring for their problems, challenges and future aspect.
Clment, Fillon et al. (2010) introduce a web-based application of LIS for the gathering and
display of data generated through medium to large-scale single nucleotide polymorphism (SNP)
identification by re-sequencing called TreeSNPs. It was built on an open-source platform with
the objective to organize, centralize, and share genomic and genetic data among the different
research units of the project. Another open-source application of LIMS was introduced by Melo,
Faria-Campos et al. (2010) called Sistema Integrado de Gerncia de Laboratrios (SIGLa)
because the researchers has found that the available LIMS are not easy to be implemented in
various laboratories as it was developed to suit one kind of laboratory only. By having SIGLa,
the researchers intend to introduce new approach of LIMS that can cater various types of
laboratories. A workflow management system has been incorporated into the system so that new
laboratory can define their activities, rules and procedures.
Another LIMS called Emergency Response Management System (ERMS) was introduced by
Sandlin, Johnson et al. (2009) and has its own customizable ability to support chemical terrorism
emergency response laboratory activities. This LIMS collect data from laboratory instruments to
identify the chemical agent of interest and report these data to public health responders and
decision makers. From here, public health system will use the result to facilitate the treatment of
patients who were already exposed and protect others who might be exposed to the harmful
diseases. Vu and Nguyen (2010) designed a LIS called BK-LIS for health facilities in Vietnam
which can automatically acquire and manage data from the medical laboratory equipment. By
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having BK-LIS, clinical doctors or medical staff in hospital will be able to review patient
information for diagnosis and treatment. A more in depth screening system called Screensaver
was developed by Tolopko, Sullivan et al. (2010) high throughput screening facilities. This
LIMS is based upon the Java Server Faces and Facelets web development technologies, allowing
its web pages to be defined in terms of reusable templates and high-level components. It gives a
consistent user interface to the user and easily interpreted and modification for developer. The
characteristics of each LIS and LIMS mentioned above are summarized in Table 1.
Table 1
Summary of LIS/LIMS and its characteristics

1
.

LIS/LIMS
Application
TreeSNPs

Function

Software
platform

Researchers

Gathering and display of data

Open source
generated through medium- to -Ruby on Rails
large-scale for single nucleotide -PostgreSQL
polymorphism (SNP)
identification

Clment, Fillon et
al. (2010)

Melo, FariaCampos et al.

(2010)

2
.

Sistema
Integrado de
Gerenciamento
de Laboratrios
(SIGLa)

Incorporated workflow
management system to adapt it
activities and processes to
various types of laboratory.

Independent
- JSP & J2EE
- MySQL

3
.

Emergency
Response
Management
System (ERMS)

To support chemical terrorism

Microsoft
Sandlin, Johnson
emergency response laboratory - MS Access 2003 et al. (2009)
activities at the Centers for
- SQL Server 2000
Disease Control and Prevention
(CDC)

4
.

BK-LIS

Automatically acquired and

Microsoft
Vu and Nguyen
managed data from the medical - VB.Net
(2010)
laboratory equipments and
- SQL Server 2000
transform it into readable
electronic medical records.

5
.

Screensaver

Supports the storage and

Open source
comparison of screening data
-Java
sets, as well as the management -PostgreSQL
of information about genomescale RNAi screening, libraries
and laboratory work requests.

Tolopko, Sullivan
et al. (2010)

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LIS modules
LIS can be defined broadly, and some specific functionality listed might be provided by software
modules not strictly considered as LIS. For this paper, various LIS models has been study to get
the idea of what specific module should be in the priority of developing LIS for NPHL. The
common modules identified from various LIS examples are as describe in Table 2.
Table 2
LIS modules
Module

Function

1
.

Patient
Management

Flexible patient query tools; centralized management of demographic

details, including family genealogy; patient merge tool; patient alerts
and flags that can be displayed at test ordering or accessioning.

2
.

Specimen
Registration

Responsible to register the specimen received and categorize it

according to the test unit. More efficient specimen registration will
involve bar code system for easier labelling, tagging and tracking.

3
.

Test Order

Customer-configurable, template-driven booking screens for test

request and specimens; test order frequency alerts; reflex tests; delta
checking and configurable reference range criteria (e.g., age, gender,
clinical study, diagnosis, etc.).

4
.

Test Unit

Specific unit to do the test such as Microbiology, Serology, Virology,

Mycology, Cytology etc. The number of units depends on the size of
the laboratory.

5
.

Result

Result of the test will be generating through this module. Clients can
either view this result through the system or simply print it for record
management.

6
.

Billing

Comprehensive invoicing and billing for management of all types of

private and commercial billing. Automatic generation of claims and
individual patient invoices. For public health laboratory, this module is
not applicable as the entire test is funded by government.

7
.

Reporting

Report formatting that is entirely configurable by the lab. Support for

HL7 web-based reports. Integrated remote access for clinicians
providing fully secure access to reports.

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8
.

Quality Control

Allow the users to control gauge and sample quality, data entry
standards, and workflow.

9
.

Audit Trail

This module ensures the security handling of each specimen. Every

step taken by the staff will be recorded to prevent data loss, theft, and
any illegal access to the data.

