See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/6959739

SIBAS: A blood bank information system and its

5-year implementation at Macau

Article in Computers in Biology and Medicine · June 2007

DOI: 10.1016/j.compbiomed.2006.03.010 · Source: PubMed

CITATIONS READS

9 534

3 authors, including:

Bing Nan Li Ming Chui Dong

Hefei University of Technology University of Macau
52 PUBLICATIONS 403 CITATIONS 42 PUBLICATIONS 210 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Bing Nan Li on 18 December 2016.

The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document
and are linked to publications on ResearchGate, letting you access and read them immediately.
 Computers in Biology and Medicine 37 (2007) 588 – 597
www.intl.elsevierhealth.com/journals/cobm

SIBAS: A blood bank information system and its 5-year

implementation at Macau
Bing Nan Lia,∗ , Sam Chaoa , Ming Chui Donga, b
a Institute of System and Computer Engineering of Macau, University of Macau, Block 3, 1/F, Taipa 1356, Macau
b Department of Electrical and Electronics Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau

Received 15 August 2005; accepted 29 March 2006

Abstract
Automation systems and information technology can greatly help medical facilities to improve their working efficiency and optimize the
whole workflow. This article surveys electronic information management in blood donation and transfusion service, and explores the rationale
and archetype of blood bank information systems, then exemplifies a successful in-running system—Sistema Integrado de Bancos de Sangue
(SIBAS), which is developed by the Institute of Systems and Computer Engineering of Macau (INESC-Macau) in cooperation with the Macau
Blood Transfusion Center (CTS-Macau). Its implementation and the related lessons are briefly introduced too. In essence, this article is oriented
to serve as a reference of contemporary blood bank information systems.
䉷 2006 Elsevier Ltd. All rights reserved.

Keywords: Blood banks; Information management; Workflow control; Automation systems; Electronic records

1. Introduction sampling, laboratory testing and especially inventory manage-

ment of blood components were found to be an important con-
Blood donation and transfusion service involves collect- tributory factor in many of such incidents too [3,4].
ing, processing, storing and providing human blood intended Information and computer technology has been widely de-
for transfusion, performing pre-transfusion testing, cross- ployed in medicine, and reveals the great potential to improve
matching, and finally infusing into a patient [1]. Therefore, efficiency as well as quality. In terms of blood donation and
generally speaking, the blood bank system consists of the in- transfusion service, combined with various automation appa-
dependent blood centers, which collect, store and distribute ratus, it can obviously ease and secure most procedures of
human blood, and hospital blood banks charging of transfusion- donor screening, blood collection, laboratory testing and cross-
related services. Given the life-threatening nature of blood and matching, etc. Especially, as to the issue challenging blood
blood components, it entails the rigorous controlling, monitor- banks, namely, the complete documentation for possible back-
ing and the complete documentation of the whole procedure ward inspection, the introduction of information and computer
from blood collection to blood infusion. technology can effectively relieve workload of blood banks and
However, in face of the tremendous amount of data and reduce the incidence of “wrong blood” episodes [5–8].
information in a daily interval, various errors inevitably lead As a consequence, worldwide researchers initiated many
to significant risks in the mentioned procedure of blood do- pilot projects early in 1960s–1980s [9–14]. Then, with the
nation and transfusion service. Errors at the time of adminis- systemization of computers in blood banks [15–17], US Food
tration of blood or blood components are the most frequent & Drug Administration (FDA) officially recommended the
documented site of error cumulating in the transfusion of implementation of blood bank computerization in 1988 [18].
the wrong blood [2]. Furthermore, preceding errors in blood It pointed out “Automated or electronic data systems used
in blood and plasma establishments should have the capacity
∗ Corresponding author. Tel.: +853 835 923; fax: +853 835 928. to trace the history of every donation forward through final
E-mail address: bingoon@ieee.org (B.N. Li). disposition of each component and from each transfusion,
0010-4825/$ - see front matter 䉷 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.compbiomed.2006.03.010
 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597 589

