The greener side of middleware

April 1, 2010

The recent buzz about middleware focuses primarily on
the implementation of autoverification and the supporting role
middleware plays. Laboratory staffing, workload, and productivity
requirements emphasize the need for middleware for a higher level of
autoverification not fully realized by laboratory information systems
(LIS) alone. All the nuances of autoverification that the laboratory
wants to achieve now can be fulfilled through the inclusion of
middleware in the system. A review of the middleware survey in the
February 2010 issue of CAP Today1 illustrates a litany
of features and their subsequent applications in the laboratory —
reinforcing middleware’s mission to fill gaps in the clinical laboratory

In today’s green economy, the mantra is reduce, reuse,
recycle. Laboratorians have been utilizing middleware to increase efficiency
and improve workflow but now it is being recognized for its
environmentally-friendly augmentation. One of the emerging gaps for which
laboratories are profiting with middleware is archiving results, including
images, for regulatory compliance. Laboratories are required to maintain
results from their instrumentation for a specified period of time. Some
regulators have incorporated images produced by the instruments, such as
histograms and scattergrams, in their definition of results and require
those images as part of the results to be maintained. Laboratories must
resort to storing paper copies of these images since their LIS cannot
receive and archive this information. Some middleware systems are able to
receive and store these images, along with the results and audit logs for
the patient results, for years.

To provide a perspective of the cost of storing paper,
the Minnesota Office of Environmental Assistance performed a study in 2005
which estimated the cost of archiving paper copies to be as much as 31 times
the original purchase price of the paper, making a $5 ream of paper actually
cost more than $150 to use and store. Using middleware to archive results,
along with images, not only allows organizations to reduce archiving costs
significantly and improve regulatory compliance without additional effort
but also makes the retrieval and use of this information easier, faster, and

Maintenance procedures and the associated documentation
of their performance also generate large volumes of paper. The traditional
notebooks and clipboards floating around the laboratory have proven to be a
crude method of addressing overall maintenance management in laboratories.
Middleware allows electronic creation, scheduling, and documentation of
maintenance tasks for all lab equipment.

Now, the electronic tracking system used for instrument
maintenance is the same system used to track eye-wash and fire-extinguisher
maintenance. These electronic tracking systems can alert technologists to
maintenance that is due and allow them to document their performance of the
scheduled and unscheduled events by storing electronic copies of service
records and instrument printouts. Middleware-based maintenance-management
systems even provide repositories for procedure manuals, websites, training
videos, and operator manuals for easy reference during task performance and
for guidance when procedures do not perform as anticipated. For supervisory
personnel, electronic maintenance-tracking systems furnish reports of
performed tasks, as well as those requiring approval and reminders of
overdue tasks, all from a secure, networkable, paperless system that ensures
greater confidence during unannounced lab inspections.

In today’s green economy,
the mantra is reduce, reuse, recycle.

Disruptive to laboratory productivity is LIS downtime —
planned or unplanned — during which the lab regresses to paper consumption.
Techs manually type requisitions into and collect paper printouts from all
instruments, distribute chartable reports to critical-care areas, and try to
keep track of events. With middleware, computers can be used for data entry
and for printing downtime labels on demand. Samples placed on instruments
are processed, with middleware supplying test instructions, just as if the
LIS were in operation.

Once resulted, middleware also gives electronic access to
test results for custom reporting while rules can be designed to
automatically print results to critical-care areas. When the LIS is
available, middleware eases the conversion and recovery processes with full
audit logs for traceability — providing a greener alternative for timely,
accurate actionable healthcare information when the LIS is unavailable.

Green initiatives are more enticing when the benefits go
beyond saving our natural resources. Changing physician- ordering patterns
has resulted in a marked increase in add-on tests to samples previously
analyzed by the laboratory. Without a mechanism to quickly track and
retrieve needed samples, laboratory productivity is reduced. Middleware
systems offer sample-tracking systems to locate samples in the laboratory in
under a minute, reducing the need for unnecessary redraws which, in turn,
reduces medical waste and disposal. Labs also report better management of
existing refrigerated storage space, thus lowering the requirement for added
storage systems as testing volume increases.

Middleware cannot solve all the world’s environmental
issues; but by using middleware, a laboratory can effectively impact its
community by making it a little greener while realizing some significant
savings along the way.

Gina M. Coughlin, MT(ASCP), is a middleware specialist at
Data Innovations in South Burlington, VT.


  1. Aller R, Weiner H. Middleware Systems Survey. CAP
    , 2010:24(2); 31-42.