3. Problems Background

As a central public health laboratory in Malaysia, National Public Health Laboratory (NPHL)
receives a lot of specimens to undergo for test each day. These specimens could come from
various facilities including health clinics, hospitals, district offices, institutes or general
practitioners from both private and public sector. All of them are called clients as they request
NPHL to do the test. Each time NPHL receives a specimen, it will first be inspected whether the
specimen is in good condition without any leakage at the sample reception counter. The
turnaround time (TAT) will started to count as NPHL receive the specimens. With current
conventional system, clients will have to wait for NPHL to issue final result and send by mail to
respective clients addresses. Not to mention that this process added more clerical work on
laboratorys staff and it is not cost efficient. This mail result will take longer TAT if the
specimens were sent by batch. By that time, other people might have the possibility to be expose
to harmful diseases as public health authorities cant get information on the diseases in the first
hand with reasonable time to warn other people.
Having four other PHL running at different region, it is cumbersome task for NPHL to compile
reports which were sent by each PHL. With no electronic centralized database, many reports
could not be produce in time and it became harder for the physicians or clinicians to analyze
manual reporting data. Furthermore, there is no information sharing between all the public
laboratories. If a single patient demographic was being registered at one PHL, the next time
around the same patient demographic had to be re-registered if their specimen is being tested at
other PHL. This situation did not create a unique data for single patient demographic and no
history of the patients specimen can be captured.

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4. Research Implications

The pressures on a laboratory to improve performance in terms of sample turnaround and the
quality of the data being reported are becoming more intense and a well implemented LIS can
assist in these areas. The introduction of a LIS into a laboratory provides great implications to all
aspects of the business, not just to the laboratory itself but also to the clients of the laboratory
whether they are internal or external clients. Kim Futrell (2013) stated in her paper that
implementing LIS has the advantages on reduced clerical work, better evaluation of workload,
faster communication, improvement of information given to the clinicians in terms of adapted
reference values, better interpretation, comments, improved retrieval operations and faster billing
process. Supporting these advantages were paper written by Blaya, Fraser et al. (2010) that says
there are two major benefits that LIS can provide; one is decreasing times for communications of
results which also means turnaround time and secondly is improving the productivity of the
laboratory. Vu and Nguyen (2010) in other words said that having LIS can reduce unnecessary
delays due to paper-based result or report and this will also reduce errors due to manual entry of
data.
Our healthcare system has developed in disjointed silos of care, and this has created an
inefficient system that causes poor utilization of lab tests. By using the LIS and the data within,
labs can make a positive impact at the point of order for diagnostic testing. This will ensure that
the most appropriate and cost-effective tests are selected and eliminate redundant tests.
Laboratorians and pathologists can be instrumental in the collaborative efforts needed to track
and monitor test utilization patterns and be involved in committees to develop and implement
best-ordering guidelines and evidence based testing algorithms or cascades that lead to optimum
patient outcomes and benefits the entire organization (Futrell 2013).
Having an electronic database also allow data to be retrieved with just a click of a button and
data can be archive rather than rummaging through a bunch of files. These and other benefits
such as improving business efficiency, improving data quality has been highlighted by Tagger
(2011).

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Challenges
The past 30 years have seen the development of laboratory information system from simple
system designed just to generate results to even complex system capable of tracking the entire
laboratory workflow throughout all phases of the total testing process, including pre-analytical,
analytical and post analytical (Futrell 2013).
As it will be a web-based application, LIS will not have an exception from harmful attack from
the cyberspace. Sepulveda and Young (2013) suggest that information system must be secured
from unauthorized from both internal and external access without hindering the functionality of
the legitimate users as they are working on highly confidentiality data of patients. This security
features should be provided along three directions: data entry validation, system access control,
and memory protection.
As healthcare continues to transform and facilities decide where and how their laboratory fits in,
laboratory professionals and pathologists need to be in tune and involved in these decisions. In a
large healthcare facility, the administration may not see the lab as a big priority because it is not a
large cost; however, it can be a huge factor in improving patient outcomes as diagnostic
information becomes ever more important in the future of healthcare (Kim Futrell 2013).
With the explosion in the use of smart phones and tablets that provide anytime, anywhere access
to a broad variety of business and personal information, expectation from clients and clinicians
have increasing with regard to timely access to clinical laboratory data. Therefore, LIS should be
design to suit in various platforms of technology to ensure its high availability of accessibility.
Other biggest challenge for implementing a LIS is likely due to human factors. Lack of a
proficiency in user requirements specification will lead to failure to meet the users initial
expectations. As user requirement might change accordingly, it takes very skillful personnel not
just to understand the business needs and problems arise, but also to identified and put it in
standard documentations (Tagger 2011).