infusion or sale backward to the original donor”. And FDA banks. But, benefited from the advances of science and tech-
published the detailed requirements for blood bank comput- nology for blood preservation and circulation, nowadays the
erization in 1989 [19]. Further, in accordance with the de- mode of independent blood banks is widely accepted for vol-
velopment of information and computer technology, FDA has untary, directed and aphaeresis blood donation service in most
to keep updating the instructive specifications exemplified by countries and regions [30].
the subsequent publications in 1994, 1997 and 2005 [20–22]. Obviously, an environment-friendly blood bank, compared
Meanwhile, other developed countries and regions, including with hospital blood banks, is more conducive to the mood of
the United Kingdom and France, also developed corresponding blood donors, which is of importance for donor recruitment and
blood bank computing standards [23–27]. retention. On the other hand, with the discovery of more and
Nowadays, it has been well established about the necessity more transfusion–transmitted diseases, it necessitates a series
and feasibility of blood bank computerization. In face of such of sophisticated blood testing and analyzing apparatus for the
exigent demands, many institutes and vendors have devoted to secure blood donation and transfusion service. The centralized
this field of blood bank computerization. For instance, merely blood banks hence contribute to decreasing national medical ex-
in the United States, FDA licenses a series of computer soft- penditure on these apparatus and related professional training.
ware for blood bank computing [28]. Different from Hospital The reason is also justifiable from the viewpoint of blood pro-
Information System (HIS), here it is noteworthy that most of cessing and production. Finally, the independent blood banks
these released computer software are designed and optimized can effectively guarantee the impartial blood distribution and
for the specific blood banks. Despite several industrial consen- supply. In other words, such model has been proved to optimize
sus for specific aspects of blood bank and transfusion service the national blood utilization.
[29], lacking of widely accepted standards definitely hampers At the same time, hospital blood banks also play the key
the development of blood bank information systems. Therefore, role in blood transfusion service. First of all, to guarantee
even though some general industrial concepts exist about sys- safe blood transfusion, cross-matching and validation are in-
tem and information models, it is still time now to inspect the dispensable operations before formal blood infusion. In the
essential role, mission and framework of blood bank informa- second, although most blood banks run in the 24/7 mode, any
tion systems, and explore the feasible standard and consensus. hospital has to preserve an appropriate portion of blood in
Anyway, a clear development framework and the effective im- its blood bank so as to ensure the quick response to medical
plementation reference will definitely contribute to the success emergencies. Finally, as mentioned previously, the autologous
of blood bank information systems. blood donation and transfusion is recommended to be con-
ducted within a hospital blood bank according to the patient’s
2. Rationale of blood bank information systems residence. Consequently, although blood analyzing and pro-
cessing can be submitted to a tertiary blood center, the hospital
2.1. Role of blood centers in transfusion service blood bank is in essence a self-contained system.
In a whole, the integral network of blood donation and trans-
According to its formal definition, the whole life cycle of fusion service should comprise blood centers, hospital blood
blood donation and transfusion service involves collection, pro- banks and small or ambulatory blood stations. If we see their
cessing, storage, transportation, pre-transfusion testing, and fi- advantages and disadvantages, obviously, the successful oper-
nal infusion. Although these operations may take place in a ation and management of blood banks should be attributed to
single hospital blood bank, in fact, they are often performed modern information and computer technology. In the first, the
in two separate places. For example, the blood for transfusion donor screening procedure calls for the computerized and net-
is usually collected in the independent blood centers (or blood worked donor information systems so that blood banks could
establishments), which then process, store and disseminate it preclude the illegible donors in time. Secondly, if all blood in-
for utilization by a hospital’s transfusion service. Hence, unless ventory information systems can run transparently and subject
special notification, the term “blood bank” hereinafter will be to the surveillance of independent committees, it is possible to
defined as a blood center responsible for maintaining an ade- revise and optimize the traditional network of blood donation
quate supply of needed blood and blood components, and re- and transfusion service. For instance, the blood center can be
leasing the blood for transfusion service. And a hospital blood affiliated as a complex hospital blood bank. Of course, all de-
bank refers to the blood and transfusion division in that hospital. pend on the advances of computerized and networked blood
However, from the viewpoint of blood circulation, the role bank information systems.
of independent blood banks seems questionable. Generally
speaking, the integral transfusion service can be sketched as in
Fig. 1. Due to the separate operations in blood banks and 2.2. Automation systems in a blood bank
hospital blood banks, many factors inevitably increase the risk
of blood transfusion service in terms of secondary infection, In a blood bank, automation benefits from a broad range
misplacement and so forth. Then, why the independent blood of systems and apparatus, including automated manufacturing
bank? As a matter of fact, hospital blood banks were firstly equipments, control systems, automated laboratory systems,
introduced into blood transfusion service. Moreover the au- computers including laboratory or manufacturing database
tologous blood donations are often settled in hospital blood system, etc. And all of them are organized in a hierarchy of
590 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597

Donor Reception N Collection Blood Stock

Nurse Doctor Y Clinical Ward
Eligible? Nurses Physicians
Donor Registry Nurse
Blood Collection Cross Match
Donor Screening Blood Specimen
Blood Dispatch

Laboratory
Component Blood Stock
Technicians Y Clinical Ward
Technicians Eligible? Technicians
MicroBiology Nurse Doctor
Blood Components Blood Products
ImmunoHematology N Patient Verification
Blood Infusion Patient
Incineration

Fig. 1. The operational model of blood donation and transfusion service.

