Lab software: The global scene

At the AACC annual
meeting last month in Chicago, we were impressed, once again, by the
increasing numbers of international visitors to that venue and wondered
if we could get an “insider's view” of what American companies are doing
in laboratories globally. Bob J. Rothstein, managing director of Data
Innovations Europe, who works in Brussels, Belgium, was gracious enough
to answer our questions, which we share to give readers a broader
knowledge of what is happening in their overseas counterparts'
laboratories.

MLO: While there is much being made by
many organizations that “global” is a relatively new way of doing
business, Data Innovations (DI), according to a statement you made to
MLO, has been engaged for many years in global entrepreneurship.
What were you originally charged to do for the company overseas” What
happened that made you realize that your performance had succeeded”

Bob J. Rothstein: Data Innovations is
celebrating its 20th year in business in 2009; and while the company had
installations outside the United States early in its history, the first
foreign subsidiary, Data Innovations Europe (DIE), was opened in
Brussels 10 years ago and is responsible for the Europe, Middle East,
and Africa (EMEA) region. Data Innovations Asia (DIA) in Hong Kong, and
Data Innovations Latin America (DILA), in Sao Paulo, followed soon
thereafter.

My job with DI, like those of my colleagues Macma
Suen in Hong Kong and Jos'e Colleoni in Brazil, has been to market, sell,
install, support, and provide additional consulting and implementation
services for our Instrument Manager (IM) middleware product — and to do
it profitably. I am not sure when one can say, “It's a success,” because
there is always the next challenge. Nevertheless, the subsidiaries were
all profitable within one to three years of their founding and their
cumulative percentage of sales continues to grow in relation to DI's
total business.

For me personally, the job changed quite
significantly in 2007, when DIE acquired 25-year old PGP, a middleware
pioneer in Europe. Our Brussels office continues to develop PGP's
original product, Lab Production Manager (LPM), and our three European
offices (Brussels, Paris, and Birmingham) provide sales, support, and,
particularly, consulting services for both LPM and IM.

MLO: What are the general differences
in medical laboratories in Europe compared to those in the United
States” Have European labs advanced in those areas to a greater degree
than their American counterparts”

Rothstein: Generalizations are always
dangerous. A generalization about “Europe,” with more than 50 sovereign
states, is even more hazardous. Since DIE's main market is in “Western
Europe,” I think we can safely say that, compared to the United States,
Western Europe has:

• higher personnel costs. Although the average medical
  technologist may have a lower take-home pay, total personnel costs
  for Western European laboratories are higher than in the United
  States, due to higher European social-security costs, longer
  holidays, and relatively stronger European currencies vs. the U.S.
  dollar.
• little pricing flexibility. In most Western European countries,
  lab-test procedure prices, like most medical-procedure prices, are
  fixed by law. In addition, lab-procedure prices have been
  continually adjusted downward in the last 20 years. Again, 50
  different countries represent 50 different fixed tariffs and methods
  of including additional services (e.g., phlebotomy) in the price.
  Nevertheless, the consensus is that the prices labs can charge in
  Europe are lower than in the United States.
• significantly lower levels of healthcare spending. In general,
  Western European countries spend 50% less per capita on healthcare
  than the United States.

Given these factors, medical laboratories in
Western Europe have been forced to find efficiency improvements for many
years. For example, certain European laboratory information systems
(LIS) already had implemented rules-based autoverification in the 1970s.
In Europe, as in the United States, middleware firms have been quicker
to create core functionality to address these needs. In particular,
Western European labs have also looked to middleware for a high degree
of customization.

DILA and DIA report, however, that for their
regions some of the points mentioned above are not valid. For instance,
lower salaries in those regions have hindered productivity gains using
technology, in general, and middleware, in particular. Nevertheless,
there are always exceptional laboratories that have been on the cutting
edge.

MLO: Can you outline examples of
laboratories with which you have worked that have used middleware to
improve some aspect of their performance”

Rothstein: Just for EMEA, I can point to a
number of interesting cases:

