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 IIHenry 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

LH 755 Analyzer

LH 755 Analyzer

LH 755 Analyzer

ElectronicMedicalRecord

HospitalInformationSystem

LaboratoryInformationSystem

Direct Interface

Positioning Middleware

LH 755 Analyzer

LH 755 Analyzer

LH 755 Analyzer

ElectronicMedicalRecord

HospitalInformationSystem

InformCorrectRepeat

PASS

FAIL

Server

LaboratoryInformationSystem

Initial Interface Setup

LH 755 Analyzer

LH 755 Analyzer

LH 755 Analyzer

Workstation 2Workstation 2Orchard Aqueduct® Hematology Workflow Client

BI DIRECTIONAL(Orders/Results)

Workstation 1Workstation 1Orchard Aqueduct® Hematology Workflow Client

HospitalInformationSystem

LaboratoryInformationSystem

Remote Remote ServerServerOrchard Aqueduct® Hematology Workflow Server

Initial Interface Setup- Backup

LH 755 Analyzer

LH 755 Analyzer

LH 755 Analyzer

HospitalInformationSystem

LaboratoryInformationSystem

Workstation 2Workstation 2Orchard Aqueduct® Hematology Workflow Client

Workstation 1Workstation 1Orchard Aqueduct® Hematology Workflow Client

Remote Remote ServerServerOrchard Aqueduct® Hematology Workflow Server

BI DIRECTIONAL(Orders/Results)

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

Challenges

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)

SolutionsSolutions

Modified Interface Setup

LH 755 Analyzer

LH 755 Analyzer

LH 755 Analyzer

DOWNLOAD

Orders

UPLOADResults

Workstation 2Workstation 2Orchard Aqueduct® Hematology Workflow Client

Workstation 1Workstation 1Orchard Aqueduct® Hematology Workflow Client

Remote Remote ServerServerOrchard Aqueduct® Hematology Workflow Server

Workstation 3Workstation 3Orchard Aqueduct® Hematology Workflow Client

HospitalInformationSystem

LaboratoryInformationSystem

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