hardware, software and network components [31]. In essence, cal personnel to perform in an optimized and efficient manner.
these systems firstly attempt to automate various process- Hence, the HIS is in essence a patient-oriented system with the
ing, testing and producing activities so as to avoid human- underlying objective to improve hospital efficiency. As to blood
introduced contamination and errors. At the same time, these bank information systems, one of their objectives is no doubt
automation systems are designed to streamline diverse opera- to optimize the streamline of blood donation and transfusion
tions taking place in a blood bank such as donor screening, data service. However, the most important is to track every unit of
analyzing, blood management and dissemination, etc. [23,32]. blood and blood components from donation to infusion so that
Nowadays all of these activities have been deeply intertwined the safety could be fundamentally guaranteed. Obviously, such
with the computerized and networked information system in a difference rooting in their missions brings the distinct models
blood bank. and frameworks in nature.
First of all, its information system enables the genuine au-
tonomous blood processing without human intervention. Those 3. Design considerations
processing results can be automatically imported into its in-
formation system as electronic data in database via various 3.1. Information in a blood bank
hard/soft interfaces. In the second, thanks to the integral in-
formation system, the heterogeneous operations in the blood Few healthcare operations are as complex as managing blood
donation and transfusion service can be really streamlined due and blood components. A blood bank needs to handle daily
to the consistent data and information. Similarly, the close net- hundreds and thousands of pieces of data and information cov-
work of blood donation and transfusion service can be built to ering from blood donation to blood distribution. Therefore, to
cope with those challenging issues such as global optimization develop a robust blood bank information system, the first task
of blood dissemination, tracking adverse transfusion reaction, should locate in archiving those related heterogeneous data and
and the possible backward inspection, etc. information. Here, it is addressed in accordance with the life
Coming back to the blood bank information system, there cycle of blood components from original donor to final patient,
are two alternatives widely accepted in the blood donation and as shown in Fig. 2.
transfusion service. The first one is to build the blood bank in- Recruiting healthy donors is the first whilst crucial step
formation system as a subsystem of HIS, exemplified by the to guarantee the safe blood donation and transfusion ser-
blood bank module in Sushrut䉷 HIS [33]. Such paradigm is vice. Thereby, it is necessary for any blood bank information
recommended for hospital blood banks because it close in- system to provide the effective solution for donor screening
tegrates with other HIS modules like in-patient management, and tracking. Traditionally, donor screening is based on the
billing, and out-patient management, etc. On the contrary, most self-conscious questionnaire covering general information of
independent blood banks prefer to the standalone blood bank personal data, medial record and donation history. The ad-
information systems, which exchange information with outside ditional information includes simple physical examination,
systems via the special interfaces. post-donation reactions and subsequent blood testing results
To understand the intrinsic difference between two alterna- [34]. However, in contemporary blood bank information sys-
tives, it is necessary to capture their respective missions of HISs tem, more and more objective data and information, such as
and blood bank information systems. A HIS is generally devel- accurate donation parameters and believable medical informa-
oped with the objective of streamlining the treatment flow of tion from hospitals, are desired to improve the safety of blood
a patient in the hospital, which allows doctors and other medi- donation and transfusion service [35].
 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597 591

Donor Donation Lab Blood Stock

Module Module Module Module
Blood
Apparatus & Materials Info.
Distribution

Medical
History
Pre-transfusion

Patient
Info.

Info.
Testing

Post-donation

Testing Data

Components
Information

Information

Information
Collection

In terface

Inventory
Inventory
Blood

Blood

ED I
Info.
Transfusion
Examination Information

Staff Info.
Medical
Physical

Post-transfusion
Transfusion
Information
Agencies
Blood Bank Staff Info.
Info.
Blood Bank Module in HIS
Blood Bank Information System

Fig. 2. Data and information in the blood donation and transfusion service.

Similar as other medical facilities involved in life-threatening intervention, which not only guarantees the consistency of
affairs, any related apparatus, materials and staffs in blood do- blood bank information but also improves blood bank working
nation and transfusion service should be rigorously labeled and efficiency [37].
recorded for the possible backward inspection. This part of in- As to intelligent decision-making support, two intrinsic chal-
formation consists of the unique identifications and their con- lenges call for the development of autonomous information an-
nection with every unit of blood and blood components, for alyzing technology in blood banks. The first one stems from the
example, blood containers, staff’s decisions and operations, etc. fact that most blood bank staff lack of professional IT skills.
Another appreciated function of blood bank information sys- And the other one comes from the challenge of tremendous
tems is able to optimize blood distribution and utilization. It is and heterogeneous data and information. Without the effec-
built on the integral information of blood inventories in blood tive analyzing and decision-making support tools, any blood
banks and hospital blood banks. The peripheral information bank information system will not be fully embraced by blood
includes lists of transfusion facilities and blood distribution bank staffs, which no doubt impairs its deserved status. Conse-
records. Again, the computerized and networked management quently, two paradigms including data-driven and knowledge-
substantially promotes the quick response ability of blood banks driven decision support modules have advanced to answer the
to various medical emergencies. aforementioned challenging issues [38,39].
Final part of information is comprised of the feedback data
and messages from outside transfusion facilities with the help 3.3. Streamlined information system
of electronic data interchange (EDI). More than the substitut-
ing role of text documents, a contemporary blood bank infor- As mentioned previously, barcode technology is an essential
mation system contributes to blood donation and transfusion tool for the implementation of automated blood bank informa-
service through the complete chain of information interchange tion system. As a matter of fact, the full participation of bar-
and share. As a consequence, the blood information can be code technology promotes blood bank working efficiency too.
considerably enriched due to those feedback information in- For example, since all blood materials are uniformly barcoded,
cluding blood transfusion records and patients’ transfusion the involved working procedures such as laboratory testing and
reaction, etc. component producing can be undertaken simultaneously. Of
course, besides barcode technology, the streamlined workflow
3.2. Autonomous information system should be firstly ascribed to the application of information and
computer technology in blood banks. Thanks to network and
A blood bank information system is in essence an au- information technology, it is possible to synergize various ac-
tonomous system. And two major aspects embody its auton- tivities in blood bank via information interchange and share.
omy: the interfaces for automated data acquisition and the As a consequence, one feature of contemporary blood bank
modules of intelligent decision-making support. Automated information system is able to streamline overall blood bank
data acquiring interface, a salient feature of contemporary procedure so as to improve working efficiency whilst keeping
blood bank information system, can effectively reduce human- the high-performance safety of blood donation and transfusion
introduced errors. For instance, with the help of barcode service [40].
printers and readers, most materials in that blood bank can
be labeled and verified through their unique barcodes [36]. 3.4. Close information system
At the same time, owing to the automated interface to var-
ious blood testing and processing apparatus, most of raw The term “close” implies two aspects of blood bank man-
data and detailed information can be archived without human agement: firstly, a blood bank information system should
592 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597

