advantages of integrated (homogenous) systems

Advantages of Integrated (Homogenous)Systems

John Gilbertson MDAssociate Chief of Pathology

Director of Pathology InformaticsMassachusetts General HospitalAssociate Professor of Pathology

Harvard Medical School

HARVARDMEDICAL SCHOOL

Pathology Informatics 2010John Gilbertson: Monday September 20

Integrated (Homogeneous) System:

• An information system, that supports multiple, horizontal activities and is sold and maintained by a single company

• The degree and method of the integration can vary

• There are other was to integrate: third party, open standards


Thesis

• When the workflows and data structures of two laboratory activities become similar there are compelling reasons to integrate under a single system

• AP and CP are converging in a number of ways, and it is time to think about integration of the LIS systems. Both the convergence and the integration will take time

• We have moved our AP and CP platforms to a single vendor to facilitate this convergence

• While not the only approach, homogeneous integration allows departments to focus developmental resources in other areas


The MGH – Sunquest Co-Development

• MGH and Sunquest have established a long term collaboration agreement for the co-development of aspects of future versions of the Sunquest Copath AP LIS

• Under the terms of the agreement, both MGH and Sunquest will provide resources to the development of LIS modules that will be commercialized (generally available) and maintained by Sunquest. MGH will receive a revenue stream back from Sunquest based on the resources provided and the commercial success of the modules


The case for (homogeneous) integration


Sometimes activities are so different, that an “integrated” system is not needed or is too complex to be effective…

…. or even to be understood


As long as best of breed is providing significantlybetter performance there is no case for integration

There is real value in specialization….… “Best of Breed”

CP LISAP LIS


If the differential performance begins to decrease,combining the systems begins to have real value

CP LISMicrobiology

Chemistry

Heme


Operations

x 3

The value of (homogeneous) integration

Disaster RecoveryHardwareUpgrades

Patches, Security

Management ReportsDictionary Maintenance

OS, DB, Development KitsLicenses

MeetingsMeetings

AP TMCP

None of this adds value

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Interfaces

Interface maintenance“Handoffs”

x 3

Data Models / RelationsTimings

HIS

Imaging

AP TMCP



Subsystems

Pyramids of sub-systems

x 3

Image ImageImage

AP TMCP

HIS




Subsystems

Device Interfaces

x 3

Image ImageImage

AP TMCP

HIS




Personnel

PersonnelCall

Admins

x 3

PACS PACSPACS

AP TMCP

HIS


TrainingBackup

Succession



Societal

Feudalism

x 3The case for (homogeneous) integration


The cost of castles

Strategic:Enterprise LeverageProject LeverageOpportunity Cost of Projects

Medical:Data and Operational FragmentationIntellectual Schism Limits the pathologist as an integrator and interpreter of laboratory dataThe opportunity cost of consultation great-castles.com/index.pl?official.html

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AP LIS CP LIS AP LIS

When the performance of a homogenous integration approaches theperformance of best of breed it is time to consider homogenous integration

None of this matters if the best of breedsystem is providing better performance

We think we are getting very close


• Will it the integration be homogenous or will you do it yourself?

• Do you have the resources to do it - – Time– People– Money– Test– Train

If integration is possible and worth the cost…

• Who is in charge?

• Will you be able to maintain it?

CP LIS AP LISAP LIS


• Do you have nothing better to do?


Clinical Laboratory for Research and the Bio-repository(CLR)


Clinical Laboratory for Research and the Bio-repository

• Need for a laboratory to do clinical pathology work and tissue banking for clinical trials and translation research projects

• Work had been done in the clinical lab but this proved inefficient and expensive

• Initial software was home grown, was not scaling and developers had left the institution

???LISClinical Lab CLR


Clinical Laboratory for Research and the Bio-repository

• CLR did clinical testing for clinical trials and tissue banking

• Additional (special) functions required

• Data exchange with the main clinical lab for 24/7 and full test menu

• Accept discarded clinical specimens (for banking) in future

Tissue (blood) bankExtra Data CollectionConsent Status AwareResearch BillingBatch Accessioning

Special research reportsRequisitions consistent with protocolsSelected results to EMRIntegration with “EMSI” and “RFDR”


We decided to use an second instance of our CP LIS


LIS

MULHOS (CP LIS)

BillingADTResults

Batch

EMSI

R-EMR

HL7

SpecimenInventory

Straw AliquoterClinical Lab

Tissue bank front endTissue bank InventoryConsent Status AwareResearch Billing

Special research reports

Batch Accessioning

Requisitions consistent with protocolsSelected tests to EMRIntegration with “EMSI” and “RFDR”Data exchange with the main clinical lab

CLRLIS


LIS

MULHOS (CP LIS)

LIS

BillingADTResults

Batch

EMSI

RPDR

HL7

SpecimenInventory

Straw Aliquoter

TrainingInterfacesPersonnelMaintenance

D.R. HardwareDictionariesNo castles

UpgradesUpgrade CyclesPatchesPriority

Clinical Lab CLR

A Vendor


“Infrastructure”


LIS LIS

BillingADTResults

Batch

EMSI

RPDR

HL7

SpecimenInventory

Straw Aliquoter

Clinical Lab CLR

Accession

“DoneRacks”

?

Large scale clinical discard banking


No Developers Used


AP CP CP TM


AP CP Integration


AP CP Integration

AP CP

EMR

AP CP

EMR

We will work with our vendor

It will take a long time

We will not lose our informaticscard

Today


• It is not that we can’t do it, put that we chose not to• There is an opportunity cost to every project• The integration is more of a technical as opposed to a

domain expertise initiative• We think that departmental developmental resources are

better focused elsewhere

AP CP


• It is used by hundreds of physicians who increasingly require guidance

OrderInterpretation

LISPre-analytic

Analytic

Reporting

• The clinical laboratory is perhaps the most powerful, most complex diagnostic tool on earth

• We need better tools for clinical context & “presence” at ordering and interpretation


Anatomic Pathology is beset buy– Increased volume– Increased Complexity

The AP Laboratory high “variation” and very low efficiency


• Meanwhile over the next several years ~ 3 Billion people will be looking for pathology services


The pathology department has three missions….

…The LIS only supports one


• The will likely be a fight for resources sometime in the future

• Understanding and documenting the value of pathology in health care…


Enterprise Systems

AP CP LIS

POE EMR ADT PACS70/70/3/0

Communication

Efficiency

Quant Value

Teaching&

Research

Departmental Sub SystemsPACS MOL DASH LH


Summary

• When the mission, workflows and data structures of two laboratory activities become similar there are compelling reasons to integrate under a single system

• AP and CP are converging in a number of ways, and it is time to think about integration of the LIS systems. Both the convergence and the integration will take time

• We have moved our AP and CP platforms to a single vendor to facilitate this convergence

• While not the only approach, homogeneous integration allows departments to focus developmental resources in other areas


Integration, systems and standards

• The importance of open AMSI standards in the integration of AP / CP and the LIS of future

• The model of DICOM and IHE

• Asset IDs

• Report (data) Archives

• Image Archives

• HIS – LIS, Device Interfaces….

advantages of integrated (homogenous) systems

Documents

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