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