15.3 Laboratory Information System (LIS) Functions

15.3 Laboratory Information System (LIS) Functions

Quick Answer: The LIS is the laboratory’s digital backbone for orders, accessioning, labels, tracking, results support, and comments. Enter data accurately, generate labels that match the right patient and tests, track specimen status, document rejections/problems, protect passwords, and follow downtime paper backups when the system is down. Barcodes help only when the human workflow stays disciplined.

Laboratory Information System (LIS) functions appear under Domain IV Laboratory Operations on the current ASCP MLA guideline (testing dates beginning June 1, 2026). MLAs may not configure middleware or validate interfaces, but they live in the LIS every shift: registering specimens, printing labels, updating locations, and flagging issues that keep the testing process honest.

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Why LIS Accuracy Matters

Every keystroke can become a clinical decision:

Data entry accuracy is a patient-safety skill equal to venipuncture technique. Slow down at the keyboard the same way you slow down at the bedside for ID checks.

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Specimen Accessioning

Accessioning is the process of receiving an order/specimen into the laboratory system and assigning an accession number (unique lab identifier for that specimen episode).

Typical MLA-supported steps (vary by site):

1. Verify the order exists and matches the physical specimen and requisition.
2. Confirm patient identifiers (name, DOB, MRN) against labels and paperwork.
3. Enter or confirm collection date/time, collector ID, and specimen type/source.
4. Assign or accept the accession number and generate labels as required.
5. Route the specimen electronically and physically to the correct department queue.
6. Resolve mismatches before accessioning—do not “force” a wrong tube into a convenient order.

Common accessioning pitfalls

• Selecting a patient with a similar name from a pick list
• Using today’s date automatically when the draw was yesterday (outpatient courier)
• Accessioning before two-identifier verification of the physical specimen
• Ignoring order comments (e.g., “draw in NaF,” “protect from light”)
• Creating duplicate accessions for the same specimen without following merge/cancel policy

If something does not match, stop and clarify with the ordering location or supervisor. Accessioning is not a race that excuses wrong-patient registration.

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Label Generation

LIS-generated labels typically include patient name, identifiers, accession number, tests, tube type cues, and barcodes.

Rules that prevent disasters:

1. Print labels at the point and time policy requires (often bedside for blood collection; central receiving for some send-ins).
2. One patient at a time during labeling workflows when possible.
3. Affix labels to the correct tubes immediately; never pre-label empty tubes for multiple patients in a pocket.
4. If labels jam or print partially, reprint after verifying patient context—do not guess from a torn strip.
5. Destroy unused labels with PHI in confidential bins.
6. Handwritten additions only if SOP allows and must remain legible and permanent.

Barcode-rich labels still fail when humans apply them to the wrong container. Technology reduces typing errors; it does not replace identity discipline.

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Specimen Tracking and Status

Modern LIS modules show specimen status such as: ordered, collected, in lab, in process, completed, cancelled, or rejected (wording varies).

MLA tracking responsibilities often include:

• Updating receipt time when specimens arrive
• Scanning specimens into department or storage locations
• Answering “Where is my specimen?” with system status + physical check, not guesses
• Flagging missing specimens early so recollection can occur
• Understanding batch and courier lists for outreach draws

When the LIS says “in lab” but the tube is not in the expected rack, treat it as a lost specimen workflow: search, document, escalate—do not silently cancel without authorization.

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Comments for Rejection and Problems

Free-text or coded comments communicate why work stopped or needs attention.

Write comments that help the next person

Include what happened, what you did, who you notified, and time when policy requires. Avoid blame-filled language and protected gossip. Comments become part of the legal/medical record in many systems—be factual.

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Barcode Workflows

Barcodes link physical tubes to electronic orders.

Good barcode practice:

• Scan rather than key-enter when the system supports scanning
• Verify the human-readable name still matches after scan (scan can be wrong if label is wrong)
• Replace damaged barcodes that will not scan—do not repeatedly enter the wrong accession “because the scanner is picky” without checking identity
• Keep scanners clean; report wireless dead zones
• Do not photocopy barcodes from one patient’s label onto another tube

Bedside barcode systems (patient wristband + tube label) are powerful when both scans succeed. If a scan fails, follow downtime or override rules exactly—unsafe overrides recreate wrong-patient events.

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Password Security and Session Control

Never share logins. Shared credentials destroy audit trails: when a mislabel or inappropriate chart access occurs, investigators cannot tell who acted. If a float needs access, they use their own provisioned account. Working under another person’s ID can be a terminable offense and a compliance violation.

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Downtime Procedures (Paper Backup)

LIS outages happen—upgrades, network failures, disasters. Facilities maintain downtime procedures the MLA must know before the screen goes blue.

Typical elements:

1. Paper requisitions or downtime forms with required identifiers and tests
2. Manual accession logs or pre-printed downtime accession number lists
3. Handwritten or downtime printer labels meeting minimum ID requirements
4. Clear marking of downtime specimens so they are easy to find later
5. Priority rules for STAT and critical care during limited capacity
6. Recovery entry: when the LIS returns, enter downtime work carefully to avoid duplicates and wrong times
7. Communication to nursing units about delay expectations

Recovery cautions

• Enter collection times from documented paper, not estimated memory
• Match each physical specimen to the correct electronic order before resulting pathways resume
• Escalate volume backlogs; do not rush recovery entry into wrong patients
• Retain downtime paper per retention policy until verified in the LIS

Practice downtime drills if your lab offers them—exam questions love “system is down, what do you do next?”

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Integration with Other Lab Roles

The MLA’s LIS work feeds technologists, pathologists, send-out staff, and billing. Clean accessioning reduces:

• Phone calls asking for redraws that should have been prevented
• Interface errors between EHR and LIS
• Credits and compliance issues from tests performed without valid orders

When an order looks wrong (duplicate daily CBC without clinical note, impossible specimen type), query—do not accession on autopilot.

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Quick LIS Safety Checklist

1. Right patient in the system?
2. Right order/tests?
3. Right collection data?
4. Labels applied to the right containers?
5. Status/comments reflect reality?
6. Session secured under my credentials only?
7. If downtime—paper process followed and recovery planned?

/practice/ascp-mlaPractice questions with detailed explanations