accomplish the complete information flow from blood dona- records. Moreover, the integral blood information can be
tion to blood infusion; secondly, the blood bank information built from initial blood donor, involved staffs and materials
system should keep as a black box to unauthorized users. to the final blood recipient.
Workflow synergy and information synchronization are par- 3. Information synergy: A salient contribution of blood bank
ticularly appreciated in contemporary blood bank information information systems lies in promoting blood bank working
systems. It means that any data or information in blood do- efficiency. However, the concurrent operations of blood an-
nation and transfusion service will play a global role. On the alyzing and processing threaten the safety of blood dona-
other hand, facing the harsh network environment permeated tion and transfusion service. Therefore, information synergy
with Trojan and virus software, blood banks should pay more plays a very crucial role in this field. Here, barcode tech-
attention on the issue of data security. It is necessary to build nology is recommended and has been practically proved
blood bank information systems in a hierarchical framework. effective for such synergic workflow.
Any operation on database should be rigorously verified and 4. Information security: Same as other medical facilities, in-
monitored. Similarly, the privilege of every group of users formation security is always an inevitable issue with regard
should be clearly configured so that even authorized users are to life-threatening products in blood banks. The related
only able to conduct the permitted operations. topics include protecting donor privacy, preventing unau-
thorized data operation, and information system disaster
recovery, etc. A robust blood bank information system
3.5. Open information system
should guarantee not only the consistent data recovery but
also quick disaster response due to its 24/7 uninterrupted
Paradoxically, at the same time, blood bank information sys-
operation mode.
tems should subject to the open platform for information in-
terchange. As discussed in above, to form a complete informa-
tion flow, blood bank information systems need to exchange
4. SIBAS at Macau
various data and messages with outside subjects, such as hos-
pital blood banks at least. However, due to diversified infor-
4.1. Blood donation and transfusion service at Macau
mation systems in blood donation and transfusion service, it is
no doubt a challenging issue to implement the effective open
Macau Special Administration Region belongs to the terri-
interface for EDI. In this field, the related exploration includes
tory of People’s Republic of China, covers the area of about
“United Nations/Electronic Data Interchange for Administra-
27 km2 , and populates near 470,000 residents. In Macau, the
tion, Commerce and Transport” (UN/EDIFACT), “American
medical and health service providers can be classified as gov-
Society of Testing and Materials” (ASTM), and “Health Level
ernmental and nongovernmental facilities. The former includes
Seven” (HL7) [41–43].
government health centers and the Conde S. Januario Hospital
while the latter consists of medical entities subsidized by the
3.6. Essences of blood bank information government and other institutions such as Kiang Wu Hospital,
the Workers’ Clinic and Tung Sin Tong Clinic, as well as vari-
As a whole, contemporary blood bank information systems ous private clinics and laboratories.
should pay more attention on the following characteristics of However, in terms of blood donation and transfusion service,
information in blood donation and transfusion service: the Macau Blood Transfusion Center (CTS-Macau) is in sole
charge of nonremunerated Macau-wide blood collection and
1. Information credibility: Firstly, in terms of health informa- legal supply of blood components. Meanwhile, blood transfu-
tion, besides donor’s subjective response, more objective sion service is mainly implemented in two complex hospitals:
items, including electronic patient/health records, are intro- the Conde S. Januario Hospital and Kiang Wu Hospital. In
duced to assure information credibility so that the eligibility 2004, total 12,035 residents registered for blood donation and
of blood donation could be improved. In the second, do- about 10,457 units of blood were collected. Over 2240 patients
nation and transfusion information is checked and verified accepted transfusion service in two complex hospitals with a
throughout the whole procedure with the help of barcode consumption of more than 26,800 units of blood components.
technology. Thirdly, as to blood information, not only is it CTS-Macau keeps promoting the safety of blood donation
guaranteed by barcode technology but also it benefits from and transfusion service at Macau. And presently it has passed
various automatic testing and processing apparatus in blood through ISO9001:2000 quality management system. At the
donation and transfusion service. same time, its affiliated laboratories for blood testing and pro-
2. Information integrity: It is mentioned that blood bank in- cessing also participate in “United Kingdom National External
formation systems appreciate the close information flow in Quality Assessment Service (UK-NEQAS)” and “National
order to improve information integrity of donors as well as Serology Reference Laboratory of Australia (NRL)” so that
blood components. Obviously, thanks to information inter- all blood components could rigorously comply with the stan-
change and share, candidate donors can be evaluated in all dards of European Transfusion Committee. In 1999, to further
sides because of donation reaction, blood testing results, improve its service performance and quality, CTS-Macau, co-
subsequent blood utilization, and electronic patient/health operated with Institute of Systems and Computer Engineering
 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597 593

of Macau (INESC-Macau), initiated the computerized and net- the barcode-based blood tracking and managing paradigm, and
worked blood bank information system—Sistema Integrado de has fully realized the computerized and networked blood bank
Bancos de Sangue (SIBAS). information system, whose practical infrastructure is shown in
Fig. 3. The involved apparatus and systems can be generally
categorized as following:
4.2. Infrastructure of SIBAS

