검사 정보 시스템 (Laboratory information system, LIS)

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의료정보시스템을 공부하다보면 LIS라는 단어를 접하게 되는데, 생소한 단어라 어려움을 느낄 수 있습니다. 오늘은 병원에서 사용되고 있는 검사 정보 시스템 (LIS)에 대해서 알아보도록 하겠습니다.

LIS의 정의

LIS는 Laboratory Information System의 약자입니다. 환자가 병원에 방문하면 담당 의사가 진단을 위해 검사 처방을 하게 되는데, 검사 처방부터 검체 채취, 검사, 결과보고, 검사결과 조회까지의 일련의 과정이 진행됩니다. 이러한 과정 속에서 검사실 업무 흐름상 발생하는 정보들을 받고, 처리하고, 저장하는 소프트웨어가 바로 LIS 입니다. LIS는 HIS(Hospital information system)의 여러가지 정보 시스템들(OCS, PACS, EMR 등) 중에서 가장 복잡하고 광범위하며 데이터량이 많은 시스템입니다. LIS는 아래 그림과 같이 HIS 안에서 다른 정보 시스템들과 다양하게 정보를 교환하게 됩니다.

진단검사의학 6판 p.101

LIS의 필요성

LIS가 필요한 이유는 무엇일까요? LIS는 검사결과의 신뢰도 향상, 검사 속도의 향상, 표준화되고 효율적인 검사실 운영을 위해 필요합니다. 현대화된 병원의 검사실에서는 수많은 자동화 장비를 사용해 검사가 수행되고 있습니다. 이러한 자동화 장비에서 나온 결과값 들을 적절하게 병원 시스템과 연결해주는 소프트웨어가 필요하게 되는데, LIS가 이러한 가교 역할을 하게 됩니다.

검사 결과가 신속하게 전송됨으로써 검사 소요시간이 단축되었고, 그 결과 검사자는 검사 결과의 품질에 더욱 집중할 수 있게 되었습니다. 또한 전산화된 검사 결과로 인해 검사실 간 결과 비교가 가능하게 되어 검사실 간 검사 결과의 품질 차이가 줄어들게 되어 표준화가 가능해졌으며, 증가하는 검사량에도 효율적으로 대처가 가능하게 되었습니다.

LIS 운영 및 관리

진단검사의학과 의사와 검사실 직원은 LIS개발 과정에 참여하여 검체명, 검사코드, 검사수가 등의 정보와 사용자화면 구성, 자동화기기 인터페이스와의 연동 등 검사가 이루어지는 과정 전반에 대하여 확인하여야 합니다. 또한 검사실에서는 LIS 담당직원을 두고 병원의 의료정보 관련 부서와 소통하는 것이 일반적입니다. 검사와 관련되어 변동사항이 생기면 LIS에 즉각 반영하여 임상의사가 검사를 처방할 때 이를 인지할 수 있도록 처방화면과 연계하는 것이 바람직합니다.

LIS는 천재지변을 대비하여 재난 복구 체계가 미리 마련되어 있어야 합니다. 자료들은 이중으로 저장하여 관리해야 합니다.

검사정보의 흐름

환자 등록 및 검사 처방

의사가 검사를 처방할 때, HIS의 환자관리 데이터베이스를 통해 환자정보가 LIS로 전달됩니다. 환자정보는 환자등록번호나 주민등록번호와 같은 개인식별번호를 통해 구별되고, 이들이 기준정보로서 사용됩니다.

검체 채취

입원 환자의 검체 채취과정을 알아보겠습니다. 검체 채취자(의사, 간호사, 임상병리사)가 환자목록과 검체라벨, 환자바코드를 인식할 수 있는 휴대형 단말기 등을 지참하고 환자를 방문합니다. 환자는 보통 손목에 바코드 등 환자정보를 인식할 수 있는 인식표를 가지고 있는데, 검체 채취자는 이 인식표를 검체라벨과 대조하고, 질문을 통해 환자확인을 한 후, 검체 라벨에 인쇄된 검체 종류와 용량을 확인하여 적절한 검체 용기에 부착을 한 후 채혈을 시행해야 합니다. 채혈이 시행 된 경우 이 정보는 LIS를 거쳐 HIS에 전달되며, 의사는 검사결과 조회 화면을 통해 채혈이 되었음을 확인할 수 있게 됩니다.

