Autoverification of Hematology Results Using Middleware
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Transcript Autoverification of Hematology Results Using Middleware
Auto-verification of Hematology Results Using Middleware
Integrated with Laboratory Information System
Technical Design, Challenges, and Solutions
L Dwyer, G Sharma, JJ Mammen and MJ Tuthill
Presenter:
Gaurav Sharma, MD
Resident, PGY II
Henry Ford Hospital
Detroit, Michigan
Auto-verification in today’s labs
Complex technology
Compatibility and connectivity issues
Requires advanced planning to face technical issues
before, during and after implementation
In today’s laboratory there is a lack of:
Expectations and outcomes
In house expertise or interest
Available literature on lab experiences
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)
Pre- Middleware Workflow
Electronic
Medical
Record
LH 755 Analyzer
Hospital
Information
System
Direct Interface
LH 755 Analyzer
LH 755 Analyzer
Laboratory
Information
System
Positioning Middleware
Inform
Correct
Repeat
LH 755 Analyzer
FAIL
PASS
LH 755 Analyzer
LH 755 Analyzer
Server
Electronic
Medical
Record
Hospital
Information
System
Laboratory
Information
System
Initial Interface Setup
Remote Server
Orchard Aqueduct®
Hematology Workflow
Server
LH 755 Analyzer
Workstation 1
Orchard Aqueduct®
Hematology Workflow
BI DIRECTIONAL
Client
(Orders/Results)
LH 755 Analyzer
LH 755 Analyzer
Workstation 2
Orchard Aqueduct®
Hematology Workflow
Client
Hospital
Information
System
Laboratory
Information
System
Initial Interface Setup- Backup
Remote Server
Orchard Aqueduct®
Hematology Workflow
Server
LH 755 Analyzer
Workstation 1
Orchard Aqueduct®
Hematology Workflow
Client
LH 755 Analyzer
Laboratory
Workstation 2
Information
Orchard Aqueduct® BI DIRECTIONAL System
Hematology Workflow(Orders/Results)
Client
LH 755 Analyzer
Hospital
Information
System
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
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)
Modified Interface Setup
Remote Server
Orchard Aqueduct®
Hematology Workflow
Server
LH 755 Analyzer
Hospital
Information
System
Workstation 1
Orchard Aqueduct®
Hematology Workflow
Client
LH 755 Analyzer
Workstation 2
Orchard Aqueduct®
Hematology Workflow
Client
Workstation 3
LH 755 Analyzer
Orchard Aqueduct®
Hematology Workflow
Client
Laboratory
Information
DOWNLOAD
System
Orders
UPLOAD
Results
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
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