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Stand-Alone Applications: Filling the LIS Functionality Gaps
Liron Pantanowitz, MD
Associate Professor of Pathology & Biomedical Informatics University of Pittsburgh Medical Center
Stand-Alone Apps
Laboratory information system (LIS) at the core of most lab operations
Legacy LIS as newer technology becomes available to perform tasks
Add-on modules (SLAMs) & upgrades can extend/enhance a legacy LIS
Supplemental solutions fill growing functionality gaps
◦ Enable labs to perform tasks not currently possible with existing hardware/software
◦ Tools often easy to use, maintain and many are plug-&-play (seamlessly connect to LIS)
◦ Provide increased efficiency, better patient care & ROI (e.g. save FTE time)
Solutions may include:
◦ IT tools from middleware or lab instrument vendors
◦ Vendors cater to all size/type of labs (e.g. POLs)
◦ Expert services & training provided by consulting firms
New user friendly & helpful solutions are constantly being designed
Stand-alone applications provide inexpensive solutions for
labs struggling with several problems:
Staff shortages (med techs)
Increased test volumes
More complex instruments
More complex lab operations
EMRs demanding connectivity
Trend toward ensuring quality of care
Demand Drivers
IMPROVEMENTS
Operations (Management)
Workflow (Processes)
Productivity (Services)
Quality (Safety & Compliance)
Revenues (Billing)
Operation Improvements
3rd-party software components that support LIS operations – separate install recommended by LIS vendors (e.g. MS Word, AccuSoft, Excel, Crystal Reports)
Data transmission (e.g. Forward Advantage manages faxes, LabDE automates capture & transfer of data in lab reports)
Storage solutions (e.g. HP StorageWorks EVA8000, Mesa Corp)
Support for virtual applications, legacy apps & web-based cloud management (e.g. VMWare, Citrix)
User connectivity (e.g. remote login, password control)
Electronic change control process (e.g. SharePoint)
Automated testing software helps lab test new/changes to software (e.g. Software Testing Solution)
Management of personnel & trainees (e.g. human resources packages, resident evaluation systems)
Workflow Improvements
Need: Inefficient current processes
Answer: Optimize workflow process
Several solutions: ◦ Instrument connectivity & maintenance
◦ Automation (e.g. autoverification)
◦ Continuous (vs. batch) workflow (e.g. Lean tools)
◦ Tracking solutions (barcodes, RFID)
◦ Remote system monitoring (real-time, web-based)
◦ Scheduling (according to staff availability/subspecialty, work distribution & workload demands)
◦ Inventory management (supplies, reagents, equipment)
Middleware “Plumbing - Stuck in the Middle”
Hardware & software that acts as an intermediary between instruments & LIS (connect legacy to newer systems)
Allows data exchange or performs data management tasks the LIS can’t handle
3 types of middleware solutions: ◦ Instrument level: Instrument data management
◦ Work area level: Work area management (WAM)
◦ Lab level: Lab production management
e.g. Instrument Manager, Laboratory Production Manager, Remisol Advance, Sysmex WAM, TD-Harmony, Roche Middlware Solutions, JavLin interfaces, JResultNet, IM2, AgilityEngine
Autoverification
Automatic review & release (verification) of results received from a lab instrument without technologist review
Application of rule-based logic allows communication between a lab instrument & LIS to generate an action (pass/fail) based upon pre-defined rules/algorithms
Greatest benefit obtained with frequently ordered tests (e.g., automated chemistry assays, routine hematology tests)
Systems enabled through the lab instrument, middleware, or LIS
Apps for Automation
Pre-Analytical Phase ◦ Courier services to optimize fleets, routes, special
situations like stat specimens, tracking & call center coordination (e.g. Gajema, Logitrac, Elite)
◦ Pneumatic tubing systems (incl. carrier tracking)
◦ Specimen collection (e.g. scheduling)
Analytical Phase ◦ Lab automation systems (robotic sub-systems, process
control software)
◦ Sample processing, transportation & queuing
Post-Analytical Phase ◦ Storage & retrieval systems (e.g. add-on testing)
Advantages of Automation
Increased productivity
Offset staff shortages
Economic gains
Error reduction
Improved turnaround time
Avoid operator exposure to hazards (e.g. blood)
Avoid operator exposure to injury (e.g. repetitive tasks)
Continuous Processes Improvement
Lean & Six Sigma IT tool kits e.g. LeanKit Kanban
Value stream mapping (draw, analyze & design workflows)
Dashboards (real-time monitors of performance/metrics)
LEA
N S
IX
SIG
MA
Asset Management
Tracking solution benefits: ◦ Automate, standardize & timestamp data collection process
◦ Facilitate Lean manufacturing process (e.g. JIT technique & reduce turnaround time)
◦ Drive workflow at point of contact (e.g. barcode driven protocols)
◦ Error reduction (improve quality/patient safety) ◦ Provide measurable metrics to enhance processes (detect workflow bottlenecks)
◦ e.g. Vantage (Ventana)
Quality Improvements
Need: Standardize QC/QA processes & continuously monitor compliance
Answer: Single electronic database & current documentation
Several solutions: ◦ Positive patient ID solutions (e.g. wCareCollect, BD.id,
Identi-Match, MedPoint, CareChek)