Any process or procedure within a blood bank must subordi- 1. Personal computers: Include desktop computers, laptop
nate to the safety of blood donation and transfusion service no computers, and tablet PCs; run under Windows-compliant
matter in the sight of blood donors or blood recipients. Once environment including Windows 98䉷 , Windows 2000䉷
a donor reaches the blood bank, a unique donor number and and Windows XP䉷 . These computers scatter in every di-
donation number will be firstly assigned to this donor; before vision of the blood bank such as reception, collection
his/her donation, the nurses will conduct a series of simple area, laboratories, stocks, and even blood mobiles. Most
physical examination; then, based on the donor’s background of them connect to blood bank databases through Intranet
information and the nurses’ examination results, the doctor will network in order to share and interchange blood bank
make the final decision whether this donor is suitable for blood information.
donation without influence on his/her health condition. If donor 2. Servers: Support information share and workflow synergy.
screening is successfully passed, this donor is eligible to enter Here, two measures are adopted to guarantee data safety
the area of blood collection for blood and blood specimen. Af- and network robustness. The first one is to implement
ter donation, this donor will be requested to have a rest and the one-to-one service strategy, namely, a serve (maybe as vir-
nurse will record his/her post-donation reactions. tual machine) is specially designed and optimized for the
Then the blood specimen will be transferred to professional specific service such as data management (independent
laboratories for blood ABO/Rh grouping and testing blood database for donor, donation, laboratory, stock, staff and
transmitted diseases, including hepatitis (a liver infection), HIV materials, etc.), document management (printing, scan-
(the virus that causes AIDS), HLTV I/II (the virus associated ning, and faxing, etc.), Virtual Private Network (VPN)
with a rare form of leukemia), and syphilis, etc. Meanwhile the to hospitals and health bureau, and Internet information
whole blood is submitted to be separated into red blood cells, accessing. Secondly, there is a server for synchronous
platelets, plasma, and other human blood clotting agents. If database backup and a magnetic tape server for daily
the validating results from blood testing laboratories are nega- database backup.
tive, the produced blood components will be conveyed to blood 3. Automated blood testing apparatus: CTS-Macau makes
stock for inventory management. Otherwise, those blood com- good use of various automated blood testing and produc-
ponents and blood specimen should be incinerated in time. ing apparatus so as to assure the quality of testing results
As introduced in previous, automation systems including in- and final blood products. For instance, there are a series of
formation and computer technology have participated in the sophisticated instruments for blood tests in CTS-Macau,
blood bank in all sides and substantially improved its oper- including Microdom䉸 ’s “Mitis2” for blood typing and an-
ating efficiency. Coming to CTS-Macau, nowadays it owns tibody screening test, Vitros䉸 ’s “ECi” for blood immun-
full-function Intranet/Internet network system, adopts all-round odiagnostic test, Roche䉸 ’s “MagNA Pure LC System” and
autonomous blood testing and producing apparatus, utilizes “Cobas Amplicor” for microbiologic test, etc.

Fig. 3. Workflow and infrastructure of a blood bank information system.

594 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597

Fig. 4. The software framework of SIBAS.

4. Peripheral apparatus and instruments: In terms of data and information management, SIBAS pro-
• Barcode reader and printer: Zebra䉸 barcode print- vides the all-round Oracle䉸 -based database solution in server
ers are deployed in reception division for donation end:
number label printing and in component division for 1. Data archiving: The independent Oracle䉸 databases are
product label printing. Every division of the blood configured, respectively, for the data and information of
bank is equipped with barcode readers so that a blood donors, donation, blood laboratory testing, blood pro-
series of complex processing could keep rigorous ducing and inventory management, etc. In general, there is
consistency [44,45]. an optimized database for every division of CTS-Macau so
• Electronic donor card read/write machine: CTS- that the efficiency of data management and information ac-
Macau is always desired to provide the best ser- cessing could be substantially improved.
vice to blood donors. Electronic donor card may be 2. User role controlling: In SIBAS, there is a specific database
the most welcomed one. It can not only store the for use role management and controlling. Before any oper-
donor’s basic data in magnetic bar but also print ation on real database of blood bank information, the user
the fine picture about the donor’s donation infor- has to pass through a series of independent procedures of
mation. The whole solution is based on the thermo identification and verification. On the other hand, the user’s
rewritable card technology of Rewrite Card Tech- any operation on blood bank information will be recorded
nology Inc.䉸 [46]. for backward inspection in this database.
• Donation monitoring apparatus: CTS-Macau 3. Middleware: To improve the efficiency of data operation
adopts Terumo䉸 ’s “T-RAC System” to control do- and information accessing, SIBAS makes good use of the
nation procedure and accurately reflect the donor’s concept and method of middleware, namely, packaging pro-
health condition, including duration, volume, aver- cedures, functions and triggers in Oracle䉸 database for data
age/minimal/maximal flow rate, and venepuncture operation. Then the client end just submits its request and
delay of the collection, etc. receives the desired results.
4.3. Software implementation and taking effect 4. Data mining for decision-making support: SIBAS owns the
powerful decision-making supporting function. First of all,
Based on the preceding discussion, a blood bank information there are various statistic reports based on SQL statements
system has to face the challenging issues on workflow synergy, for accurate decision-making information. Moreover, ben-
data integrity, and information security, etc. Here, SIBAS fol- efited from Oracle䉸 Data Mining (ODM) toolkit, SIBAS
lows the client/server framework, namely, implementing data also provides fuzzy decision-making ability for the discov-
management, user role controlling, EDI in server end while ered associated rules, etc.
providing the distributed information processing ability in an 5. Data backup and disaster recovery: As mentioned previ-
integrative operation environment in client end (Fig. 4). ously, there are independent servers for synchronous and
 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597 595