• An LPM system in an HMO lab in Israel is currently the largest
  system DI has installed (six tracks, 193 workstations, 134
  instruments).
• A hospital lab in the Netherlands that was manually validating
  every single one of its 900 samples per day acquired a chemistry
  automation system from a DI partner. Today, that lab autovalidates
  99% of its 1,000 CC/IA samples and, since its personnel are no
  longer “glued to PCs,” they use IM's Notifier function to trigger a
  light pole, alerting them to a sample that needs their attention.
• Several groups of private labs in France, each comprising five
  or more labs, use LPM's extensive configurable algorithmic
  capabilities to split requests and results in a myriad of ways among
  the instruments on the individual sites. In addition, each of the
  labs in the groups has its own LIS system, from multiple LIS
  vendors. In these scenarios, each lab acts like a reference lab for
  the others.
• A clinical-trials firm with its LIMS and IM systems in the
  Netherlands — but with some instruments located in China and
  Singapore — is controlled directly through the Internet without any
  local middleware. The same firm acquired a lab in the United States
  that has to allow its existing clinical trials to complete on the
  LIMS system (from another manufacturer) on which they were
  initiated.
• At a hospital in the Netherlands specializing in organ
  transplants, LPM was customized to automate the layout of plates of
  tissue DNA samples for donor-compatibility testing. Operations that
  required manual exchange of identification data between instruments
  and manual tracking of specimens through the different steps are now
  done automatically.
• A hospital group using a single IM system to handle labs in 21
  different locations. This group currently has a total of 93
  instruments in the 21 different labs, some of which are actually
  located in fitness centers.

MLO: DI has overseas offices in
Belgium, Brazil, China, France, and the United Kingdom … and it has
installed more than 6,500 middleware systems in 58 countries. Can you
give examples of the varied uses of the DI middleware systems in some of
those countries”

Rothstein: DIE, DILA, and DIA have
installations in all the major countries in their respective areas. Some
of the more “exotic” places where we have installations include Mayotte,
Dominican Republic, Jamaica, La Reunion, Curacao, Rwanda, Bosnia,
Malaysia, Lithuania, Thailand, and Malta. Here are some of the more
unexpected or original uses with which we have been involved:

• an Excel spreadsheet being used as the LIS, working
  bidirectionally with a single instrument;
• an LIS in New York communicating over the Internet to our
  middleware connected to local instrumentation in Dublin;
• because of budgetary restrictions, both IM and LPM being used
  without any LIS whatsoever, providing all request entry and result
  printing, in addition to “classic” middleware functionality; and
• labs serving the underprivileged favelas of Sao Paulo using the
  same advanced middleware as the more affluent private labs serving
  the middle and upper classes.

The challenges the overseas subsidiaries face and
the different operating modes of the laboratories we encounter inspire
DI to enhance its products and services. Some significant examples of
changes due to our global reach have been:

• the creation of a basic connectivity version of IM called
  IMConnect, aimed at the multiple smaller LIS manufacturers in
  individual countries. These firms do all the results management in
  their LIS and use IMConnect to be able to immediately connect to any
  instrument on the market, thereby allowing them to concentrate on
  their core competencies without having to worry about the next new
  instrument to come out;
• the introduction of multilanguage capability on a single system,
  with the language tied to the user's logon parameters;
• the creation of a managed-service contract to supply expertise
  for the acquisition, deployment, and parametrization of middleware
  products. DILA created this service at the request of the largest
  Latin American laboratory group, that finds it extremely
  cost-effective compared to recruiting, hiring, and training its own
  personnel to support these activities;
• creating drivers for instruments, LIS, QC applications, and
  robotics systems that either are local to a region or, for various
  reasons — particularly regulatory — are introduced outside the
  United States before they are introduced in the United States; and
• significant input into the continuous improvement of IM's rules
  engine and user workspace.

MLO: What challenges do DI
representatives overseas face” What does — and what has — DI as a
company faced in the many years it has been developing its global
business” What are the “Top 3″ suggestions you would give a newly minted
DI employee”

Rothstein: First of all, each of our
regions is very heterogeneous: different countries, languages,
currencies, healthcare systems, and salary levels. This is often very
difficult for U.S.-based companies to manage. We have weekly status
meetings with our headquarters and quarterly meetings in person on a
revolving basis in our different offices. These frequent and open
communications among all regions allow us to move successfully forward
as one worldwide company with a single global vision, while retaining
each region's organizational structures.

Different languages throughout the regions also
present a challenge. Each DI-subsidiary employee speaks a minimum of two
languages, and often three or more, enabling us to provide services in
the language of most end-users. The regional spread of the offices
allows us to more easily provide our 24-hour support across all time
zones, as well as be able to efficiently go on-site for installations.

Most importantly, our partners and direct
customers can count on us to work with them to propose the appropriate
products and services so that an end-user in Kuala Lumpur, Malaysia; or
Santiago, Chile; or Vilnius, Lithuania, all have the same satisfaction
with their middleware as an end-user in Boston.

In our (DIE, DILA, DIA) collective opinion, the
“Top 3” suggestions for a new DI employee would be to have:

• the ability to communicate effectively in more than just
  English;
• an interest in and appreciation of the diversity of laboratory
  work flows around the world; and
• a profound ability to listen, in order to help customers and
  contribute to the improvement of our products.

Note: If you are a company with a global
outreach, alert the editor of MLO at
[email protected]
 for a possible interview in the “International Corner” in LABline.