Advantages of integrated homogenous systems
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HARVARD MEDICAL SCHOOL. Advantages of Integrated (Homogenous) Systems. John Gilbertson MD Associate Chief of Pathology Director of Pathology Informatics Massachusetts General Hospital Associate Professor of Pathology Harvard Medical School. Integrated (Homogeneous) System:

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Advantages of integrated homogenous systems

HARVARDMEDICAL SCHOOL

Advantages of Integrated (Homogenous)Systems

John Gilbertson MD

Associate Chief of Pathology

Director of Pathology Informatics

Massachusetts General Hospital

Associate Professor of Pathology

Harvard Medical School


Advantages of integrated homogenous systems

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

Pathology Informatics 2010


Thesis

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

Pathology Informatics 2010


The mgh sunquest co development

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

Pathology Informatics 2010


Advantages of integrated homogenous systems

The case for (homogeneous) integration

Pathology Informatics 2010


Advantages of integrated homogenous systems

Sometimes activities are so different, that an “integrated”

system is not needed or is too complex to be effective…

…. or even to be understood

Pathology Informatics 2010


Advantages of integrated homogenous systems

AP LIS

There is real value in specialization….

… “Best of Breed”

CP LIS

As long as best of breed is providing significantly

better performance there is no case for integration

Pathology Informatics 2010


Advantages of integrated homogenous systems

Chemistry

Heme

Microbiology

CP LIS

If the differential performance begins to decrease,

combining the systems begins to have real value

Pathology Informatics 2010


The value of homogeneous integration

Disaster Recovery

Hardware

Upgrades

Patches, Security

  • Management Reports

  • Dictionary Maintenance

  • OS, DB, Development Kits

  • Licenses

AP

CP

TM

The value of (homogeneous) integration

Operations

x 3

Meetings

Meetings

None of this adds value

Pathology Informatics 2010


The case for homogeneous integration

Imaging

The case for (homogeneous) integration

x 3

Interfaces

HIS

AP

CP

TM

Interface maintenance

“Handoffs”

Data Models / Relations

Timings

Pathology Informatics 2010


Advantages of integrated homogenous systems

The case for (homogeneous) integration

x 3

Subsystems

HIS

AP

CP

TM

Image

Image

Image

Pyramids of sub-systems

Pathology Informatics 2010


Advantages of integrated homogenous systems

The case for (homogeneous) integration

x 3

Subsystems

HIS

AP

CP

TM

Image

Image

Image

Device Interfaces

Pathology Informatics 2010


The case for homogeneous integration1

HIS

AP

CP

TM

PACS

PACS

PACS

The case for (homogeneous) integration

x 3

Personnel

Personnel

Call

Admins

Training

Backup

Succession

Pathology Informatics 2010


The case for homogeneous integration2

The case for (homogeneous) integration

x 3

Societal

Feudalism

Pathology Informatics 2010


Advantages of integrated homogenous systems

The cost of castles

Strategic:

Enterprise Leverage

Project Leverage

Opportunity Cost of Projects

Medical:

Data and Operational Fragmentation

Intellectual Schism

Limits the pathologist as an integrator and interpreter of laboratory data

The opportunity cost of consultation

great-castles.com/index.pl?official.html

Pathology Informatics 2010


Advantages of integrated homogenous systems

AP LIS

AP LIS

CP LIS

None of this matters if the best of breed

system is providing better performance

When the performance of a homogenous integration approaches the

performance of best of breed it is time to consider homogenous integration

We think we are getting very close

Pathology Informatics 2010


If integration is possible and worth the cost

AP LIS

AP LIS

If integration is possible and worth the cost…

  • Who is in charge?

  • Will you be able to maintain it?

  • 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

CP LIS

Pathology Informatics 2010


Advantages of integrated homogenous systems

  • Do you have nothing better to do?

