open software solutions: don't get caught in the middle! · copyright 1993-2006 - not to be...

Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 1

"Open" Software Solutions: Don't Get Caught in the Middle!

LAB. INFOTECH SUMMITMiddleware Industry Dialogue

March, 1st 2006


Contents

Definitions

Information Management

Lab Challenges

An Open Middleware Solution

Suggestions


Traditional IT Definition for Middleware

MIDDLEWARE (mid´&l-wār) (n.)

Software that connects two otherwise separate applications. For example, there are a number of middleware products that link a database system to a Web server. The term middleware is used to describe separate products that serve as the glue between two applications. It is, therefore, distinct from import and export features that may be built into one of the applications. Middleware is sometimes called plumbing because it connects two sides of an application and passes data between them.


Suggested definition for the Lab IT Domain

MIDDLEWARE (mid´&l-wār) (n.)

It is an information system dedicated to the management of the Lab Test production. It is based on a reliable and flexible communication engine.

“Middleware can be considered the information processing hub of the new Lab.” D. & M. Winsten


LAB PORTAL HIS / EMR

Order Entry / Result Reporting / Billing

Automation Instruments Manual W.

MIDDLEWAREResult / Test Production

Illustration of that suggested definition


Middleware in the Enterprise

LIS

Middleware The TestProduction

ManagementSystem

Financial System BillingWEB

Manual Work Automated Testing Pre-Analytical

HIS EMR


Suggested definition of an Open System

OPEN SYSTEM

It is a system that allows connectivity and associated interoperability to any manufacturer’s devices. It is a generic solution independent of instrument, automation, LIS vendors. It also supports all Lab disciplines (Biochem., Hem., Immuno., Micro., …).

“Open” is an approach not a classification.


Definition: Lab Information Management

Laboratory

Validation &Report

Reception

«Information Production Process»

ReliabilityAccessibilityTurnaround timeProduction cost

QUALITY

«Clinical Information Subsystem»

ASTM, HL7, IHE,…Open data access with R.D.B.M.S.

« An Information Business »


Contents

Definitions


Lab Challenges


Suggestions


Concepts On Information Management

Access to information is the key factor : “Push” system (i.e. Alerts)

Important Information Updated in real timeOn one screen, and complete (no post-it technology!)Detailed information available in maximum 2 mouse clicks

Automate management of the information Automate the access: Click on Rerun Box to display a Rerun List

Navigation“Switching without losing context”

Control Panels, Dashboards

“The Lab. is an Information business”


Concepts On Information Management

Real-Time & Automated processesResponse-Time and User-FriendlinessContinuous flow and not batch driven

Not only Push the information but do it in Real-Time

A Real-Time process produces information.

A Batch process may produce data only !Either before of after an event => too late or too earlyRequest (Pull) data rather than being Informed (Push)

Real-Time processes manage and supportThe whole Lab workflow and associated tasksThe verification of test information data (delta check, plausibility check, normal ranges)The broadcasting of reports

“The Lab. is an Information business”


Contents

Definitions


Lab Challenges


Suggestions


Successfully achieve total Integration and Consolidationwithin the Lab and within the Health Care Enterprise

Connectivity Intra & Extra Lab.Inst., Automation, EMR, Clients (extranet), Digital Imaging, …

Productivity (w. Quality)Fewer trained / skilled technicians

Cost pressure: doing more with lessActually benefit from Lab Automation

Productivity & Quality Gains

Lab Challenges

Can a Lab. satisfied with its Legacy LIS, or not willing to face the cost of ownership of a new LIS, access to & benefit from new technologies?

Need to evolve and cope with advances in instrumentation, automation, new techniques & associated changes


Contents

Definitions


Lab Challenges


Suggestions


Attributes of an Open Middleware Solution

Connectivity <> Communicate

Scalable

ComprehensiveAll devices from all vendors,All disciplines,Automated and Manual testingPatients, Orders, and Specimens

Real-Time Rule Based Provides flexibility, to cope with Lab complexity

“Focusing on Lab. Organization, Workflow & Processes”


LAB PORTAL HIS / EMR

Order Entry / Result Reporting / Billing

Automation Instruments Manual W.

