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Glims
Laboratory Information System
Glims
General Laboratory
Information Management System

S.A. MIPS N.V.
Industriepark Zwijnaarde 3A
9052 Gent
Belgium
MIPS France S.a.r.l.
15, Place de la Nation
75011 Paris
France
MIPS GmbH
Borsigstrae 22
21465 Reinbek bei Hamburg
Deutschland
Http://www.mips.be
MIPS Iberica
Calle Orense 34, 8a Planta
28020 Madrid
Espaa
MI PS
Experts in Healthcare IT
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Glims
Laboratory Information System
Glims
Laboratory Information System
Automating your laboratory is an impor-
tant factor for success in todays com-
petitive world. GLIMS takes advantage
of and inherits many years of experience
from MIPSYS. In the competitive market
of Laboratory Information Systems,
GLIMS offers you even more - its graphi-
cal user interface, sample tracking, GLP
compliance and relational databases, to
name but a few of its advantages.

From the start, MIPS' policy has been to
develop its products in close cooperation
with key people in the clinical pathology
business. Advice from experts in hospi-
tal and ambulatory environments, and
also in academic centers has resulted in
a very user-friendly product, offering sig-
nificant improvements in operational
management and reduction in staff
costs.

The latest technologies are used, includ-
ing:
A relational Database Management
System, open to external query via
ODBC
An Object-Oriented development ap-
proach
Client/Server & Multitier application
partitioning
Internet / Intranet communication
Multiple user interfaces (Teletype,
Graphical, World Wide Web)

The product's flexibility is truly excep-
tional, allowing the user to completely
define the layout and content of screens
and reports. It also incorporates a labo-
ratory oriented expert system to imple-
ment diagnostic support rules or reflex
testing. In multilingual sites or distrib-
uted networks, each user can log into
the system in his/her own language and
consult the tailor-made generated re-
ports.

Direct access to all functions is imple-
mented by means of a user-specific tool-
bar. Users have multiple search possi-
bilities to obtain results for a patient, or
for a prescribing physician, for in-
stance Analyzers are bi-directionally
connected, allowing centralized control
Introduction and highlights

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Glims
Laboratory Information System
and cost savings. Dedicated technical
modules are available for all special labo-
ratory departments, including microbiol-
ogy, transfusion management, pathol-
ogy. Billing and accounting modules
are kept up-to-date with fast-changing
legislation.

GLIMS has a unified communication
model for external applications improv-
ing robustness and increasing GLIMS'
flexibility for integration into a larger in-
formation Network. Support is provided
for quality assurance functions (ISO/
GLP).

Users identify themselves when logging
in. They must provide a log-in name and
a password. GLIMS hides the menu op-
tions to access those functions prohib-
ited to any user.

GLIMS plays a vital role in implementing
Good Laboratory Practice and is a key
tool for your laboratory in achieving its
goals on quality. An internal audit trail
imposes extra demands on software de-
velopments. GLIMS also has Standard
Operation Procedures (SOP) to ensure
the validity and traceability of data on
the internal, routine and daily operation
laboratory procedures. Thus it is possi-
ble at any time to show, monitor and
record the various procedures to which
data or laboratory activities have been
subjected from start to finish (of the
work).

GLIMS also performs audits. For exam-
ple, all result modifications and status
changes are automatically logged. The
report of any individual result is also
logged. All billing operations are logged
and traceable.

Procedures
GLIMS offers a unified model for the de-
scription of all technical laboratory ac-
tivities, including sampling, preprocess-
ing, observation and derivation. The
model allows combining basic activity
descriptors into an elegant representa-
tion of complex procedures.
Introduction and highlights

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Glims
Laboratory Information System
The figure above is an example of an
action diagram, leading to an assess-
ment of Low Density Lipoproteins in a
clinical laboratory.

GLIMS is highly flexible because it can
loosely connect administrative, technical
and financial configurations. Properties
are attributes of the analyses requested.
They can be assessed through one or
several alternative methods or proce-
dures. System commands available in-
clude the selection of specific tests, pan-
els of tests, specific samples of method-
ologies which can either be explicitly re-
quested at order entry, or automatically
using reflex test triggers.

