I think the big issues include:
1 Effect on workload
Reduction of the marginal cost of requesting to the user will, in theory, produce greater demand. This is supported in practice by the experiences of most laboratories I've asked,
including Tim's.
This can only be put in the advantages or disadvantages side of the account when you know:
* how the laboratory is funded: does the laboratory want to increase its workload or not? Most NHS laboratories do not receive adequate extra income to cover increase in workload.
* the clinical benefit from the change in the number of investigations being performed.
2 Do you set up smart remote requesting or dumb remote requesting? Smart requesting might include:
* informing the requester that an investigation was carried out several times recently and might not be necessary,
* automated "care pathways".
Dumb requesting is easier to implement but will probably exacerbate the increase in workload. Smart requesting is harder to implement but might ameliorate the increase in workload.
3 Do you encourage the use of predefined batteries of analyses or adopt a highly discriminatory approach? This has big effects on the design of the human-computer interface.
4 Do you restrict the remote requesting to those requests which will use a phlebotomy service? This gives an extra step where problematic requests can be resolved before the specimen
arrives in the laboratory.
5 Where in the workflow do you put the barcode printers, readers or other AutoID devices? This is strongly related to 4.
6 Is it better to try and develop the LIMS to support remote requesting or to install a dedicated system that passes the requests to the LIMS?
Jonathan Kay
University of Oxford
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