The Internet Revolution in Clinical Laboratories

“In clinical laboratories as well, the use of these networks has in many cases already become routine, as the electronic transfer of laboratory results from one unit to another or the use of email is part of the everyday work of many laboratories.”

Moodi 5/1998. Translated from Finnish.

Internet and the Clinical Laboratory

Antero Julkunen

International electronic data networks, in their various forms, have since the 1960s grown into some of the most significant channels for information exchange worldwide. Their advantages include speed, cost-effectiveness, flexibility, the ability to transfer large volumes of data, and a broad user base. In Finland, this development was first driven by universities and later by commercial companies and various public-sector organisations.

Today, electronic communication with other parties via data networks is part of the daily routine of most Finnish healthcare units. In clinical laboratories as well, the use of these networks has, in many cases, become routine, as the electronic transmission of laboratory results between units or the use of email is part of everyday laboratory work.

THE INTERNET

The internet – the network of networks – has been a hot topic of discussion internationally, especially within the scientific community, for several decades. In Finland, it has only entered wider public awareness in recent years, largely through World Wide Web (WWW) software and websites. Internet use and WWW use are often incorrectly regarded as the same thing, even though the Internet is much more than merely a platform for web pages.

At the core of the internet is its communication protocol (Internet Protocol, IP), which standardises how data is transmitted. All computers connected to the internet understand this protocol and can therefore communicate with each other. IP places few restrictions on hardware or operating systems, allowing common personal computers (PCs, Macintosh, Sun, etc.) and large mainframe systems (IBM, Digital, etc.) to communicate regardless of operating system (MS-DOS, UNIX, VMS, etc.).

This is one of the key reasons for the internet’s widespread popularity. It is estimated that more than 10 million computers are currently connected to the internet, serving nearly 80 million users. In practice, anyone with access to a computer and a network connection can communicate with any corresponding party worldwide. Information stored on connected computers can also be shared across the network, if desired. Naturally, this has raised concerns related to privacy, ownership, security, and economic inequality.

INTERNET SERVICES

As noted above, the internet is a network solution that enables the distribution of a wide variety of electronic information to a very broad user base. In addition to text-based information, audio and images (both static and moving) can be transmitted. The main limitation is the speed of data connections—transferring large image or audio files over slow connections can be frustratingly time-consuming. However, in so-called developed countries, progress has been rapid (high-speed backbone connections and ISDN).

It is entirely possible that the internet will, within a few years, largely replace the traditional telephone. This has already transformed—and will continue to transform—the telecommunications sector, as internet connections are relatively inexpensive.

Common Internet Services

Email
The oldest and most widespread use of the internet. Nearly all internet users can send and receive email, which may include text, images, audio, and attached documents or files. Email is also used to distribute messages in mailing lists and newsgroups.

Email addresses are typically identified by the @ symbol (pronounced “at”), commonly formatted as firstname.lastname@xxx.zzz.yy, where xxx and zzz identify the service provider and yy is a country code (e.g. fi for Finland) or an organisational identifier such as .com, .org, .edu, .gov, or .net.

Email is often more efficient and economical than telephone, fax, or traditional mail. It is estimated that up to 40% of letter-based communication will shift to electronic form in coming years, much of it via email.

World Wide Web (WWW)
Developed at CERN, the European Organization for Nuclear Research, the WWW is currently the most effective way to utilise the internet’s capabilities. It integrates text, images, sound, and interactivity using hypertext and multimedia elements. It is based on HTML documents (pages) that are published and linked to other pages on the network. Pages can be publicly accessible or restricted to specific user groups via passwords or intranet solutions.

Each page has a unique URL address entered into a web browser. Many internet users can publish their own material online—unfortunately, much of it is currently of questionable value.

Newsgroups and Discussion Lists
Near real-time discussion platforms focused on specific topics. Newsgroups are usually publicly accessible, while mailing lists distribute messages via email to subscribed members only. It is estimated that there are over 14,000 newsgroups worldwide.

Other Internet Services

• IRC – real-time text-based chat
• FTP – file transfer (e.g. software distribution)
• CHAT – voice communication between users (internet telephony)

THE INTERNET AS A SUPPORT TOOL IN CLINICAL LABORATORY WORK

Until recent years, internet connectivity in clinical laboratories has been fairly limited, and therefore, relatively few services specifically supporting laboratory work have emerged. This has been the case both nationally and internationally. In Finland, inter-laboratory data transfer has not even been formally recognised as part of telemedicine, although it clearly belongs there.

In contrast, fields such as radiology, pathology, dermatology, surgery, ophthalmology, and even psychiatry have advanced more rapidly in this respect. Their web-based applications often make extensive use of internet capabilities.

Nevertheless, the situation is not so dire that clinical laboratories have fallen completely behind. This area has simply received relatively little attention, at least in Finland. The internet still offers many opportunities for laboratories to develop their work through existing services.

Examples of national and international services include discussion forums, institutional websites, scientific databases, online ordering systems, laboratory nomenclature databases, and congress and training materials.

Labquality Oy is also beginning to use WWW-based communication as part of its operations.

FUTURE OUTLOOK

Easier and freer information flow has already changed—and will continue to change—our everyday work and private lives. Clinical laboratories will not be left outside this development. External and internal healthcare communication will increasingly take place via data networks, including the internet. Commercial partners will offer their services through networks, often at lower cost than traditional delivery methods.

In the near future, laboratory instruments and analytics will be remotely serviced directly via internet connections to distributors or manufacturers. Ordering reagents and supplies will be done electronically or automatically via inventory systems linked to analysers.

Quality control will increasingly use network-based solutions. Internal quality control is already supported by centralised laboratory information systems, and in the future, external quality assessment may be integrated so that results are transmitted directly from analysers to the provider’s database. Feedback will be delivered electronically via email, files, or web portals.

Training for laboratory staff will also increasingly move into the digital realm. High-quality educational materials prepared by leading experts will be more easily accessible, enabling more equal training opportunities regardless of location.

Combined with advancing laboratory automation, these developments can free staff to focus on the core task of clinical laboratories: ensuring the production and delivery of high-quality results. At the same time, closer collaboration with stakeholders, clients, and service providers will become possible.

However, the adoption of new technology also carries the risk that those without access may be left behind and permanently lose opportunities to develop their operational environment.