Order entry
Linking orders to patients is effected ei-
ther with or without communication to
hospital information systems. When a
patient identification code is entered,
GLIMS queries all connected systems,
which support the code format. Patient
data input is stored locally to ensure
availability in the event of a HIS commu-
nication problem.

Tests and specimen are requested either
individually or in profiles/panels. GLIMS
uses aliases, or abbreviations, to define
the current set of tests performed in the
laboratory. Sample lists can be re-
quested to obtain a summary of the
available tests and profiles. Different
configurable screen-windowed order
forms can be displayed graphically on
screen to visually guide the order entry
process. Duplicate requests are auto-
matically detected.

Using its configuration data, GLIMS de-
cides which procedures to use and what
information or specimens are still re-
quired to fulfill an order. They are re-
quested (and, optionally, logged in)
automatically.

GLIMS is able to detect a possible reuse
Order entry

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Laboratory Information System
of a specimen or a result, which may
have been delivered earlier for the same
patient. If applicable, you can decide
whether or not to reuse the previous re-
sult or specimen, by creating a link with
the new order.

If GLIMS determines that some or all of
the required specimen for the requested
tests are missing, the specimen records
are kept in a special mode to ensure
scheduling of specimen collection. Sub-
sequently, sample collection lists can be
generated to be taken along during sam-
ple collection.

GLIMS will provide printed labels, con-
taining information about the specimen,
the patient and the tests to be per-
formed, as configured by the database
manager. Specimen numbers are as-
signed using a site-configurable format.

GLIMS enables definition of sample pre-
processing (centrifugation, aliquoting,
etc.). Consequently, work lists can sum-
marize preprocessing work as well as
sampling or test requests. Chained ac-
tions will automatically be synchronized
to wait until all requisites, including ali-
quots or preprocessed materials, are
available.

Work lists
Work lists can be used for manual result
entry or for review of instrument data.
Special attention was given to offer
maximum flexibility and to consider the
user's wishes.

Samples are sequenced, with sorting
controlled by work list specific criteria
such as urgency or test priority. This
sequencing may also be driven by a
dedicated tray layout, determining the
relative positions of quality control sam-
ples among patient samples.

The work list can include user-selected
demographics or test results from the
GLIMS database. Results requiring spe-
cial attention are highlighted. Different
types can be predefined as templates, to
determine layout, selection and sort cri-
teria, as well as the relative position of
quality control samples among patient
samples. Pop-up menus provide easy
Result acquisition

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Laboratory Information System
access to information related to the fo-
cused result.

Work list forms are organized in rows
and columns, corresponding to orders
and tests, respectively. Their appearance
on screen matches the printed sheet for
easy result entry by lab technicians.

The succession of print-outs and sorting
is also parameterized (by department,
priorities, emergencies, etc.). There is
full control over successive versions,
sorting etc.
The number of work lists is virtually
unlimited.
Successive work list versions are stored
on disk.

Instrument interfacing
GLIMS supports direct communication
with any instrument (supporting host
query if applicable), over either a serial
or a TCP/IP connection.

Among the many benefits are multiple
instrument monitoring from any general-
purpose workstation, standardized pro-
cedures for quality control and direct ac-
cess to historical patient data for valida-
tion purposes.
Communication via dedicated high prior-
ity processes, capable of stand-alone
operation in the event of server downing
is also supported.

Manual result entry
In the absence of an instrument link, re-
sults can be typed in a spreadsheet-like
grid interface, with rows corresponding
to specimen and columns corresponding
to properties. The grid size is unlimited,
as it can scroll both horizontally and ver-
tically. The size of the result itself is also
unlimited, as the grid cells can also be
Result acquisition

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Glims
Laboratory Information System
scrolled (the result may be numerical or
free text of unlimited length). From the
result context in the grid cells, any result
method can be activated.

Numerical results can be entered in dif-
ferent units; GLIMS automatically con-
verts to the applicable base unit prior to
performing any checks. Exponential no-
tation is accepted, as are comparatives
(less or greater than).