daily backup, respectively, both of which are blind for egorized as the following: (1) technical training and tutorial;
blood bank users. Two HP䉸 servers run synchronously for (2) abnormal data or inconsistent information; (3) database mi-
hot backup with the help of Oracle䉸 Recovery Manager gration and revision; (4) new user specifications, such as user
(RMAN) while a third-party backup system, Veritas䉸 , com- interface revision, workflow revision, automated interfaces for
bined with HP䉸 magnetic tape database, is charge of the new apparatus and so forth. Obviously, most of these problems
daily incremental backup. are in essence related to the scalability of SIBAS.
Although any revision or modification maybe influences its
Coming to the client end, SIBAS provides a uniform solu- integration and robustness, three facts necessitate the funda-
tion of blood bank information system for all divisions. Al- mental updating of SIBAS:
though it also follows the common modules such as donor re-
cruitment, donation monitoring, laboratory blood testing, and 1. The development of blood banks: Due to the absence of IT
inventory management, SIBAS can implement dynamic self- knowledge, it is implausible for blood bank staffs to provide
configurations according to the group privileges of different perfect user specifications regarding a blood bank informa-
user roles. For instance, all users in the blood bank are grouped tion system. In fact, the blood bank should consider the op-
as reception, nurse, doctor, immunohematology, microbiology, timization of its workflow as a long-term strategy in face
validation, component, etc. In addition, the role “supervisor” is of the variations of blood donation and transfusion service,
allocated for systematic configuration and maintenance. for example, the number of blood donors, the introduction
In principle, every group of users lives only in its legitimate of new apparatus and so on.
society. Namely it owns unique user interface suitable for the 2. The development of blood donation and transfusion service:
specific workflow, and calls different subroutines for data op- As a matter of fact, even the official standards keep evolv-
erations and statistic reports. Of course, despite rarely, SIBAS ing so as to provide safer blood donation and transfusion
is powerful enough to permit such users granted more than one service. Obviously, the newly discovered blood transmitted
user role. diseases will no doubt call for the upgrade of blood test-
ing procedure. In SIBAS, one of the underlying revisions in
5. The 5-year implementation and discussion accordance with official standards is the upgrade of blood
bank barcode technology from Codabar to ISBT 128.
The initiative of computerized blood bank information man- 3. The development of information and computer technology:
agement was undertaken at CTS-Macau from October 1999. It is inevitable to upgrade SIBAS so as to keep up with
And INESC-Macau fully participates in this procedure since the fast development of hardware and software technology.
then. From the deployment of basic automated apparatus to For instance, Windows 98䉸 was the mainstream operation
the release of official SIBAS, INESC-Macau, cooperated with system in 1999 while it has been upgraded to Windows
CTS-Macau, pursues to utilize advanced information and com- XP䉸 today. Similarly, Oracle䉸 database has evolved from
puter technology in blood bank automation system and infor- version 8.0 to 10g too. In CTS-Macau, the database was
mation management. upgraded from Oracle䉸 8.0 to Oracle䉸 9i in 2004 because
Nowadays, SIBAS has been deployed in every division of the latter can provide more flexible operations and support
CTS-Macau and provides various automated interfaces for bar- Chinese characters better.
code system, electronic donor cards, blood testing and pro-
cessing apparatus, etc. In the supporting Oracle䉸 database of At present, INESC-Macau still keeps tracking the newest
SIBAS, it records the complete data and information of blood technological development such as “Wireless WiFi LAN” and
donation and transfusion service since 1999. Despite the com- RFID, and explores their applications in blood bank information
paratively tiny blood donation and transfusion service in Macau systems. Of course, with regard to life-threatening blood and
society, there are more than one million pieces of records ar- blood components, any new technology should pass through the
ranged among about 300 tables of five independent databases. rigorous testing and assessment before its formal introduction
At the same time, the amount is still in an increasing rate of daily to blood banks.
thousands of records. During the implementation and mainte-
nance of such a complicated system, the following challenging Acknowledgments
issues should be specially mentioned and discussed.
The authors would like to thank Mr. Bryan (INESC-Macau)
5.1. Implementation challenges and solutions and Mr. Wiok Sam (CTS-Macau) for their technical support
during system deployment.
The 24/7 uninterrupted running mode of blood bank infor-
mation systems necessitates the quick response for technical References
support and service, especially for the situation of disaster re-
[1] American Association of Blood Banks (AABB), Standards for Blood
covery. However, owing to the reliable planning and designing,
Banks and Transfusion Services, 21st ed., American Association of Blood
SIBAS has continuously run for more than 5 years without any Banks, Bethesda, MD, 2002.
serious accidents. Besides the monthly regular maintenance, till [2] K. Sazama, Reports of 355 transfusion-associated deaths: 1976 through
now, the requests for technical support and service can be cat- 1985, Transfusion 30 (7) (1990) 583–590.
596 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597

