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"Open" Software Solutions - Association for Pathology Informatics
"Open" Software Solutions: Don't Get Caught in the Middle! LAB. INFOTECH SUMMIT Middleware Industry Dialogue March, 1st 2006 Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 1 Contents Definitions Information Management Lab Challenges An Open Middleware Solution Suggestions Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 2 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. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 3 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 Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 4 Illustration of that suggested definition LAB PORTAL HIS / EMR Order Entry / Result Reporting / Billing MIDDLEWARE Result / Test Production Automation Instruments Manual W. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 5 Middleware in the Enterprise WEB LIS HIS Financial System Billing The Test Production Management System Middleware Manual Work EMR Automated Testing Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA Pre-Analytical 6 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. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 7 Definition: Lab Information Management « An Information Business » Laboratory Reception «Information Production Process» Validation & Report 9 9 9 9 Reliability Accessibility Turnaround time Production cost QUALITY «Clinical Information Subsystem» 9 ASTM, HL7, IHE,… 9 Open data access with R.D.B.M.S. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 8 Contents Definitions Information Management Lab Challenges An Open Middleware Solution Suggestions Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 9 Concepts On Information Management “The Lab. is an Information business” Access to information is the key factor : 9 “Push” system (i.e. Alerts) Important Information 9 Updated in real time 9 On one screen, and complete (no post-it technology!) 9 Detailed information available in maximum 2 mouse clicks Automate management of the information 9 Automate the access: Click on Rerun Box to display a Rerun List Navigation 9 “Switching without losing context” Control Panels, Dashboards Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 10 Concepts On Information Management “The Lab. is an Information business” Real-Time & Automated processes 9 Response-Time and User-Friendliness 9 Continuous 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 ! 9 Either before of after an event => too late or too early 9 Request (Pull) data rather than being Informed (Push) Real-Time processes manage and support 9 The whole Lab workflow and associated tasks 9 The verification of test information data (delta check, plausibility check, normal ranges) 9 The broadcasting of reports Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 11 Contents Definitions Information Management Lab Challenges An Open Middleware Solution Suggestions Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 12 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 Connectivity Intra & Extra Lab. ) Inst., Automation, EMR, Clients (extranet), Digital Imaging, … Productivity (w. Quality) ) Fewer trained / skilled technicians ) Cost pressure: doing more with less Actually benefit from Lab Automation ) Productivity & Quality Gains Successfully achieve total Integration and Consolidation within the Lab and within the Health Care Enterprise Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 13 Contents Definitions Information Management Lab Challenges An Open Middleware Solution Suggestions Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 14 Attributes of an Open Middleware Solution “Focusing on Lab. Organization, Workflow & Processes” Connectivity <> Communicate Scalable Comprehensive 9 9 9 9 All devices from all vendors, All disciplines, Automated and Manual testing Patients, Orders, and Specimens Real-Time Rule Based 9 Provides flexibility, to cope with Lab complexity Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 15 Communicate LAB PORTAL HIS / EMR Order Entry / Result Reporting / Billing MIDDLEWARE Result / Test Production Automation Instruments Manual W. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 16 Communicate Analyzer 1 Analyzer 2 Analyzer 3 Analyzer 4 Analyzer 5 Analyzer 6 Consolidate & Distribute Information LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 17 Communicate: Multi Sites Configuration LIS Site A LIS Site B Middleware Middleware • Interconnect sites Instruments Instruments Instruments Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 18 Scalability Lab Test Production Management WorkCell Multiple Workstations Multiple instruments Single Instrument LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 19 Comprehensive Solution All devices from all vendors All Lab disciplines Automated and Manual testing Patients, Orders, and Specimens Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 20 Comprehensive AT&T AT&T BAXTER BAXTER CIS CISBio Bio IRIS IRIS ORTHO ORTHO ABBOTT ABBOTT BAYER BAYER DADE DADEBehring Behring Johnson Johnson&&JJ RADIOMETER RADIOMETER ABX ABX BECKMANBECKMANCOULTER COULTER DIAMED DIAMED KONE KONE ROCHE ROCHE ADALTIS ADALTIS BECTON BECTON DICKINSON DICKINSON EPPENDORF EPPENDORF MENARINI MENARINI SEBIA SEBIA ALFA ALFABiotech Biotech BIOCHEM BIOCHEM EUROGENETICS EUROGENETICS MERCK MERCK STAGO STAGO ALFA ALFAWasserman Wasserman BIOMERIEUX BIOMERIEUX HELENA HELENA NOVA NOVA SYSMEX SYSMEX AVL AVL BIORAD BIORAD HITACHI HITACHI OLYMPUS OLYMPUS WALLAC WALLAC ALIFAX ALIFAX BIOVISION BIOVISION ORGANON ORGANON ++OTHERS OTHERS… … Instrument Instrument Laboratory Laboratory Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 21 Multi Disciplines Biochemistry & Immunology LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 22 A Complete Work Area Hematology Routine Backup LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 23 A Complete Work Area Microbiology LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 24 A Complete Work Area Stat Lab LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 25 Consolidated / Remote QC Consolidate & Distribute QC Information Stat 1 Stat 2 Hem 1 Hem 2 Bioch 1 Bioch 2 Immuno LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 26 Comprehensive: Manual Testing Middleware • Definition of panels of tests performed together • Customizable worksheets • Results checked immediately on entry • Application of rule-based system • Lists of overdue tests • Specimen ID + Rack and position • Patient information + Ordering Physician and Location • Requested tests and specimen type Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 27 Specimen Management Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 28 Real Time – Rule-Based System Smart rule base system : 9 Applied in real time for efficiency 9 Easy to use, no need of supplier support 9 Optimize the system flexibility 9 Large range of criteria and actions 9 Can be use from order entry to clinical validation Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 29 Real Time – Rule-Based System Applied to request reception If result of Total bilirubin exceeds 60 OR serum is Icteric, then replace Jaffe Creatinine by Enzymatic creatinine. Automatically selects the right method to provide the right result. Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 30 Real Time – Rule-Based System 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 Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 31 Real Time – Rule-Based System 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 Always provides the appropriate specimen type Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 32 Real Time – Rule-Based System Applied to exception review 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. No review needed when not necessary. Limits the need of review to real pathological cases Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 33 Real Time – Rule-Based System 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 Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 34 Example #1: Hospital in Wales TELEPATH - LIS Labs have an aging LIS for Biochemistry and Hematology ASTM 1238 Protocol Requires a system to facilitate a more streamlined result management process and introduction of auto-verification of test results. Middleware Future extension: 2x Point of Care ABX Micros 60 Lab performs all the testing for the hospital, external GP clinics and outpatients. Advia 120 Bayer Advia 120 Bayer Middleware manages the Lab test production: 9 2 instruments for Hematology 150,000 FBC’s per annun Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 35 Example #2: Hospital, Canada Meditech - LIS ASTM Middleware Biochem. Hematology Microbiology Middleware manages the Labs test production: 9 5 instruments for Biochemistry, Hematology, Microbiology, Average of 400 orderss / day Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 36 Example #3: Hospital, France Labs share the same LIS MOLIS - LIS Needed enhanced response HPrim / ASTM Protocol time & flexibility for Clinical Review Middleware 2x Chemistry Instruments Olympus 1x HbA1c Instrument Menarini 2x Immunology instruments Beckman-C. 3 x Blood gas analyzers 1x Stat Chemistry Instrument Hitachi Middleware manages the Lab test production: 9 9 instruments (Routine & Stat) for Biochemistry and Immunology Average of 800 specimens / day Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 37 Ex#4: Brittany Group of 9 private Labs All 9 Labs share the same LIS Laboratory #1 Laboratory #2 Laboratory #3 Laboratory #4 Laboratory #5 Laboratory #6 Laboratory #7 Laboratory #8 Laboratory #9 HPrim / ASTM / HL7 Protocol LIS GWI EuropMedica •Order Entry •Result Reporting •Billing Middleware 14 instruments connection Middleware manages the Labs test production: 9 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 Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 38 To do list: suggestions Change the Legacy LIS, or enhance it with a Middleware Solution? 9 How to best cope with evolution changes? Perform a detailed analysis of the existing situation with focus on Processes & Workflow: 9 Collect the data • Key Metrics / Factors 9 Confirm the workflow • • Routine / Exceptions Bottlenecks 9 Real-Time or Batch? 9 What are the issues to be addressed, 9 What are the problems to be solved? Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 39 Defining Solutions How to best organize the test production? 9 Consolidation of workstations / work cells 9 What to automate in the decision Making? 9 Optimization of resources utilization and outcomes • • • Test menu-reagents, tubes requirements, primary vs.. secondary samples Routine and other shifts 9 Backup / “degraded” mode Find the right balance between complexity / flexibility / maintainability Command & Control the system Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 40 Why use a Open Middleware solution? “Filling in the Gaps & Connecting the Dots” Improve productivity while ensuring / maintaining the necessary quality standards 9 Get more work done with less resources (staffing) 9 Minimize to an absolute minimum extra work (repeats) 9 Being Alerted immediately to correct a problem before time, reagents, resources, have been wasted Increase Lab competitiveness 9 Decrease Turnaround time 9 Decrease Production cost Access to newer technology, added-value functionality Offers down-time redundancy to the legacy LIS Copyright 1993-2006 - Not to be reproduced without written consent of TECHNIDATA 41