Quality control
One of the prime objectives of laborato-
ries is to ensure that laboratory quality-
control practices are adequate to achieve
satisfactory analytical quality.

GLIMS provides internal and external
quality control. Internal quality control
(IQC) checks whether test results on
quality control materials are reproduci-
ble.

External quality control (which may be
enforced by law) checks whether differ-
ent laboratories produce comparable re-
sults on the same material. In this case,
the control samples may not even be
recognizable as such. IQC is based on
the regular scheduling of analyses on
quality control specimens. This schedul-
ing can be defined by the LIMS, but this
is not mandatory.

Beside simple accuracy control and
trend checking, GLIMS supports the QC
algorithms of Westgard and Trigg. Qual-
ity control specimen can be scheduled
automatically at predefined positions
among routine specimen. Alternatively,
unsolicited QC results sent by any con-
nected instrument are also processed. In
any case, quality control results must be
stored to perform the quality control
function. The usual norm validation may
Quality control

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Laboratory Information System
have to be disabled for IQC samples.
Violation of quality control checks puts
the associated result output channel in
Unreliable status, until it is manually
reset. Patient results obtained from an
unreliable channel are marked as such.

Result validation
Method-specific normal range checks
according to sex, age, menstrual cycle
and MISPL (see further) rules are avail-
able. If so configured at the test level,
each result may have to pass a series of
automated checks: for format, accuracy
and precision, channel trend, range, and
shift (delta checks).

All check definitions allow to specify
how the result must be treated if an
alarm is signaled. Severity levels can be
assigned, comments can be associated
and MISPL trigger code can be launched
to add comments or schedule reflex test-
ing. GLIMS also supports two explicit
validation levels: technical and biologi-
cal. Configuration allows specification of
the result severity level, below which the
respective validation procedures are per-
formed automatically.

Reporting
GLIMS features cumulative reports with
configurable content, layout and condi-
tions for output. Different test types
shown on the reports can be organized
hierarchically. Report models can be set
up for each individual correspondent or
group of correspondents, if required. Re-
ports support variable formats: plain
text, HTML, MS Word reports, HL7,
HPRIM, LDT, Medidoc, HealthOne, Edi-
fact, Medar messages, etc.

At order entry, reports are automatically
scheduled according to the issuers pref-
erences. As results become available,
scheduled reports are automatically
marked for output by dedicated back-
ground tasks.

Because of direct contact with the phy-
sician prescribing the test, report gen-
eration is a particularly important part of
GLIMS. The report generator makes it
possible to build up personalized reports
for each physician. Each physician may
Result validation

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Laboratory Information System
obtain reports in the preferred layout, in
his/her own language, with one or more
recapitulative result columns, and with
results expressed in units to which he /
she is accustomed. These and other
physician preferences are stored in the
physician database.

Report retrieval is driven by user search
specifications. Search keys are order
number, an external reference number,
patient name or physician name. For in-
dividual tests, GLIMS keeps track of a
result's availability and reporting status.
This feature can be used to prevent the
report generator from redundant report-
ing. (i.e. by not printing out a report if
all test results are not available).

MISPL
The MIPS Site Programming Language
is an easy to use, object-oriented pro-
gramming language available to end-
users. Site personnel maintain programs
written in MISPL. It is a single configura-
tion language for use throughout the
application.

At application startup time, MISPL reads
the complete scheme information and
hence is able to compile and run site-
specific programs. Many built-in func-
tions are available.
Applications include filtering, statistics,
calculations, diagnostic support rules,
Reporting

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Laboratory Information System
reporting, test method selection, label
definition, result derivation
The MISPL builder is a user-friendly tool
which allows browsing through the
GLIMS database and offers all available
information and functions. While wan-
dering through the database structure,
the corresponding documentation is up-
dated on the fly in a help window.

Microbiology
One of the main differences here lies in
the fact that frequently the lab is pro-
vided with a material and a question
'See what you can find'.