[3] J.V. Linden, B. Paul, K.P. Dressler, A report of 104 transfusion errors [29] International Council for Commonalty in Blood Banking Automation
in New York State, Transfusion 32 (7) (1992) 601–606. (ICCBBA), ISBT 128 Standard: Technical Specification (Version 2.1.0),
[4] J. Linden, H. Kaplan, Transfusion errors: causes and effects, Transfus. York, PA, August 2004.
Med. Rev. 8 (3) (1994) 169–183. [30] The History of Blood Banking and Transfusion Service
[5] R.N.I. Pietersz, Automation/computerization in blood processing, www.bloodbook.com.
Transfus. Sci. 16 (3) (1995) 235–241. [31] International Society of Blood Transfusion (ISBT), Guidelines for
[6] D.A. Kern, S.T. Bennett, Informatics applications in blood banking, Clin. validation and maintaining the validation state of automated systems in
Lab. Med. 4 (1996) 947–960. blood banks, Vox Sang. Suppl. 1 (2003) s1–s14.
[7] Central Laboratory of the Blood Transfusion Service of the Netherlands [32] Center for Biologics Evaluation and Research, Premarket Notification
(CLBTS), The use of the computer cross-match, Vox Sang. 82(3) (2001) Submissions for Automated Testing Instruments Used in Blood
184. Establishments (Drafted Guidance), August 2001 http://www.fda.gov/
[8] S.H. Butch, Computerization in the transfusion service, Vox Sang. 83 cber/guidelines.htm.
(Suppl. 1) (2002) 105–110. [33] http://www.cdac.in/html/his/bbank.asp.
[9] D. Singman, C.A. Catassi, C.R. Smiley, W.H. Wattenburg, E.L. Peterson, [34] Center for Biologics Evaluation and Research, Guidance for Industry:
Computerized blood bank control, J. Amer. Med. Assoc. 194 (6) (1965) Streamlining the Donor Interviewing Process: Recommendations
583–586. for Self-Administered Questionnaires, July 2003 http://www.fda.gov/
[10] B. Kempf, All French blood donors in a computer: outlook in 1990 or cber/guidelines.htm.
reality in 1970? (French), Transfusion (Paris) 10 (1) (1967) 59–62. [35] Center for Biologics Evaluation and Research, Guidance for
[11] Y. Oba, S. Otani, N. Yasuda, K. Terada, Management of blood donor Industry: Acceptable Full-Length Donor History Questionnaire and
examination by computers (Japanese), Rinsho Byori 19 (Suppl.) (1971) Accompanying Materials for Use in Screening Human Donors
422. of Blood and Blood Components (Draft Guidance), April 2004
[12] F. Peyretti, Automation and computer science in blood transfusion (Italy), http://www.fda.gov/cber/guidelines.htm.
Minerva Med. 88 (1971) 4363. [36] Department of Health and Human Services in FDA, Bar code label
[13] R.W. Chambers, J.A. Lundy, L.I. Friedman, S.B. Gordon, A computerized requirements for human drug products and biological products (Final
donor processing system for a regional blood collection center, Rule), Fed. Regist. 38 (2004) 9119–9171.
Transfusion 2 (1975) 170–173. [37] Center for Biologics Evaluation and Research, Guidance for FDA
[14] E. Brodheim, Regional blood center automation, Transfusion 3 (1978) Reviewers: Premarket Submissions for Automated Testing Instruments
298–303. Used in Blood Establishments (Draft Guidance), August 2001
[15] B. Page, A review of computer systems in blood banks and discussion http://www.fda.gov/cber/guidelines.htm.
of the applicability of mathematical decision method, Methods Inf. Med. [38] J.F. Kros, P.R. Yim, A decision support system for quantitative
2 (1980) 75–82. measurement of operational efficiency in a blood collection facility,
[16] E. Brodheim, Automated systems in blood banking, Clin. Lab. Med. 1 Comput. Methods Programs Biomed. 74 (1) (2004) 77–89.
(1983) 111–132. [39] B.N. Li, S. Chao, M.C. Dong, On decision making support in blood
[17] B.A. Myhre, F. Ritland, The computer in the blood bank, Crit. Rev. bank information systems, Expert Systems with Applications, Elsevier,
Clin. Lab. Sci. 1 (1986) 21–42. Amsterdam, submitted for publication.
[18] Center for Biologics Evaluation and Research (CBER), Recommenda- [40] G. Brataas, P.H. Hughes, A. Solvberg, Framework for performance
tions for Implementation of Computerization in Blood Establishments, engineering of workflows: a blood bank case study, in: Proceedings
1988 http://www.fda.gov/cber/guidelines.htm. of 31st Hawaii International Conference on System Sciences, 1998,
[19] Center for Biologics Evaluation and Research, Requirements for pp. 230–239.
Computerization of Blood Establishments, 1989 http://www.fda.gov/ [41] R.L. Hirsch, E. Brodheim, Blood distribution systems and the exchange
cber/guidelines.htm. of information between hospital blood banks and regional blood centers,
[20] Center for Biologics Evaluation and Research, A Letter to Vox Sang. 3 (1981) 239–244.
Blood Establishment Computer Software Manufacturers, 1994 [42] D. Weisshaar, Electronic data transfer from computer to computer in
http://www.fda.gov/cber/guidelines.htm. blood banks using HL7, Beitr. Infusionsther. 28 (1991) 370–372.
[21] Center for Biologics Evaluation and Research, Reviewer Guidance for [43] P. Larson, EDI: Electronic Data Interchange, International Council for
a Premarket Notification Submission for Blood Establishments, 1997 Commonality in Blood Banking Automation (ICCBBA), Pittsburgh, PA,
http://www.fda.gov/cber/guidelines.htm. August 1999.
[22] Center for Biologics Evaluation and Research, Draft Guideline for [44] B.N. Li, S. Chao, M.C. Dong, Barcode technology in blood bank
the Validation of Blood Establishment Computer Systems, 2005 information systems: upgrade and its impact, J. Med. Syst., DOI:
http://www.fda.gov/cber/guidelines.htm. 10.1007/s10916-006-9026-z.
[23] British Committee for Standards in Hematology (BCSH), [45] B.N. Li, M.C. Dong, M.I. Vai, From Codabar to ISBT 128: implementing
Recommendations for evaluation, validation and implementation of new barcode technology in blood bank automation system, in: Proceedings
technologies for blood grouping, antibody screening and cross-matching, of 27th IEEE Annual Conference of Medical and Biological Engineering
Transfus. Med. 5 (1995) 145–150. Society, 2005, pp. 542–545.
[24] British Committee for Standards in Hematology (BCSH), Guidelines for [46] B.N. Li, M.C. Dong, Electronic donor cards, Computing and Control
the management of blood and blood components and the management Engineering, IEE, London, submitted for publication.
of transfused patients, Transfus. Med. 9(9) (1999) 227–238.
[25] British Committee for Standards in Hematology (BCSH), Guidelines for
blood bank computing, Transfus. Med. 10(4) (2000) 307–314.
[26] P. Moncharmont, P. Lacruche, B. Planat, A. Morizur, E. Subtil, The case Bing Nan Li received his B.E. degree in Biomedical Engineering from
for standardization of transfusion medicine practices in French blood Southeast University, Nanjing, China, in 2001, and M.S. degree in Elec-
banks, Transfus. Med. 9 (1) (1999) 81–85. trical and Electronics Engineering from University of Macau, Macau, in
2004. He has been with the Institute of System and Computer Engineering
[27] Australian & New Zealand Society of Blood Transfusion Inc. Guidelines
(INESC), Macau, as an R/D engineer. Mr. Li was the Session Co-Chair
for the Administration of Blood Components, October 2004. of IEEE EMBS 2005 which was held in Shanghai, China. Moreover, he
[28] Center for Biologics Evaluation and Research, 510K also serves IEEE Potentials Magazine and several international conferences
Blood Establishment Computer Software. http://www.fda.gov/cber/ as a peer reviewer. His research interests are the applications of computer
guidelines.htm. and information technology in medicine and healthcare, including medical
 B.N. Li et al. / Computers in Biology and Medicine 37 (2007) 588 – 597 597

