Autoverification of Hematology Results Using Middleware Integrated with Laboratory Information Syste

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Auto-verification of Hematology Results Using
Middleware Integrated with Laboratory Information
System Technical Design, Challenges, and
SolutionsL Dwyer, G Sharma, JJ Mammen and MJ
Tuthill
Presenter Gaurav Sharma, MD Resident, PGY
II Henry Ford Hospital Detroit, Michigan
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Auto-verification in todays labs

• Complex technology
• Compatibility and connectivity issues
• Requires advanced planning to face technical
  issues before, during and after implementation
• In todays laboratory there is a lack of
• Expectations and outcomes
• In house expertise or interest
• Available literature on lab experiences

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Auto-verification Design In Automated Hematology

• Misys Laboratory v6.2 (Misys Healthcare, Raleigh,
  NC)
• Three Beckman Coulter LH 755 (Beckman Coulter,
  Hialeah, FL)
• Two HP ProLiant DL 380 G4 servers running
  Microsoft Windows Server 2003 (Microsoft,
  Redmond, WA) and Orchard Aqueduct Server v4.0
  (Orchard Software Corporation, Carmel, IN)
• Four Dell Optiplex 620 (Dell, Roundrock, TX)
  running Orchard Aqueduct Hematology Workflow
  Client v4.0 (Orchard Software Corporation,
  Carmel, IN)

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Pre- Middleware Workflow
Electronic Medical Record Hospital Information Sy
stem
LH 755 Analyzer
Laboratory Information System
Direct Interface
LH 755 Analyzer
LH 755 Analyzer
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Positioning Middleware
Inform Correct Repeat
Electronic Medical Record Hospital Information Sy
stem

LH 755 Analyzer
FAIL
Laboratory Information System
PASS
LH 755 Analyzer
Server
LH 755 Analyzer
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Initial Interface Setup
Remote Server Orchard Aqueduct Hematology
Workflow Server
Hospital Information System
LH 755 Analyzer
Workstation 1 Orchard Aqueduct Hematology
Workflow Client
Laboratory Information System
BI DIRECTIONAL (Orders/Results)
Workstation 2 Orchard Aqueduct Hematology
Workflow Client
LH 755 Analyzer
LH 755 Analyzer
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Initial Interface Setup- Backup
Remote Server Orchard Aqueduct Hematology
Workflow Server
LH 755 Analyzer
Hospital Information System
Workstation 1 Orchard Aqueduct Hematology
Workflow Client
Laboratory Information System
Workstation 2 Orchard Aqueduct Hematology
Workflow Client
LH 755 Analyzer
BI DIRECTIONAL (Orders/Results)
LH 755 Analyzer
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Challenges

• Data collision on Misys interface.
• Result uploads take precedence over downloads
  (functionality of an ASTM interface)
• Delays appearance of orders in Aqueduct and LH
  755s
• Poor workstation performance
• Heavy data volume from three instruments and one
  bidirectional interface to a single workstation
• Interface/port configurations reside on local
  workstation
• Data backup and archiving
• HFH IT prefers backups to run as service, not an
  application
• Archive server based patient data on routine
  basis caused
• 20 minute system unavailability

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Solutions

• Install
• Additional Misys interface Dedicated upload
  download interface to separate workstations
• Additional workstations to balance data and work
  volume
• Optimize performance
• Reboot workstations on daily basis to free memory
• Duplicate interface/port configurations on more
  than one workstation (to serve as backup in case
  of hardware failure)
• Compromise on patient data backup and archiving
• Run as application but are mapped to redundant
  server
• Archive performed monthly on Sunday (low volume
  day)

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Modified Interface Setup
Remote Server Orchard Aqueduct Hematology
Workflow Server
LH 755 Analyzer
Hospital Information System
Workstation 1 Orchard Aqueduct Hematology
Workflow Client
Laboratory Information System
DOWNLOAD Orders
Workstation 2 Orchard Aqueduct Hematology
Workflow Client
LH 755 Analyzer
Workstation 3 Orchard Aqueduct Hematology
Workflow Client
UPLOAD Results
LH 755 Analyzer
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Post Implementation Results

• 77 of CBC and 51 of differentials auto-verify
• Laboratory staff need time and experience to
  understand data flow
• Increased complexity of trouble shooting
  multiple failure points
• Monthly archiving requires advanced notification
  to ED and IPD
• Pathology Informatics as a coordinator between
  HFH IT Department and vendors (LIS, middleware,
  instrument)
• for installation and single issue resolution
• server standards and security policies regarding
  remote access

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Conclusions

• Contact other sites with similar volume and
  complexity
• Involve hospital IT and LIS staff with vendors in
  the process
• Increased complexity of the operational and
  technical requirements must be taken into account
  before purchase and implementation
• Regardless of the technical complexity,
  auto-verification through a middleware product
  provides significant benefits that translate to
  higher quality patient care through improved
  laboratory efficiency