Since the procedures to be carried out
and the results to be stored are not
known beforehand, the Microbiology LIS
subsystem should be very flexible in its
data model and user interface.
It should be able to suggest procedures
to be undertaken through evaluating the
current specimen data, but should allow
storage of any related or intermediate
result entered by the analyst. All relevant
data should be stored in a way that per-
mits fast and easy retrieval of result for
daily result operation, previous patient
results, statistical and epidemiological
reports,

A table of antibiotics is present, contain-
ing mnemonic, name, reporting order (if
any), medical comments and result type
(R RR Resistant, I II Intermediate, S SS Sensible or free
text). Antibiotic thresholds assist in the
calculation of the RIS code starting from
a diameter.
Antibiotic panels group antibiotics to be
tested by default, given a certain combi-
nation of organism group and sample
material.

Results of macroscopic evaluation, mi-
croscopic evaluation, presence of red or
white blood cells, etc. are entered as op-
tional results and treated as output of
the initial. This output can, and probably
will, automatically trigger further test
requests. At any time, the analyst can
decide to add extra tests or results to
the specimen being studied.

MISPL expressions allow fine-tuning for
selection criteria such as patient age,
patient location, test requestor, etc. At
Microbiology

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Laboratory Information System
run time, the analyst can decide to sup-
press or add antibiotics for a specific
specimen. Intermediary reports can be
sent to inform the test requester of the
current status. Such intermediary results
may be "Negative after ... days' incuba-
tion", "Suspicion of...", etc. The data
model also offers the possibility of easy
database query for statistical or epidemi-
ological purposes.

Highlights Highlights Highlights Highlights
Explicit support for all microbiology-
related data (isolation, carriers, isola-
tion tests, carrier tests, etc.)
Normalized, relational data model
Seamless integration with other
Glims modules
Multiple specimens per order
User-definable specimen information
(method, location, etc.)
Fast patient history retrieval
Dedicated result entry screens
Expert system support (e.g. for anti-
biogram filtering)
User-definable alarms and flags on
isolation, specimen and patient level

Transfusion Management
The blood transfusion management has
three constituent parts. The first part
handles the determination and storage
of blood groups, rhesus pheno types,
irregular antibody screening, typing and
the specification of antigens and anti-
bodies.

The requests for any of the above men-
tioned tests can be linked to previous
results, sex, age, previous transfusions,
etc. in order to decide whether to pro-
ceed or discontinue the request.

Based upon the data acquired, addi-
tional criteria can be specified.
to derive a valid result from sub-tests
Microbiology

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Laboratory Information System
to check consistency of independ-
ently obtained results as e.g. the
blood group which can be derived
from the serum part and the erythro-
cytes part;
to check consistency of the current
result with respect to the previous
result;
to check the reusability of previous
results with respect to the blood
group, rhesus, phenotype, etc.
to effect condi ti onal request
(avoiding unnecessary requests by
taking into account sex, age, etc.)
to store the blood group, rhesus and
screening information in a person
oriented table;
to store absence or presence of anti-
gens and antibodies like duffy, lewis,
etc.

The second part is the management of
the blood bag database, which allows
obtaining an overview of the current
blood bag supply with respect to the
different manipulations to which the
blood bags are submitted during the
transfusion process. These manipula-
tions include:
data entry for new blood bags is per-
formed manually or via barcodes.
This allows storing data on proper-
ties like blood group, rhesus and
pheno types, antigens for blood
types or even the authology and the
corresponding person if specified.
There is provision for self-transfusion
product data storage.
queries for an up-to-date overview of
stored blood bags or of (urgent)
blood product requests;
marking blood bags as discontinued
or expired, so that these blood bags
will no longer be used in further
transfusions;
blood requests can be marked as dis-
continued to indicate that those par-
ticular requests need to be cancelled;
generation of order advice lists at
any time to obtain an up-to-date
overview of the total number of
transfusion-ready blood bags;
Finally, the third part offers a complete
trace on blood bags during transfusion.
The transfusion trace includes the re-
quest of blood products, the selection of
Transfusion management

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Laboratory Information System
blood bags based on a predefined com-
patibility system, the physical or elec-
tronic (Type and Screen) compatibility
check, the checkout of blood bags, gen-
eration of a transfusion form and the
completion of a blood bag trace by the
transfusion data and a possible transfu-
sion reaction. In some exceptional cases,
during the life cycle of the blood bag, it
may be returned to stock, or discarded
because of accident or expiry.

