Advanced middleware can keep your laboratory tuned in, on track, and in control.
In a perfect world, every laboratory information system (LIS) would give clinical laboratories exactly what they need—the ability to manage data, quickly respond to physician requests, monitor instrument QC performance to ensure quality results, and expertly adapt to ever-changing workflow needs. Unfortunately, most LIS fall short. They simply can’t deliver the flexibility and responsiveness today’s laboratories need.
It’s no surprise that many laboratories are turning to advanced middleware, a server-and-software platform that sits between the LIS and laboratory instrumentation. Middleware fills a crucial gap by providing real-time insights and functionality that put laboratories back in control. Here are four ways that middleware can empower the clinical laboratory:
1. Optimizes daily operations with exception-based results.
Middleware streamlines testing processes by automating the laboratory’s standard operating procedures (SOPs). Protocols for rerun criteria, delta checks, reflex testing, and sample flagging can be automated. With rules, laboratories can perform autoverification to automatically release results into the LIS without the need for laboratory personnel review.
Laboratorians can use their specialized skills to review the outlier results requiring detailed attention. Because the laboratory staff is more focused on specific results, they have more time to evaluate challenging specimens and act upon critical results, leading to better decision-making and patient care.
Autoverification—made easier by middleware—can work wonders for any clinical lab. It ensures standardization of data review, increases productivity, decreases turnaround time, and improves staff efficiency (and stress levels). With turnaround time and errors down, both staff and physician satisfaction improve. In addition, middleware provides like solutions across disciplines (e.g., hematology, chemistry) to further increase efficiency. This is an advantage over autoverification at the system console level.
By adding optional dashboard and reporting modules, laboratories can also monitor and manage current workflow activities, access historical information to benchmark against past performance, and discover insights to take measurable actions to improve operational performance.
2. Boosts responsiveness with a flexible rule-writing engine.
While many LIS’s offer advanced rule-writing for autoverification, few laboratories have a dedicated resource to do this programming. Instead, many labs must rely on the corporate IT team or another department to build new rules, make changes, or add comments in the LIS, which means turnaround time can be slow and responsiveness to physician requests can suffer. Furthermore, IT analysts may not have the relevant experience to understand the nuances of clinical testing rules. The bottom line: Writing and validating rules through the LIS is often a complicated, cumbersome, and time-consuming process.
With middleware, laboratories can take control of creating their own rules directly from their own consoles, based on the urgency of the need. Laboratory personnel with appropriate security access can quickly prioritize, apply, and test new rules to accommodate dynamic workflows as their schedule demands. These changes can include rules and/or comments that apply to specific physicians and laboratory locations, rules for the review of automated CBC and differential results, and rules to enhance workflow between instruments. Having this level of rule-writing control empowers laboratory staff and drives efficiency and quality.
3. Drives consistency through network standardization.
With multiple sites, middleware can standardize rules and information across all networked locations—regardless of whether they are using the same LIS. This ability gives laboratories a
cost-effective way to ensure greater consistency and control over information system-wide. The dictionary can be the same at all locations, taken from the primary site and uploaded to all other sites for enhanced standardization. Data can be easily distributed to all sites across a wide area network.
With consolidated rules, dictionaries, and databases made possible by middleware, today’s networked laboratories can gain powerful capabilities. Laboratories can:
- Perform delta checking of results from samples run in different laboratories
- Route and receive orders from one laboratory to another
- Generate reports with consolidated data from all laboratories viewed at any hospital (to show trends, test volume, etc.)
- View activity of testing and instrumentation at different labs
- Configure and monitor setup at all laboratories
- Generate reports from all laboratories into a single report
- Verify orders, review results, and review QC across laboratories regardless of where the results were generated
- Control and limit functionality and access to data
- Create review stations with the ability to review results from any laboratory
- Create a mirrored backup server that can be used if the main server goes down
Despite the network-wide visibility, middleware also allows for flexibility and control at the individual laboratory level. Each site can still write its own rules for specific physician preferences (e.g., specific add-on tests), as needed.
The Alverno Clinical Laboratory (Hammond, IN) hospital network found middleware to be the perfect solution for a potentially costly challenge. This organization needed to connect and standardize information across its 28-hospital network, but converting all the locations to the same LIS would have cost nearly $30 million and required multiple years to complete the transition. Implementing an advanced middleware solution across remote sites with different LIS’s allowed identical rules to be applied throughout the network, giving Alverno the necessary standardization at a much lower cost.
4. Ensures quality results through integrated QC management.
Advanced middleware also enables laboratories to automatically stop autoverification if commercial controls are out of limits. On one commercially available middleware, the use of exponentially weighted moving averages (EWMA) can alert users immediately about instrument trends and potential QC problems. The additional use of patient data to do continuous real-time monitoring of system performance ensures consistent, quality results between QC intervals.
Depending on how the protocol is defined, EWMA can either warn the laboratory, stop sending test requests to a specific instrument, or automatically shut-off autoverification to prevent the release of potentially erroneous results and eliminate the need for retesting, physician notification, and other corrective actions. This round-the-clock insight keeps laboratories in control of their results and provides an additional level of quality assurance.
Middleware can be the key to efficiency throughout the healthcare ecosystem. Regardless of a laboratory’s individual challenges, location and workflow needs, advanced middleware can be a crucial tool that helps the lab to fulfill its mission most effectively.
Carol J. Ross, MT(ASCP), CPHIMS, FACHE, serves as a Senior Manager, Product Management, for California-based Beckman Coulter, Inc., provider of Remisol Advance middleware.
