As explained by Dr. Lawrence A. Kaplan:

Introduction

What we directors and clinical scientists need today is a vehicle that could connect our knowledge and training to the electronic tools that provide us access to the growing mass of information we need to manage our laboratories. This vehicle has to be very user friendly, in a manner that will not seem terribly alien to us. We need a modern encyclopedia or, to use today’s jargon, an Infobase!

Why an Infobase?

The practice of clinical laboratory medicine has been undergoing major changes that have resulted in fewer laboratory professionals having greater responsibility for a greater amount of service work. These laboratory managers will be carrying an increasingly larger “information burden,” that is, the difficulty associated with rapidly accessing and understanding the rapidly growing body of scientific, medical, legal (that is, regulatory), and technical information. Swift, dependable access to information is needed to manage the modern laboratory.

Traditional access to information has been based on books, copies of articles, and monographs. These traditional paper-based sources are limited by nature to be physically separate from related sources of information; the need to collect and sort through these paper resources by hand greatly slows access to information.

If the laboratory manager of today is to cope with the information burden, that professional must be able to use modern electronic information systems, or “infobases.” We define the term “infobase” to describe a body of information organized by a sophisticated mark-up language which electronically indexes the information. Electronic infobases have distinct advantages over the traditional, non-electronic media including:

• greatly enhanced storage capacity, approximately 10x over traditional formats. A single CD-ROM disk can hold the textual equivalent of 10 traditional encyclopedia sets!

• the ability to directly and immediately move from one piece of information to another piece of related information. This instant ‘jump’ is accomplished through hyperlinks. In paper format, these same pieces of information might be separated by hundreds of pages or be in a separate volume.

• the ability to rapidly search (query) the infobase for specific information. The only search mechanisms available in a traditional database are the table of contents and the index. These devices are limited by the terms or words deemed to be important by the author. The table of contents and index might bring one to the relevant chapter, section, or, with a bit of luck, the correct page containing the desired information. On the other hand, electronic search engines are extraordinarily flexible, with almost unlimited capacity to search the entire infobase, bringing the searcher directly to the place(s) in the infobase that includes the desired word or phrase . These modern electronic search programs perform Boolian logic searches, using terms or built-in levels, fields, or groups to make searching for information extremely rapid and simple.

• the ability to integrate text, figures, and video into a multimedia infobase. Where our traditional encyclopedia offered information a flat, two-dimensional format, the electronic cyclopedia can be seen in three-dimensional format.

An electronic infobase realistically offers a solution to the problem of how a single laboratory manager, responsible for many divisions, can have ready, rapid access to a huge mass of information. Moreover, the electronic infobase offers a user-friendly inter to those individuals who are relatively unsophisticated with the tools of the electronic revolution.

The Solution. Laboratory Medicine: A Scientific and Managerial Infobase

A single CD-ROM with easy-to-use software that included a powerful search capability was our solution. When creating the laboratory manager’s infobase, we looked for a software program with several criteria in mind:

• a powerful search and retrieval program,
• electronic linking capability for related sections of the Infobase,
• modification capability within the Infobase,
• printing capability for desired sections (including any modifications made),
• updating capability that could incorporate new electronic information into the software program,
• an easy inter for laboratory managers with relatively little computer background,
• the capability to run on commonly available personal computers.

The software program that best met our criteria was the Folio Views product, produced by the Folio Corporation. The Views program is simple to use for those with only minimal knowledge of personal computers. The Views’ hyperlink function allowed the editors to build in logical jump-links between parts of the Infobase, adding another vehicle for rapidly accessing information. The Views program includes a powerful Boolean search engine, providing Infobase users with many ways to logically search the Infobase. Another very important feature for laboratory managers is the shadowfile program. The shadowfile program provides the user with the practical ability to modify parts of the Infobase, saving the changes on the hard drive or USB. The shadowfile turns the CD-ROM into a virtual read/write system.

Content Concerns

The Laboratory Medicine Infobase contains a fairly large amount of complex data, including reviews of methodological approaches to analysis, patient and sample requirements, many detailed methods of analysis, reference intervals, and analytical and clinical interpretation of results. The information is presented in the form of text, tables, and figures. It also integrates several other sets of information: the set of governmental regulations, CLIA ’88, which provides much of the direction for clinical laboratories in the United States; health and safety manuals from our institutions; and a large number of management forms.These forms were selected and developed to strengthen intra-laboratory communications, and are essential for helping to meet regulatory requirements and for managing a laboratory.

Altogether, the Laborabory Medicine Infobase encompasses over ten thousands of textbook pages, over one thousand figures and several hundred tables.

Structure of the Infobase

The hierarchical structure of the Laboratory Medicine Infobase was an important consideration when constructing the product. The analytes that are reviewed in the Methods section are listed in the Table of Contents in alphabetical order, which is probably the most logical manner of entrance into this section, and the one most familiar to the majority of our users.

Hyperlink jumps were established within and between the following sections of the Infobase:

• within each method, links to: analytical review of methodologies, sample and patient preparation, method, reference interval and interpretation.
• CLIA ’88
• safety manual
• MSD sheets
• management forms
• manufacturers’ methods

Use of the Infobase

The Laboratory Medicine Infobase was produced in the physical form of a CD-ROM for the reasons described earlier: relatively low costs, simplicity of use, great storage capacity, and the rapidly increasing availability of CD-ROM drives. The Infobase has been used in our laboratories for the past several years. Our own users find the Infobase to be a much faster way to access information than traditional textbooks and monographs.

Laboratory supervisors have found the shadowfiles to be especially useful for modifying method descriptions to create method write-ups in NCCLS-compatible format for their own lab manuals. Similarly, the managerial forms have provided laboratory managers with a wealth of new ideas for designing laboratory forms to help cope with the regulatory demands for monitoring and recording laboratory processes and for enhancing intra-laboratory communications. All the time-consuming work of designing, typing, and field-testing forms can be greatly reduced. In addition, managers can modify the forms in the shadowfiles, to create forms that were best suited for their specific laboratory needs.