These situations are also supported in
GLIMS. Finally, this module allows re-
porting with respect to the transfused
blood bags.

Anatomic pathology
The anatomic pathology module is fully
integrated in GLIMS and supports the
processing of material examinations.
The module is suited for biopsy, cytol-
ogy as well as autopsy.
Most of the results in a material exami-
nation are textual descriptions, but can
be more structured as well. E.g. for the
conclusion, a simple text might do,
whereas the body contains more specific
and varied text results. All these results
are gathered in the material examination
on which the pathologist is working. For
each material exam GLIMS offers a com-
pact overview of its results, the possibil-
ity to manipulate the examination until a
finished state and to produce reports for
it.

The anatomic pathology module also
supports image results which can con-
tain both microscopic and macroscopic
images. With the appropriate editing
software installed, these images can be
edited and stored from the GLIMS appli-
cation. Thanks to the MS Word report-
ing functionality in GLIMS, the anatomic
pathology module also allows to include
both macroscopic and microscopic im-
ages on reports. These reports can also
contain very long texts as for example
an autopsy report.
The anatomic pathology module also
offers support for different coding stan-
dards, like SNOMED, ADICAP, ICD-9/10
etc. The seamless integration of this
module in GLIMS provides access to all
related chemical and microbiological in-
formation.
Anatomic pathology

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Laboratory Information System
The anatomic pathology module of
GLIMS is highly flexible thanks to its
possibility to configure personalized
schemes for material examinations and
the possibility to configure reusable
texts and information blocks. In the
mean time, you have an overview of
each material examination, you can eas-
ily fill in the results and you can follow
up the evolution of the material exami-
nation. This module will give you both a
detailed and compact solution for anat-
omic pathology.

Billing
GLIMS provides an extensive billing
module. Since GLIMS is an international
product, it needs to cope with the billing
peculiarities in all supported environ-
ments.

Clinical lab billing is usually highly regu-
lated and consequently country depend-
ant. Local legislation specifies billing
rules, price levels, documents to be pro-
duced, etc. Private clinical labs typically
have to deal with invoicing for patients,
physicians and insurance companies,
while hospital labs usually send billing
information to the hospital information
system which performs the actual in-
voicing. Industrial or commercial labs
should be able to create invoices for is-
suers, object suppliers, veterinarians,
animal owners, etc. In these cases spe-
cific negotiated price lists are used in-
stead of official price lists. Billing might
also be different for orders where a labo-
ratory is operating as a sub-contractor.
In Germany, Laborgemeinschaften per-
form routine tests for physicians: these
tests are billed directly to the physician.
In France, pharmacies interfere in the
billing process. The VAT regime is also
country and environment depending.


From the outset, the GLIMS billing mod-
ule was designed to cope simultane-
ously with all these different require-
ments. The result is a general-purpose
billing engine that sets new standards in
flexibility. Billing involves two major
steps: tariffication and invoicing. Tariffi-
cation is the actual price and debt calcu-
lation while invoicing includes every-
thing from generating electronic and pa-
per invoices to payment follow-up.

Billing

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Laboratory Information System
The GLIMS billing engine supports the
tariffication for all the various lab ser-
vices (both sampling and testing; as
well as microbiology and blood transfu-
sion activities). It can be configured for
both individual or grouped billing.
Payment agreements, policies and price
lists as concepts, laboratories have great
flexibility in configuring which parties
(e.g. test requester, veterinarian, health
care insurance company or specimen
supplier) are involved in the billing proc-
ess, which billing codes to use, and at
which price. Several payers can be in-
volved in a single order and customer
specific price lists can be established.
The billing engine also takes care of
multi-firm/multi-lab environments and
sub-contracting. The definition of billing
rules supports the implementation of
test combination prohibited by specific
national reimbursement schemes. VAT,
additional charges (for urgent samples
or those analyzed at night, etc.).