Pathology Informatics 2010


Advantages of integrated homogenous systems

Clinical Laboratory for Research and the Bio-repository

(CLR)

Pathology Informatics 2010


Clinical laboratory for research and the bio repository

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

???

LIS

CLR

Clinical Lab

Pathology Informatics 2010


Clinical laboratory for research and the bio repository1

Clinical Laboratory for Research and the Bio-repository

  • CLR did clinical testing for clinical trials and tissue banking

  • Additional (special) functions required

Special research reports

Requisitions consistent with protocols

Selected results to EMR

Integration with “EMSI” and “RFDR”

Tissue (blood) bank

Extra Data Collection

Consent Status Aware

Research Billing

Batch Accessioning

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

  • Accept discarded clinical specimens (for banking) in future

Pathology Informatics 2010


We decided to use an second instance of our cp lis

We decided to use an second instance of our CP LIS

Pathology Informatics 2010


Advantages of integrated homogenous systems

R-EMR

EMSI

HL7

Batch

LIS

CLR

Straw Aliquoter

Specimen

Inventory

Tissue bank front end

Special research reports

Tissue bank Inventory

Requisitions consistent with protocols

Consent Status Aware

Selected tests to EMR

Research Billing

Integration with “EMSI” and “RFDR”

Batch Accessioning

Data exchange with the main clinical lab

ADT

Billing

Results

LIS

Clinical Lab

MULHOS (CP LIS)

Pathology Informatics 2010


Advantages of integrated homogenous systems

RPDR

EMSI

HL7

Batch

Straw Aliquoter

Specimen

Inventory

Training

D.R.

Upgrades

Interfaces

Hardware

Upgrade Cycles

Dictionaries

Personnel

Patches

No castles

Maintenance

Priority

ADT

Billing

Results

LIS

LIS

CLR

Clinical Lab

MULHOS (CP LIS)

A Vendor

Pathology Informatics 2010


Advantages of integrated homogenous systems

“Infrastructure”

Pathology Informatics 2010


Advantages of integrated homogenous systems

RPDR

EMSI

HL7

Batch

Straw Aliquoter

Specimen

Inventory

ADT

Billing

Results

Clinical Lab

CLR

Accession

?

LIS

LIS

“Done

Racks”

Large scale clinical discard banking

Pathology Informatics 2010


Advantages of integrated homogenous systems

No Developers Used

Pathology Informatics 2010


Advantages of integrated homogenous systems

AP

CP

CP

TM

Pathology Informatics 2010


Advantages of integrated homogenous systems

AP CP Integration

Pathology Informatics 2010


Ap cp integration

EMR

AP

CP

EMR

AP CP

AP CP Integration

It will take a long time

We will work with our vendor

Today

We will not lose our informatics

card

Pathology Informatics 2010


Advantages of integrated homogenous systems

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

Pathology Informatics 2010


Advantages of integrated homogenous systems

It is used by hundreds of physicians who increasingly require guidance

LIS

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

Order

Interpretation

Pre-analytic

Reporting

Analytic

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

Pathology Informatics 2010


Advantages of integrated homogenous systems

Anatomic Pathology is beset buy

Increased volume

Increased Complexity

The AP Laboratory high “variation” and very low efficiency

Pathology Informatics 2010


Advantages of integrated homogenous systems

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

Pathology Informatics 2010


Advantages of integrated homogenous systems

The pathology department has three missions….

…The LIS only supports one

Pathology Informatics 2010


Advantages of integrated homogenous systems

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

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

Pathology Informatics 2010


Advantages of integrated homogenous systems

Enterprise Systems

70/70/3/0

POE

EMR

ADT

PACS

Quant Value

Communication

Teaching

&

Research

AP CP LIS

Efficiency

Departmental Sub Systems

PACS

MOL

DASH

LH

Pathology Informatics 2010


Summary

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

Pathology Informatics 2010


Integration systems and standards

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….

Pathology Informatics 2010


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