information engineering, cardiovascular engineering, computational neuro- Ming Chui Dong received his B.S. in Electrical Engineering and M.S. degree
science, etc. in Automation both from Tsinghua University, Beijing, China, in 1970 and
1975, respectively. He visited the Institute of Automation, Roma University,
Roma, Italy, as a Visiting Scholar in 1979–1981. Since 1970, Prof. Dong
Sam Chao received her B.S. and M.S. degrees in Software Engineering has been with the Department of Automation in Tsinghua University along
both from University of Macau, Macau, in 1994 and 1999, respectively. the line of Lecture, Assistant Professor and Associate Professor. He even
She even visited the Institute of System and Computer Engineering, Lisbon, served as the Director of National 863/CIMS Training Center (Beijing) in
Portugal, as an R/D engineer for database center in 1995–1996. Since 1996, 1993–1998, and an Invited Professor of YanTai University, Shandong, China
she has been with the Institute of System and Computer Engineering, Macau, in 1996–1998. Now he is an Associate Professor of University of Macau
as an R/D engineer. Her current research interests are data mining and and the Executive Director of Institute of System and Computer Engineering,
knowledge discovery, web-based data warehouse, and object-rational database Macau, simultaneously. His research interests are automation and system
management system. engineering, and computer integrated manufacturing system (CIMS).

View publication stats