Calculation is the responsibility of the
billing engine. The results of the tariffica-
tion can be communicated to a hospital
information system using standard pro-
tocols like HL7.

The GLIMS invoicing sub-module cre-
ates the billing documents sent to the
different paying organizations. GLIMS
keeps track of invoices and credit notes.
Invoices are grouped in invoice summa-
ries, if required, allowing for easier in-
voicing to large accounts. The layout of
all billing documents (e.g. certificates,
invoices, invoice summaries) is totally
user-definable. GLIMS keeps track of the
documents produced. GLIMS allows in-
voices to be communicated to a separate
accounting system.

Billing

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Laboratory Information System
Highlights Highlights Highlights Highlights
Support for medical and industrial
laboratories
Multiple internal accounts
Individual or grouped billing of lab
services (both sampling and testing;
including microbiology and blood
transfusion activities) by means of
internal billing codes.
Payment agreements allow definition
of different payer categories (e.g. the
prescribing Doctor, Patient, Veteri-
narian, Health Care Insurance Com-
pany, Sample supplier,etc.)
Multiple payers per order
Customer specific price lists
Configurable cummulation and ex-
ception rules
VAT calculation
Su pp l e me n t a r y c a l c u l a t i o n
(administrative procedures, emergen-
cies, ...)
Variable document layouts (e.g. Cer-
tificates, Invoices, Invoice summa-
ries)
Communication with hospital infor-
mation and external accounting sys-
tems

Statistics
GLIMS comes with an extensive statis-
tics module covering production, micro-
biology, blood transfusion and finance.

All modules have a uniform look and
feel, though differ in some detailed as-
pects typical to the kind of statistics re-
quired. Guidance by the GLIMS statistics
wizard makes the collection and display
of the statistical data now easier than
ever.

The user can choose from a wide variety
of selection and classification options.
The statistical results can be consulted
Statistics

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Laboratory Information System
and edited through different output
channels.

The data can be printed, directly be dis-
played on screen in different formats,
saved into a file for use with third party
applications like MS Excel, MS Access
or any web browser and even emailed to
one or more contact persons.

Highlights Highlights Highlights Highlights
Fully integrated in GLIMS
Guidance by GLIMS statistics wizard
Uniform look and feel of all statistics
modules.
Extremely flexible selection and clas-
sification options
Open-ended: results can very easily
be loaded into 3rd-party software

Urgency monitor
The urgency monitor program shows a
continuously updated overview of ur-
gent orders that have not been entirely
completed. Depending on the time since
order creation, the order is shown in a
different color.

The user can choose from a wide range
of selection options for the orders as e.g.
the minimal urgency, maximal result
status, the issuer, the department In
addition, the display setting (colors, re-
fresh period) of the urgency monitor
can easily be customized.

Communication
MIPS places a very high priority in its
products ability to communicate with
many peripheral applications, including
analyzer control software, hospital infor-
mation systems (HIS), general practitio-
ners systems, insurance systems and
web browsers.

The standards supported include HL7,
HPRIM, LDT, ASTM and Edifact.
Urgency monitor

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Laboratory Information System
The complete list is much longer since
we have a lot of connections based on
local or national standards and connec-
tions with legacy systems. GLIMS is
able to communicate with several hospi-
tal information systems simultaneously
to support laboratories servicing several
hospitals. Each hospital may have its
own identification system and an unlim-
ited number of patient identifiers can be
stored.

Available platforms
The flexibility of the MIPS products is
one of their main features and allows us
to deploy them on many different hard-
ware platforms. MIPS has no preferred
relationship whatsoever with any hard-
ware supplier and strives to maintain
this independence. Most of the server
systems sold run on Windows 2000 or
Unix (HP, Sun Solaris, IBM, etc). GLIMS
clients typically run on Windows NT or
Windows 2000 PC's. Host-based con-
figurations without clients are also pos-
sible, using terminal servers (MS Termi-
nal Server Client, Citrix, etc.) or the
GLIMS TTY interface.
Communication