All Content © 2015 Immucor, Inc. All Content © 2015 Immucor, Inc.

IMMULINK®: IMPROVING THE

DELIVERY OF TRANSFUSION

MEDICINE LAB SERVICES

Kevin Trainor, MBA

Worldwide Marketing Manager, Molecular

Immucor

S A N D R A F A Z A R I

I M M U C O R U S E R G R O U P M E E T I N G

M A Y 5 , 2 0 1 5

A N N A P O L I S C I T Y , M A R Y L A N D

IMMULINK®: IMPROVING THE DELIVERY OF TM LAB SERVICES

OBJECTIVES

• ImmuLINK

• Function and capabilities

• Local Health Integration Networks (LHIN)

• Hamilton Regional Laboratory Medicine Program

(HRLMP)

• Our organization and services

• HRLMP vision and model(s) for ImmuLINK

EVOLVING TECHNOLOGY

TRANSFUSION MEDICINE TECHNOLOGY

THEN Now

IMMULINK

• Technology has changed the way we live and the

Transfusion Medicine lab is also impacted

• Many TM labs are transitioning to automated

instruments and now have the opportunity to enter

the virtual world

• ImmuLINK is virtually linking TM labs and introducing

innovative lab process

• Instruments and systems in hospitals are becoming

more intelligent

What is ImmuLINK™?

An data manager designed specifically for donor

centers, reference lab & transfusion medicine.

First of its kind in Blood Bank

Designed specifically for:

LIS

Data

Manager

Middleware Interface Methodology

SINGLE FACILITY

LIS

MULTIPLE FACILITIES

LIS

WORKLIST MANAGEMENT

WORKLIST STATUS ICONS

Order Received from LIS Already received result for

selected test(s)- Everything

complete Combination of different status

based on each sample Sample is

running

Green = Test

Completed Done Blue = Test Running

Test hasn’t

started

No current orders for this

sample

Tests names can be customized

RESULTS

RESULTS MANAGEMENT

• Group tests that you want to see

together

• All test group column headers are

customizable

• Customize

views

Attention required for this sample

Sample ready to be approved (no warnings by the

instrument)

Sample approved by authorized user

Sample transferred to

LIS

Sample loaded on the

instrument

LHIN- FUNCTION AND PURPOSE

• The Local Health System Integration Act, 2006 changed the way that our health system is managed in the Province of Ontario.

• The Ministry of Health and Long-Term Care created 14 Local Health Integration Networks (LHINs) to plan, integrate, and fund health care based on local needs.

• LHINs do not provide services

• Their role is to ensure the right services in the right place at the right time.

• Covering Hamilton, Niagara, Haldimand, Brant, Burlington and most of Norfolk the HNHB LHIN is home to a diverse population of more than 1.4 million people and over 200 providers to include: • 80 Community Support Services

• 45 Community Mental Health and Addictions Programs

• 7 Community Health Centres (including 10 sites)

• 1 Community Care Access Centre

• 87 Long-Term Care Homes

• 9 Hospitals (including 22 hospital sites)

LHIN – 14 NETWORKS

• ON pop ~13 million; SON pop ~ 12 million, ~53000 sq miles

• Maryland pop ~ 6 million, ~13000 sq miles

HNHB LHIN NETWORK

• HNHB LHIN covers ~2700 sq miles

• Population ~ 1.3

million

• Hamilton population

~ 600,000

• ~439 sq miles

• Baltimore population

~620, 000

• 92.2 sq miles

HRLMP – LAB SERVICES

• Hamilton Regional Laboratory Medicine Program (HRLMP) provides comprehensive laboratory testing for Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, as well as providing reference laboratory services for Ontario and across Canada.

• More than 700 staff members including 50 medical and scientific staff with cross appointments at McMaster University.

• With laboratories located at each acute care site in Hamilton, it is one of the largest integrated laboratory service programs in Canada.

Laboratory Services • Anatomic Pathology

• Clinical Chemistry and Immunology

• Core Laboratory

• Genetics

• Microbiology

• Special Hematology

• Specimen Collection

• Transfusion Medicine and HLA

CENTRES OF EXCELLENCE

HRLMP – TRANSFUSION MEDICINE

•ECHO

•11341 BP Trxn

•12773 Samples resulted

•9.5 FTE MLT

•ECHO

•3884 BP Trxn

•9703 samples resulted

•ECHO

•20156 BP Trxn

•12596 samples resulted

•ECHO & NEO

•17482 BP Trxn

•22758 samples resulted

HGH JHCC

STJ MUMC WL • ~2600 samples

• ~1000 BP Trxn

IMMULINK - THREE MODELS

1. Hub-Satellite Model

2. Consolidation Model

3. LHIN model

1. HUB-SATELLITE MODEL

• Site A is the Hub(MUMC)where all the resulting and

test approval occurs; Site B is the satellite (WL)

where the sample resides and is loaded on the

instrument

• Live date was June 6th, 2014

• Distance between WL and MUMC = ~27 miles (30

min)

