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Advantages of Integrated (Homogenous) Systems

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

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  1. 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

  2. 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

  3. 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

  4. 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

  5. The case for (homogeneous) integration Pathology Informatics 2010

  6. 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

  7. 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

  8. Chemistry Heme Microbiology CP LIS If the differential performance begins to decrease, combining the systems begins to have real value Pathology Informatics 2010

  9. 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

  10. Imaging The case for (homogeneous) integration x 3 Interfaces HIS AP CP TM Interface maintenance “Handoffs” Data Models / Relations Timings Pathology Informatics 2010

  11. The case for (homogeneous) integration x 3 Subsystems HIS AP CP TM Image Image Image Pyramids of sub-systems Pathology Informatics 2010

  12. The case for (homogeneous) integration x 3 Subsystems HIS AP CP TM Image Image Image Device Interfaces Pathology Informatics 2010

  13. HIS AP CP TM PACS PACS PACS The case for (homogeneous) integration x 3 Personnel Personnel Call Admins Training Backup Succession Pathology Informatics 2010

  14. The case for (homogeneous) integration x 3 Societal Feudalism Pathology Informatics 2010

  15. 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

  16. 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

  17. 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

  18. Do you have nothing better to do? Pathology Informatics 2010

  19. Clinical Laboratory for Research and the Bio-repository (CLR) Pathology Informatics 2010

  20. 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

  21. 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

  22. We decided to use an second instance of our CP LIS Pathology Informatics 2010

  23. 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

  24. 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

  25. “Infrastructure” Pathology Informatics 2010

  26. 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

  27. No Developers Used Pathology Informatics 2010

  28. AP CP CP TM Pathology Informatics 2010

  29. AP CP Integration Pathology Informatics 2010

  30. 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

  31. 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

  32. 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

  33. Anatomic Pathology is beset buy Increased volume Increased Complexity The AP Laboratory high “variation” and very low efficiency Pathology Informatics 2010

  34. Meanwhile over the next several years ~ 3 Billion people will be looking for pathology services Pathology Informatics 2010

  35. The pathology department has three missions…. …The LIS only supports one Pathology Informatics 2010

  36. 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

  37. 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

  38. 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

  39. 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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