◦ Statistics & method validation tools (e.g. GraphPad Prism, EP evaluator, Altosoft)
◦ Lab staff competency (web-based systems)
◦ Reporting & tracking of HR issues
QA Data Tools
Notable LIS weakness:
(collect, manipulate & display data)
Utilize QA data outside LIS
Automatic continuous updates (“real time”)
User friendly (easy wizard approach)
Better data management (impressive analytical capabilities & metrics)
Superior displays (graphs, dashboards)
Web-based solutions available
Access varied database formats (Excel, SQL, Oracle)
Document Management
Paperless environment
Scan documents, requisitions & reference lab reports
Easy document access, retrieval & data extraction
Standardize electronic policy & procedure creation, review & approval
e.g. SoftTech, policyTech, Mesa, Zequel, Policy IQ, Vignette, PolicyMedical, OnBase, Extract Systems, Scantron
Service Improvements
Need: Client & patient services
Answer: Enhanced productivity, client satisfaction & better access to information
Several solutions: ◦ Patient services (access to information & convenience)
◦ Client services (easy connectivity & tracking)
◦ Practice management systems
Patient Service Tools
Access to lab results ◦ Online patient portals
◦ Maintain HIPAA compliance
◦ (e.g. eClinicalWorks, CureMD, e-telmed)
Scheduling ◦ Automated appointment
management
◦ (e.g. Q-nomy, Quest)
Client Service Tools
Outreach LIS-EMR connectivity ◦ Several EHR integration solutions ◦ e.g. Lifepoint, Atlas, Initiate exchange platform, 4Medica,
Halfpenny, CareEvolve, Blue Iris eLaborate, JResultNet
Lab portals ◦ Lab orders, test results, schedule pick-up, inquiries, specimen
tracking, & determine status ◦ Electronic lab manuals (catalogs with test menu & user guide)
Physician Office-Lab Links (POLL) ◦ Bidirectional connectivity between instruments & EMR ◦ e.g. Fflex eLink, Atlas LabWorks, ePathLink
Help desk software ◦ Customer management & support (e.g. sample collection supplies,
coordinate issues, follow up outstanding issues) ◦ Automatic call triage & recording ◦ e.g. TrackIT, CRMdesk, Request tracker, H2Desk
LIS-EMR Connectivity using SaaS Pantanowitz et al. J Pathol Inform 2010; 26:1
Data managed & routed using vendor server & software
EMR Integration Issues
LIS-EMR interface projects can be lengthy, unpredictable & costly to implement and maintain
Solutions utilize innovative SaaS-based hub technology
Bidirectional flow of data (orders match test results) ◦ Support CPOE from many EMRs ◦ Handle complexities (e.g. add-ons, cancels, reflex tests) ◦ Result delivery with appropriate downstream display
Support mobile devices (on-the-go orders/ready-to-view results)
Meet requirements for Meaningful Use certification Behind-the-scenes business rules tailored to match unique
workflows, flexible test menus, coding & billing
Specific CP Apps
Microbiology ◦ Infection & antibiogram surveillance
Transfusion Medicine ◦ Transfusion safety (e.g. Final Check LIS codes)
◦ Virtual blood banking & remote refrigeration management
◦ Blood donor systems with computer-assisted scheduling & interviewing
Specific AP Apps
Dictation & transcription management
◦ (e.g. Winscribe, Voicebrook, Nuance)
Synoptic reporting
◦ (e.g. mTuitive)
FS diagnosis communication
◦ (e.g. FSLink @ Yale)
Automated e-reporting to cancer registries
◦ (e.g. e-Path)
Tissue banking
◦ e.g. BIGR from Healthcare IT, Daedalus
Autopsy
◦ (e.g. UPMC remains tracker)
Digital Pathology Solutions
Image acquisition (e.g. gross & microscope capture workstations)
Image management (e.g. Aperio Spectrum, Apollo PathPACS)
Image workflow (e.g. Omnyx workstation)
Telepathology (e.g. Zeiss robotic microscopy, CellaVision, web-based portals)
Automation (e.g. Pap test screening)
Image analysis (e.g. Ventana VIAS, CellSens, HistoRx, Farsight, Genie, TissueStudio, Inform)
Point-of-Care Testing
Interface managers ◦ Interface with multiple vendor devices (open connectivity)
◦ Provide a single result feed to LIS (simplified compliance)
◦ Compliant with connectivity standards
◦ Support wireless connectivity
◦ e.g. Telcor
Database management systems ◦ Flexible, web-based, centralized control
◦ Added features (e.g. QA, HR links to update staff updates, competency tools)
◦ e.g. Abbott PrecisionWeb
Revenue Improvements
Need: Maximize profits
Answer: Good business solutions
Several solutions: ◦ Revenue cycle management tools - automate large
volumes of transactions
Features: LIS interface capability, server or browser based, management & marketing reports, compliance (e.g. HIPAA & coding such as LOINC)
◦ Outsourcing with consultants ◦ e.g. Boston WorkStation, Costflex, Peachtree, Lab Outreach Business
Pro, PSA Billing & Collection Services, Chi Solutions
Practical Take Home Points
Labs have limited resources (IT skills, finances, time)
Middleware installation often easier than LIS upgrade
One-size-does-not-fit all (customization)
Beware of rapidly retired vogue solutions
Flexible homegrown systems require IT skills
Closed system architecture - middleware specific to vendor instruments may constrain the level of automation that can be achieved (e.g. inability to swap or add devices)
Open system architecture – middleware can interface with several vendor instruments & information systems
Plan ahead & avoid middleware “band-aid” solutions that create more work (e.g. additional training, maintenance & troubleshooting)