1. HUB-SATELLITE MODEL – SCREEN COMPARISON

1. HUB-SATELLITE MODEL

• Process before ImmuLINK • Group and Screen and Crossmatch testing performed by gel

methodology

• Lab not licensed to perform antibody investigation

• Stat investigation shipped to MUMC site • Full GS and AI performed by Capture methodology

• Routine investigation shipped to Canadian Blood Services

• Process After ImmuLINK • Satellite site loads the instrument

• MLT/MLA can leave and perform other lab work

• GS that have Neg ABS and no discrepancies will auto verify

• ABS Pos and/or further testing is required – Hub site reviews investigation via ImmuLINK and directs the completion of the investigation to include final results

1. HUB-SATELLITE MODEL - EFFICIENCIES

• Since live date processed 1436 samples

• 1288 Screen Neg; 148 Screen Pos

• Year estimate – 2208 Screen Neg; 254 Screen Pos

• Only 6 samples required to be shipped to Hub site

• Warm auto Ab and mixed field discrepancy

1. HUB-SATELLITE MODEL - EFFICIENCIES

• What are the realized savings and efficiencies? • Transport – saving shipping of 254 individual samples

• Autoverify of Neg results produces significant tech time efficiencies

• Preliminary data = 66 days of GS work

• Reduction in error – no manual entry of results into LIS

• Improvement in TAT – MLT can devote time to other work

• Improvement in work life

• Replacing MLT with MLA – wage savings

• With the samples that have Pos Screen

• Savings in reagent cost as there is no need to repeat entire testing at Hub Satellite

• Gain in access to expertise

• Improvement in TAT – shipping time would delay TAT

2. CENTRALIZATION MODEL

• The TM labs within the HRLMP are four labs that perform all TM lab testing and functions

• Four years ago we were in the midst of a centralization model • One main testing site (Hub) at the HGH with satellite sites at the

remaining sites

• Purchased a NEO in order to accommodate centralization of all T+1 GS to one site

• The majority of staff would be working at the Hub site with rotation to the satellite sites

• Budget cuts resulted in a loss of funding for our new labs space

• Currently all sites ship GS for T+1 or greater transfusion to the HGH

• The Centralization Model was put on hold and never resurrected until ImmuLINK

2. CENTRALIZATION MODEL

• Evaluating our processes utilizing Lean Six Sigma • Current state:

• Samples are being shipped to multiple sites

• Spend a lot of time packing and unpacking samples

• Sometimes, units gets shipped with samples

• Inbalance of workload and staffing; certain shifts at certain sites are not as busy as other sites

• ImmuLINK allows for a more efficient process • Centralize test resulting to one site eliminating shipping of

samples

• Increase in MLA skill mix

• Better staff utilization; ability to eliminate certain shifts at certain sites (ex: MUMC site)

3. LHIN MODEL

• Similar Hub-Satellite model but involves hospitals in our LHIN

• Example: Brantford General Hospital • Distance to Hamilton is approximately 25 miles (30-45 min drive

depending on traffic and weather conditions • Community hospital; population of ~100000

• Original LHIN Agreement was to ship T+1 GS specimens to HHS • Obstacles or challenges with this approach

• Maintaining competency with infrequent stat testing

• Maintaining a manual method for infrequent use

• Transport of specimens

• With an increase in retirement experiencing a decrease in expertise

• Benefits to hospital using this model are the same savings that we are seeing with the West Lincoln Model

• AS a Hub site an added benefit to is the opportunity for Revenue

IMMULINK FACILITATES ….

• Standardization of testing platforms across a region thereby promoting standardized SOPs and access to the results from any computer. • This allows for improved access to technical expertise in Transfusion Medicine. With

ImmuLINK Technical Specialists can provide can consult with any hospital and view the results via Decrease in transportation costs and turn around times from smaller facilities when the testing can be loaded on the instrument in one site and then read in a different site

• Decrease in transportation cost

• More efficient tracking of specimens and patient results

• Decrease in test redundancy across a region. For example when a patient is tested in one site and an antibody is identified, the complete investigation would be repeated if the patient went to another hospital. This history information would be readily available through ImmuLINK, providing better patient care, reduced testing and a diminished wait for blood products.

• Improving Quality Control • Tracking QC reagents and usage

• Troubleshooting

• Enables the education of students, residents and training new technologists across multiple sites.

• Promotes integration, efficiency in staffing and centralization of expertise.

ImmuLINK improves the quality of

service we provide thereby improving

patient care and allows for the

operation of lab in a cost efficient

way.

CHALLENGES

• As pilot site we are charged with identifying improvements and testing Immulink • Challenge: as with any process troubleshooting can take time

but the benefit is an improvement to the system

• Accreditation and Proficiency testing • No other comparable process within the copuntry or province

• Worked with our accrediting body on proficiency samples and licensing requirements for ub-Satellite model

• LIS build • Because of the way we have some of our tests built in

Meditech created some glitches

• These glitches have nothing to do with ImmuLINK but how we have our system set up which created challenges at times with validation

QUESTIONS?

THANK YOU