Computerized Blood Center Information System
by Matti Koskivirta
Blood transfusions are frequently needed when a patient needs a critical
surgical operation in hospital. Blood grouping, antibody detection and
compatibility testing must be made beforehand also when interventions are
not supposed to be critical. These tests are needed to be sure that there
will be enough readily available blood products for the patient in case
of emergency during the intervention.
This article briefly describes the statistical, logistical and technical
aspects of a recently developed blood center information system (BCIS)
that is in use at the Tampere University Hospital (TUH) in Finland. BCIS
has been developed by the Medical Informatics group at VTT Information
Technology. The company Promed Team Ltd. is now selling BCIS to other hospitals.
Blood transfusion statistics at Tampere University Hospital
TUH makes approximately 35.000 blood transfusions every year. Blood
grouping and compatibility testing have to be done almost every time before
the patient can be given a blood transfusion. As an example, the number
of compatibility tests between the patient's serum and the red cells of
blood product that potentially could be given to him/her is about 40.000
each year at TUH.
A rough estimate of the total number of different tests that are recorded
on TUH BCIS is about 100.000 per year. Besides making and recording these
test results BCIS must also record all details of incoming blood products.
The number of incoming blood products is approximately the same as the
number of transfused products (35.000 per year). BCIS must also keep very
strict track of which patient finally got the product. Sometimes the sent
products come back from the wards and in those cases this return information
must also be recorded to enable the returned products to be given to other
patients.
There are approximately 70 different brands of blood products and they
all have their own characteristics, such as keeping time, substitutes,
type of product, whether they are readily radiated or not, whether they
need a mandatory compatibility test, price, etc. There is a variety of
needs of patients using blood products and so must be the variety of different
properties of blood products as well. All this information must be recorded
and available to BCIS.
BCIS holds information also on possible complications during (or because
of) blood transfusions. Fortunately blood transfusion complications in
TUH are very rare, only about 100 cases per year, but recording the complication
details is still important for the safety of patients. This recording is
also mandatory because of the Finnish blood transfusion regulations.
Blood transfusion logistics
The main function of BCIS is to ensure that no blood transfusions that
puts the patient in danger will take place. This should never happen if
the staff of a hospital follows the blood transfusion rules without exception.
However, when BCIS knows these same rules and the facts on the patients
as well as the properties of the transfused products possibility of those
mistakes should be almost impossible. As an example, BCIS can prevent a
release of ABO-incompatible blood and blood components to the patient.
This is only a single and a rather simple example of one quality control
function and actually there are over 200 more or less complicated rules
and checks in BCIS that try to ensure that blood transfusion process will
go well and without any extra work.
Another main function of BCIS is to drive the logistics so that the
products will not go out of date before they are used. Since all products
are quite expensive (200-3000 FIM each) this may save lots of money in
a hospital with 35.000 blood transfusions a year because blood products
cannot be used in any way if they are outdated.
BCIS is also used to invoice the wards based on delivered and/or returned
products and tests that have been made for them. BCIS must also provide
daily working lists and other reports for the blood center nursing staff
and BCIS is used to collect material for statistical and medical analysis
as well.
Virtually all blood products as well as the static properties (eg maximum
keeping time) of different blood products in Finland come from the Finnish
Red Cross (FRC). When there is a shortage of any blood product in TUH they
make a phone call to FRC to get more products. When the products are received
they are registered in BCIS with the help of barcode readers. At this stage
also wards can be informed automatically provided that those products do
not need any further tests. Otherwise wards are noticed after these mandatory
tests have been made.
Depending on the case these notices from BCIS to the wards are sent
electronically with a single push of a button or automatically. Sending
products to wards is recorded in BCIS with the help of barcode readers,
and, if the product comes back unused, this event must be recorded as well
to keep real time state of the stock in TUH blood center.
All information mentioned above goes also to a centralized hospital
laboratory system called Tamlab at TUH. Wards usually make blood product
orders and blood test orders using Tamlab, who automatically sends those
orders electronically further to BCIS. When products are ready to be sent
to the wards, BCIS sends a notice electronically back to Tamlab so that
nurses in the wards know that they can come and get the products for the
patient.
Techniques used
The very first version of BCIS was developed during the second half
of 1995 in a Windows 3.11 environment with 2 simultaneous users. The different
versions of BCIS have been in a clinical 24 hours/day use after November
1995 without any major problems. Now there are 4 workstations connected
to BCIS Windows NT file server and they are all provided with barcode readers
and barcode/label writers and with report printers.
In developing BCIS we have used rapid prototyping techniques with Visual
Basic in a Windows 3.X, Windows 95 and Windows NT 3.5/4.0 environments
together with Visual Basic's integrated MS Access database. BCIS makes
also backups and repairing of the databases when needed and these administrational
functions are integrated in BCIS. Also archiving old information can be
made on any workstation without intruding other users of BCIS. Paths of
backups and archives as well as many other BCIS parameters are held in
INI-files for each individual workstation.
The newest version of BCIS is a 32-bit Windows NT 4.0 version with a
direct connection to Tamlab that is running in a Digital VAX computer cluster.
We are using TCP/IP based file sharing for the messaging and only the NT
file server is directly connected to Tamlab using Pathworks. Particular
effort has been put on the safety and security matters eg in case when
the centralized laboratory system or even the NT server is not in use.
In those cases BCIS uses local replications of the database on the workstations
until the connections are working once again and synchronizing of the data
is made.
Future plans
At this moment all information between BCIS and Tamlab is sent using
proprietary Tamlab- and LabOn-format files. We have plans to make BCIS
to use HL7-format messaging so that BCIS could be used with any laboratory
system that supports HL7 standard. However, BCIS itself doesn't need any
laboratory system to run since it can be used also as a stand-alone system.
Getting incoming products information directly from FRC using EDIFACT
based messaging is another interesting option for the future. This could
save a great deal of manual work in supplying information that is readily
available from FRC. Enabling this option is depending mainly on the computer
software and security policies that are currently in use at FRC, but we
are rather optimistic and looking forward to move ahead on this matter
as well.
Another considered option is to use internet/intranet technology to
enable blood product orders from hospitals to BCIS by inputting order form
data using internet browsers.
Please contact:
On technical aspects:
Matti Koskivirta - VTT Information Technology
Tel: +358 3 3163351
E-mail: Matti.Koskivirta@vtt.fi
On medical aspects:
Dr. Sanna Siitonen - Tampere University Hospital
Tel: +358 3 2475477
E-mail: smsiitonen@tays.fi
On business aspects:
Reijo Mäkinen - Managing Director, Promed Team Ltd
Tel: +358 9 426355
E-mail: reijo.makinen@promed.fi
