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Laboratory Information System (LIS) & Blood Bank

This section describes the complete diagnostic and transfusion workflows in the Laboratory Dashboard, including order accessioning, specimen collection and tube barcoding, analyzer runs, quality control (QC), pathologist validation, result dispatch, and blood bank crossmatching.

1. System Architecture — Two Linked Systems​

The laboratory workflow operates across two linked systems:

  • Doctor Orders in Moana EHR: Orders are placed via CPOE and transmitted to Moana-LIS via HL7 FHIR ServiceRequest.
  • Bench Workflow in Moana-LIS: Specimen intake, accessioning, analyzer processing, result entry, quality control, and verification happen in Moana-LIS.
  • Result Dispatch to EHR: Dispatched results return to the core EHR and immediately populate the Doctor's Results tab.
graph LR
    A[Doctor: Order in EHR] --> B[LIS: Specimen Intake]
    B --> C[LIS: Bench Processing]
    C --> D[LIS: Result Entry]
    D --> E[LIS: Supervisor Verify]
    E --> F[LIS: Dispatch Release]
    F --> G[EHR: Doctor Review]

2. Lab Technician Workflow — Step by Step​

  1. Log in to Moana-LIS: Note that Moana-LIS maintains a dedicated laboratory login.
  2. Access Incoming Orders: Open the incoming requests queue. Confirm patient Moana ID, test name, priority (Routine, Urgent, STAT), and ordering clinician.
  3. Specimen Collection & Barcoding: Collect or receive specimen. Print and affix the barcode label with Moana ID, timestamp, and test code.
  4. Chain of Custody Tracking: Track specimen through defined custody milestones: Collection → Transport → Received in Lab.
  5. Process Specimen: Process specimen on automated analyzers or manual bench assays.
  6. Result Entry & Delta Checks: Enter observation values against the test profile. The system displays reference intervals and flags abnormalities (H, L, HH, LL). Automated delta checks compare against previous patient results.
  7. Submit to Supervisor: Submit results to the Supervisor Verify queue. Lab technicians cannot release results directly to clinicians.
Specimen Tube Collection and Barcode Generation Screen
Specimen Tube Collection and Barcode Generation Screen🔍 Click to enlarge
Specimen Tube Collection and Barcode Generation Screen
Specimen Tube Collection and Barcode Generation Screen🔍 Click to enlarge
Specimen Tube Collection and Barcode Generation Screen
Specimen Tube Collection and Barcode Generation Screen🔍 Click to enlarge

3. Lab Supervisor Workflow — Verify & Dispatch​

⚡
IMPORTANT:

APPROVE vs. DISPATCH — Critical Distinction Approving a result in Moana-LIS finalizes its status within the LIS. However, the result does NOT appear in the doctor's EHR chart until a SEPARATE Dispatch step is completed. Approving validates the analytical result; Dispatch is the actual release step to the clinical care team.

  1. Open the Supervisor Verify queue in Moana-LIS.
  2. Review analytical plausibility (e.g., a hemoglobin of 18 g/L in an ambulatory walking patient prompts an immediate rerun). Approve valid results.
  3. Critical Results Protocol: If a result breaches a critical panic threshold, the system triggers the critical result dual-gate workflow. Flag the result as critical.
  4. Mandatory Verbal Contact: Make direct verbal or telephone contact with the ordering doctor BEFORE dispatching a critical result.
  5. Document in Notify Clinician Modal: Record who was notified, contact time, notification method, and read-back confirmation.
  6. Complete Dispatch: Click Dispatch. The report instantly appears on the doctor's EHR Results tab.
  7. 30-Minute Auto-Escalation: If the ordering physician has not acknowledged a critical result within 30 minutes, the system auto-escalates to the clinical department head.
Pathologist Result Verification and Dispatch Panel
Pathologist Result Verification and Dispatch Panel🔍 Click to enlarge
Pathologist Result Verification and Dispatch Panel
Pathologist Result Verification and Dispatch Panel🔍 Click to enlarge
Pathologist Result Verification and Dispatch Panel
Pathologist Result Verification and Dispatch Panel🔍 Click to enlarge
Pathologist Result Verification and Dispatch Panel
Pathologist Result Verification and Dispatch Panel🔍 Click to enlarge

4. Blood Bank & Transfusion Management​

graph LR
    A[1. Donor Screening & Collection] --> B[2. Component Processing & Storage]
    B --> C[3. Crossmatch Compatibility Testing]
    C --> D[4. Verified Unit Issue to Ward]
  1. Donor Registry: Record voluntary and family replacement donors, donor medical history questionnaires, hemoglobin screening, and collection volumes.
  2. Component Inventory: Track units categorized by ABO/Rh group (A+, A-, B+, B-, AB+, AB-, O+, O-) and component type:
    • Packed Red Blood Cells (PRBC), Fresh Frozen Plasma (FFP), Platelet Concentrate (PC), Cryoprecipitate.
  3. Crossmatch & Transfusion Issue:
    • Receive inpatient transfusion requests from Doctor/Nurse.
    • Execute Major and Minor crossmatch compatibility testing.
    • Reserve and issue verified compatible units with tamper-evident compatibility slips.

5. Common Issues & Troubleshooting in Laboratory​

Issue / SymptomProbable CauseMandatory Corrective Action
Lab order fails when placing offlineLaboratory orders require live FHIR service connectivityUse paper lab request forms during network outages; enter into Moana-LIS once connectivity is restored.
Result not visible to doctor after approvalDispatch step not yet completed in LISLab Supervisor must perform the separate Dispatch action in Moana-LIS.
Suspect result — clinically implausibleSpecimen contamination or transcription errorQuarantine the result; request a fresh redraw specimen; notify ordering doctor of testing delay.
Critical result — doctor not respondingDoctor unavailable or notification unreadContact the clinical department head or on-call medical officer; log all escalation attempts in audit record.