Communicate

MIDDLEWAREResult / Test Production


Analyzer 1 Analyzer 2 Analyzer 3 Analyzer 4 Analyzer 5 Analyzer 6

LIS

Consolidate

& Distribute Information

Communicate


Communicate: Multi Sites Configuration

LIS

Instruments

Middleware

Instruments

LIS

Instruments

Middleware

Site A Site B

• Interconnect sites


Scalability

Single Instrument

Multiple Workstations

Lab Test Production Management

LIS

Multiple instruments

WorkCell


Comprehensive Solution

All devices from all vendors

All Lab disciplines

Automated and Manual testing

Patients, Orders, and Specimens


Comprehensive

BIOCHEMBIOCHEM

AT&TAT&T

ABBOTTABBOTT

BIOMERIEUXBIOMERIEUX

ABXABX

AVLAVL BIORADBIORAD

ADALTISADALTIS

BAXTERBAXTER

BIOVISIONBIOVISION

ALFA BiotechALFA Biotech

ALFA WassermanALFA Wasserman

BAYERBAYER

CIS BioCIS Bio

DADE BehringDADE Behring

ALIFAXALIFAX

BECTONDICKINSONBECTONDICKINSON

BECKMAN-COULTERBECKMAN-COULTER

MERCKMERCK

HITACHIHITACHI

EUROGENETICSEUROGENETICS

DIAMEDDIAMED

EPPENDORFEPPENDORF

HELENAHELENA

InstrumentLaboratoryInstrumentLaboratory

Johnson & JJohnson & J

KONEKONE

MENARINIMENARINI

IRISIRIS

NOVANOVA

STAGOSTAGO

OLYMPUSOLYMPUS

ORGANONORGANON

ORTHOORTHO

RADIOMETERRADIOMETER

SEBIASEBIA

ROCHEROCHE

+ OTHERS …+ OTHERS …

WALLACWALLAC

SYSMEXSYSMEX


Multi Disciplines

LIS

Biochemistry & Immunology


A Complete Work Area

LIS

Routine Backup

Hematology



LIS

Microbiology



LIS

Stat Lab


Consolidated / Remote QC

Hem 1 Hem 2 Bioch 1 Bioch 2 Immuno

LIS

Consolidate & Distribute QC Information

Stat 2Stat 1


Comprehensive: Manual Testing

• Definition of panels of tests performed together• Customizable worksheets• Results checked immediately on entry• Application of rule-based system• Lists of overdue testsMiddleware

• Specimen ID + Rack and position

• Patient information + Ordering Physician and Location

• Requested tests and specimen type


Specimen Management


Smart rule base system :

Applied in real time for efficiency

Easy to use, no need of supplier support

Optimize the system flexibility

Large range of criteria and actions

Can be use from order entry to clinical validation

Real Time – Rule-Based System


Automatically selects the right method to provide the right result.

If result of Total bilirubin exceeds 60 OR serum is Icteric, then replace Jaffe Creatinine by Enzymatic creatinine.

Applied to request reception



Applied to redundancy check at request reception

If previous result of Total T4 is normal and dated less than one month ago, then delete Total T4.

Saves money by not doing unnecessary tests



Always provides the appropriate specimen type

Applied to collection management

If previous result of platelets is lower than 100 then use a citrate tube instead of EDTA tube for blood cell count. The patient may have an allergy to EDTA



No review needed when not necessary.

Limits the need of review to real pathological cases

Avoid unnecessary review:If the patient is diabetic and result of glucose is higher than high review limit and not a panic value then do not review.

Applied to exception review



Reflex testing:If result of Total Bilirubin exceeds 22 then add direct and indirect Bilirubin.Review may be needed later depending on results of added tests

Automatic reflex testing before review

Automates the decision process

Applied to exception review



ASTM 1238 ProtocolLabs have an aging LIS for Biochemistry and Hematology

Requires a system to facilitate a more streamlined result management process and introduction of auto-verification of test results.

Lab performs all the testing for the hospital, external GP clinics and outpatients.

Middleware manages the Lab test production: 2 instruments for Hematology

150,000 FBC’s per annun

Example #1: Hospital in Wales

TELEPATH - LIS

Middleware

Advia 120 Bayer

Advia 120 Bayer

Future extension:2x Point of Care ABX Micros 60


Meditech - LIS

Middleware

Hematology MicrobiologyBiochem.

Example #2: Hospital, Canada

Middleware manages the Labs test production: 5 instruments for Biochemistry, Hematology, Microbiology,

Average of 400 orderss / day

ASTM


HPrim / ASTM Protocol

MOLIS - LIS

Middleware

2x ChemistryInstrumentsOlympus

2x Immunology instrumentsBeckman-C.

3 x Blood gas analyzers

1x Stat Chemistry InstrumentHitachi

1x HbA1c InstrumentMenarini

Example #3: Hospital, France

Labs share the same LIS

Needed enhanced response time & flexibility for Clinical Review

Middleware manages the Lab test production: 9 instruments (Routine & Stat) for Biochemistry and Immunology

Average of 800 specimens / day


Ex#4: Brittany Group of 9 private Labs

Middleware manages the Labs test production:

14 instruments located in different laboratories for Biochemistry, Immunology, Hematology.

Average of 1,700 requests/day i.e. > 3,000 samples.

All communications are managed through Internet and secured via VPN routers

LIS GWI EuropMedica

•Order Entry•Result Reporting•Billing

Middleware

14 instruments connection

HPrim / ASTM / HL7 Protocol

Laboratory #1 Laboratory #2 Laboratory #3 Laboratory #4 Laboratory #5 Laboratory #6 Laboratory #7 Laboratory #8 Laboratory #9

All 9 Labs share the same LIS


Change the Legacy LIS, or enhance it with a MiddlewareSolution?

How to best cope with evolution changes?

Perform a detailed analysis of the existing situation with focuson Processes & Workflow:

Collect the data• Key Metrics / Factors

Confirm the workflow• Routine / Exceptions• Bottlenecks

Real-Time or Batch?

What are the issues to be addressed,

What are the problems to be solved?

To do list: suggestions


How to best organize the test production?

Consolidation of workstations / work cells

What to automate in the decision Making?

Optimization of resources utilization and outcomes

• Test menu-reagents, • tubes requirements, primary vs.. secondary samples• Routine and other shifts

Backup / “degraded” mode

Find the right balance between complexity / flexibility / maintainability

Command & Control the system

Defining Solutions


Why use a Open Middleware solution?

Improve productivity while ensuring / maintaining the necessary quality standards

Get more work done with less resources (staffing)

Minimize to an absolute minimum extra work (repeats)

Being Alerted immediately to correct a problem before time, reagents, resources, have been wasted

Increase Lab competitiveness

Decrease Turnaround time

Decrease Production cost

Access to newer technology, added-value functionality

Offers down-time redundancy to the legacy LIS

“Filling in the Gaps & Connecting the Dots”

open software solutions: don't get caught in the middle! · copyright 1993-2006 - not to be...

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