Autoverification of Hematology Results Using Middleware Integrated with Laboratory Information System: Technical Design, Challenges, and Solutions
Lisa Dwyer BS; Henry Ford Hospital; Mark J Tuthill MD; Henry Ford Hospital; Joy John Mammen MD; Henry Ford Hospital; Gaurav Sharma MD; Henry Ford Hospital;
Content:
Although the benefits of autoverification of laboratory test results are known, widespread adoption has been slow. This may be due to limitations in LIS software autoverification modules, complexity of implementation, lack of local expertise, and insufficient focus/priority by laboratories. In 2003 our laboratory began to implement LIS based autoverification in routine coagulation, chemistry and automated hematology. For the latter, perceived complexity of LIS autoverification led to acquisition of a Middleware solution. While this project has been operationally successful, there were significant unanticipated technical challenges in achieving a reliable and functional system.
Technology:
" Laboratory Information System (LIS): Misys Lab " v6.2 integrated with Misys Smart " (Misys Healthcare, Raleigh, NC) " Hematology analyzers: Three LH 755 (Beckman Coulter, Hialeah, FL) systems. " Interface workstations: Three Dell Optiplex 620 (Dell, Roundrock, TX) running Aqueduct ? Hematology Workflow Client (Orchard Software Corporation, Carmel, IN) " Aqueduct ? Hematology Workflow Manager (Orchard Software Corporation, Carmel, IN) on application servers running Windows Server 2003 " (Microsoft, Redmond, WA)
Design:
Prior to implementation of middleware, analyzers were directly interfaced to the LIS. Autovalidated results were released into the hospital information system. Failed results were released following appropriate review procedures. Initially, two workstations were configured as interface workstations, with three serial port connections to three LH 755s as well as a bidirectional interface to Misys Lab ". One workstation was the primary interface workstation; the other served as a hot spare , but was actively used for result review/release. An additional Misys Lab " interface, dedicated as download only, was installed. The original Misys interface became upload only. Subsequently, an additional workstation was added, so that the final configuration became one workstation with two serial LH755 interfaces, one workstation with the remaining LH755 interface as well as the Misys Lab " download only interface, and one workstation with the Misys upload only interface. Aqueduct ? rules are applied to each result causing the result to be autoapproved or held for operator review and manual release.
Results:
During implementation, the single workstation could not handle the volume of bidirectional data between Aqueduct? and Misys Lab " and the three LH755s requiring design modifications detailed above. Backup on the Aqueduct? server must run as an application, not as a service as desired by our Information Technology (IT) department. The three interfaced workstations must be rebooted once daily to free up memory. Troubleshooting issues is more difficult due to the multiple points of possible failure. Coordination of LIS vendor, middleware vendor, instrument vendor, and IT department for implementation and issue resolution is complex.
Conclusion:
Autoverification through a middleware provides functional benefits that translate into higher quality patient care and improved laboratory efficiency. However, the increased complexity of the operational and technical requirements must be taken into consideration before purchase and implementation.