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5. Recommendations
Investment and funding are important for implementing a LIMS in a laboratory that is why a
proposal must justify the cost and demonstrates the value of it in a laboratory in order to gain
approval for such major project. In order to justify a LIMS investment, a detailed review of
processes and practices both within and outside the laboratory is required. There are many
attributes that need to be taken into consideration while successful implementation of LIMS such
as financial fitness, technological viability, company culture, schedule and timing, business
understanding and competitive quality etc. (Prasad and Bodhe 2012). For some organization who
face IT budget constraints, an embedded in-house programmers should be in place to provide
software development support to the laboratory. This approach could also reduce LIMS
development cost and furthermore ensure easier customization of the software to meet dynamic
changes of workflow process in the laboratory (Melo, Faria-Campos et al. 2010). Having an inhouse technical expertise and well-train staff that know the structure of the LIMS also ensure
modification of the system can be done internally. Some LIMS has not been a success story due
to lack of proper customization, improper installation, non-availability of well-trained technician,
hasty installation and inefficient feedback mechanism (Prasad and Bodhe 2012).
Building data platform such as LIMS will require laboratory expertise in terms of the business
process of the laboratory itself. Thus a deep understanding of the nature of the laboratory itself
belongs to the pathologist. Software developer personnel would only interpret their
understanding into computer programs and codes, the workflow process still have to be
determined by the laboratory personnel. Hence, it is ideally to involve pathologist in LIMS
design and implementation to ensure the system work base on their activities, rules and
procedures. Living the software developer work on their understanding would lead to unwanted
functions being created and worst makes the system not meet the user requirements.
Interoperability among health facilities is well-known issues to be emphasized during LIMS
implementation. Hospital Information System (HIS) is well-known solutions for its huge
contribution for data management in hospital. In order to be competitive, LIMS need to have the
capability to deal with wide variety of HIS products in the market that vary tremendously for
their ability to send electronic lab orders (Futrell 2013). This interoperability would eliminate
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redundant work in terms of data entry as all patients demographic can come from single point of
entry which is the HIS. As more meaningful use, LIMS must keep in pace with the expanding
standards and other regulatory measures being use in the healthcare such as International
Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), the
ability of LIMS to support interoperability among multiple hospital, independent and physician
office laboratories is becoming increasingly important (Gregory, Katieb et al. 2014). Getting
data in the right form to the right system are the key examples for LIMS to not just connect but
to collaborate and going beyond the four walls of the lab hence help position the public health
laboratory for greater success. Sugijarto, Safie et al. (2013) in his paper analyze the model to
integrate LIMS with HIS. Although this study refer to LIMS within the HIS itself, further
research to use LIMS model from other laboratory can be done in the future. The LIMS and the
HIS will need to work in cycle to monitor population health dynamics, and these software
capabilities must be able to continually advance and become more sophisticated to support more
standardized, data-driven, best practice models.
Another aspect that can be considered for LIMS in this flexible future is to host the system in the
cloud. This will allow the labs free from old-fashioned, huge installations work and network
requirements. This gives the LIMS users almost instant and untethered software access which
enables management of the lab from any workstation or laptop at any time and location
(Gregory, Katieb et al. 2014). Not only has cloud computing scaled computing to the data center,
but it has also introduced software, systems, and programming models that significantly reduce
the complexity of accessing and using these resources (Grossman 2009).

With the growing number of test orders received every year, it is an essential features for LIMS
in the future to have an alert system for an emergency response especially during getting
approval from authorities. Functions like generated e-mail notifications or Short Message
Service (SMS) from the system allowed remote notifications contribute to quick turnaround time
to review the quality of results and reporting data. As the functions and demands of the
laboratory change, the functions of the LIMS may also change to include additional features such
as auditing, customer relationship management (CRM), quality assurance, and instrument
calibration in the future.
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6. Conclusion

The future of clinical laboratory software lies in its ability to adapt to the ever-changing
laboratory environment. LIS has a huge way forward to more mature quality solutions that
enable pathologist and laboratorians to be a fundamental part of the care team with a clear focus
on patient healthcare that promotes wellness and prevention while simultaneously reducing
government spending on public health care. A general LIS will not be the best solution for all the
requirements of the laboratory. A well- designed laboratory information systems have much
potential to improve patient care and public health monitoring even in resource-poor settings.
Some of the challenges described, such as lack of trained personnel, limited transportation, and
large coverage areas, are obstacles that a well-designed information system can overcome.
However, creating well-designed information systems is a difficult task necessitating appropriate
resources, expertise and time to be successful. Therefore, implementation of LIS or LIMS
requires a thorough study of the laboratory processes and understanding the operational
feasibility of experiments (Prasad and Bodhe 2012). Based on the study above, it can be said that
designing and developing an open-source web-based application of LIS for NPHL in Malaysia is
feasible. As suggested by Prasad and Bodhe (2012), the best approach to develop a LIS is by
adopting open web-based standards as it is easily customized and offer much more than sample
management and reporting functions. This standard allows LIS to connect to wider business
process by sharing scientific data through worldwide organization. For it is not a one-time
software development cycle, agile methods can be apply to suit the constantly change
requirements from the users and staff involved (Hui, Lei et al. 2012). NPHL also collaborate with
the public health laboratory internationally; World Health Organization (WHO) and other related
agencies. Therefore a comprehensive information system has to be establishing at NPHL to set a
standard benchmark of information sharing to combat communicable disease not just for the
country but also to the global epidemic.

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