외래 환자의 경우에는 대기순서를 관리할 수 있는 시스템이 필요합니다. 검체 채취자는 환자 확인을 정확히 한 후에 LIS를 통해 검사처방을 확인하고, 해당일에 채혈해야하는 검체라벨만 출력하여 적절한 용기에 부착 후 채혈을 해야합니다.

검체 접수 및 전처리

채혈된 검체는 병원의 검사실로 이동되어 접수됩니다. 검사실은 접수된 검체를 선별하여 각 단위 검사실(혈액, 화학, 미생물 검사실 등)로 배분하는 시스템을 갖추고 있어야 합니다. 검사 배분은 자동화기기 혹은 육안으로 검체 라벨을 판별함으로써 이루어지고, 이렇게 접수가 되었다는 사실은 LIS를 통해 HIS로 전달되어 임상의사는 검체가 접수된 상태임을 알 수 있습니다.

검사 시행

검체가 자동화기기에 도착하면, 각 자동화기기는 검체라벨을 읽게되고, LIS로부터 처방 정보를 받아 어떤 검사를 시행하여야 하는지 확인 후 해당 검사를 시행, 다시 결과를 LIS에 보내게 됩니다.

결과 검토 및 정도관리

모든 검사 결과가 무조건 HIS로 전송이 되게 하면, 검사의 오류로 인해 검사 결과가 잘못된 경우 환자의 진단에 큰 오류가 발생하게 됩니다. 따라서 검사실에서는 변화치 검색(delta check) 등 각종 정도관리 규칙을 LIS에 포함시켜 이 규칙을 벗어나는 결과는 자동으로 발견되게하고 검체, 기기, 시약, 인력 중 오류 원인이 무엇인지를 찾아내야 합니다.

검사 결과를 LIS에서 계산하여 계산 값을 보고하는 검사 항목의 경우는 주기적으로 계산식을 검증하여 오류가 없는지 확인해야 합니다. 또한, 선별검사에서 양성이 나왔을 경우 같은 검체로 확진 검사를 시행 할 수 있도록 진단검사의학과 의사가 추가 처방하면 불필요한 추가 채혈 및 진단 지연을 방지할 수 있습니다.

결과보고와 결과 활용

LIS는 이전 검사를 누적해서 추세로 보여준다든지, 그래프를 활용해 시각화하여 보여주는 등의 다양한 방법들을 활용하여 임상의사에게 도움이 되는 결과조회 시스템을 갖추어야 합니다.

검사정보시스템(LIS) 관련 기술

자동인식기술

바코드

바코드는 생활 속에서 이미 많이 쓰이고 있는 기술로, 다양한 폭을 가진 검은 막대와 흰 막대를 조합하여 문자를 광학적으로 판독하기 쉽도록 부호화 한 것입니다. 인쇄 방법이 다양하고, 데이터 입력이 빠르고 안정적이며, 판독 장비가 저렴하고 원거리 판독이 수월하여 병원에서도 널리 사용되고 있습니다. 한 방향으로만 표현되는 일차원 바코드가 가장 많이 사용되나, 최근에는 가로 세로 모두 정보를 표현하는 QR (quick response)코드 등의 이차원 바코드 사용이 늘고 있습니다. 인쇄면적을 적게 차지하고, 대부분의 문자를 표현할 수 있으며, 방향에 무관하게 스캔할 수 있어 향 후 검사실에서도 사용이 증가할 것으로 생각됩니다.

RFID

RFID는 IC칩과 무선을 통해 다양한 개체의 정보를 관리할 수 있는 인식 기술로 업무 전 과정의 정보를 IC 칩에 내장시켜 이를 무선주파수로 추적할 수 있게 한 것입니다. 표면의 재질이나 환경 변화 여부에 관계없이 바코드를 대체할 차세대 인식 기술이지만 가격이 바코드에 높아 아직 널리 사용되지 못하고 있습니다. 환자의 병상, 손목띠에 이 기술을 적용시켜 환자 확인에 이용하거나 수혈 혈액백의 재고관리 등에 사용되고 있습니다.

참고문헌: 진단검사의학 6판

연관 글

185 thoughts on “검사 정보 시스템 (Laboratory information system, LIS)”

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