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.
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.
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.
On technical aspects:
Matti Koskivirta - VTT Information Technology
Tel: +358 3 3163351
On medical aspects:
Dr. Sanna Siitonen - Tampere University Hospital
Tel: +358 3 2475477
On business aspects:
Reijo Mäkinen - Managing Director, Promed Team Ltd
Tel: +358 9 426355