Let s Talk Informatics

Transcription

1 Let s Talk Informatics Automated Core Laboratory A Pathology Informatics Perspective Bryan Crocker Manager Pathology Informatics April 27, 2017 Bethune Ballroom, Halifax, Nova Scotia

2 Please be advised that we are currently in a controlled vendor environment for the One Person One Record project. Please refrain from questions or discussion related to the One Person One Record project.

3 Informatics utilizes health information and health care technology to enable patients to receive best treatment and best outcome possible.

4 Clinical Informatics is the application of informatics and information technology to deliver health care. AMIA. (2017, January 13). Retrieved from

5 Objectives At the conclusion of this activity, participants will be able to Identify what knowledge and skills health care providers will need to use information now and in the future. Prepare health care providers by introducing them to concepts and local experiences in Informatics. Acquire knowledge to remain current with new trends, terminology, studies, data and breaking news. Cooperate with a network of colleagues establishing connections and leaders that will provide assistance and advice for business issues, as well as for best-practice and knowledge sharing.

6 Specific Objectives Outline the reasons for the implementation of the automated Core Lab at the VG site Outline the role that the Pathology Informatics group had during the implementation and ongoing support Outline the complexity of the integration between Millennium and the various middlewares necessary to control the automated lab and analyzers at district sites Outline the various types of rules that are necessary to ensure automation continues effectively and efficiently Outline outcomes achieved from implementation of Core Laboratory

7 Conflict of Interest Declaration I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device, health care informatics organization, or other for-profit funder of this program.

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11 Brian Mulroney is prime minister Ronald Reagan is president John Buchanan is still premier of NS Iran-Contra affair was on-going Black Monday stock market crash The Loonie coin makes its debut Jessica McClure falls down well and is rescued while the world watched The Legend of Zelda is released for NES in North America Prozac makes its debut Dr Mike Moss (head of Laboratory Services at VGH) sends a detailed letter to DoH requesting funding for essential modern Core Laboratory

12 Core Laboratory Request Consolidated Hematology/Chemistry/Immunology Laboratory Integrated equipment one vendor if possible Located on 2 nd Floor Mackenzie Transportation system between receiving area on 1 st floor and 2 nd floor laboratory Enhanced computerization and data analytics

13 Core Laboratory Request Consolidated Hematology / Chemistry / Immunology Laboratory Integrated equipment one vendor if possible Located on 2 nd Floor Mackenzie Transportation system between receiving area on 1 st floor and 2 nd floor laboratory Enhanced computerization and data analytics Core Laboratory Request Consolidated Hematology / Chemistry / Immunology Laboratory across district Integrated and automated equipment one vendor if possible Located on 2 nd Floor Mackenzie Transportation system between receiving area on 1 st floor and 2 nd floor laboratory Consolidation of non-urgent testing from CZ sites to Core Lab Enhanced computerization and data analytics

14 What has changed in 26 years?? We got bigger Central Zone vs VG alone! Critical shortage of Medical Laboratory Technologists Upgraded and advanced technology in instrumentation smaller footprint / faster throughput More reliable and full-functioning robotics including preanalytical techniques Updates and availability of test kits on automated equipment much broader menu Limited number of vendors with the capability of achieving request Pathology Informatics Group available full interfaced solution available

15 Pathology Informatics Group (PInG) Officially recognized in July 2008 as permanent entity in Dept of Pathology and Lab Medicine Mission: To create an efficient, intelligent and innovative information backbone for the diagnostic laboratory. To improve the health of the patient and health care system through effective laboratory information management and research empowerment.

16 Pathology Informatics Group (PInG) Team of 14 highly skilled individuals Senior Clinical Analysts (all MLTs) Data/Business Analysts Informatics clerk Informatics Data Integrity Officer

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18 Core Laboratory Information ~6300 tubes/day 12% inpatients / 88% outpatients Order Volume for Core Lab 4,952, 407 orderable procedures Spans Hematology/Chemistry/Immunology Includes all routine work from CQ, DG and TF

19 Core Lab: Where do we start? Manual sample processing

20 Manual storage

21 Hematology Receiving 2 nd Floor

22 Load analyzer and begin run Analysis Sample Repeat or Dilution process Data F REFLEX Wand in Acc# Manual review of results OK? NO YES Release results

23 Before Core Lab 2 nd Floor

24 Core Lab Floor Plan 2 nd Floor

25 3D Model of Automation Line

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29 First Steps - Hematology Move Hematology out of proposed Core Lab footprint on 2 nd floor Existing equipment had to be reconnected to Millennium from non-traditional spaces wiring, ports etc. Move new Hematology (Sysmex) track into swing space in old washup area on 2 nd floor connections needed district wide testing Interface Millennium to WAM middleware Extensive testing with Sysmex systems

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34 Second Steps - Hematology Install new Sysmex analyzers at all other lab sites in CZ while maintaining connections to existing analyzers Validation testing at each site Routing parameters designed in Millennium New Orderable panels and procedures based on new technologies and WAM rules Planning for go-live of Core Lab

35 Third Steps - Hematology Go-live of new Sysmex track in Mackenzie swing-space Validation testing Special routing parameters to accompany tube sorter New Orderable panels and procedures based on new technologies and WAM rules Planning for go-live of Core Lab Temporary tube sorter received from Sysmex post-live required further tweaking

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37 First Steps Chemistry / Immunology Install new Chemistry/Immunology (Abbott) equipment for testing in swing space on 3 rd floor Interface Millennium to Instrument Manager middleware for Abbott Architect analyzers New ports/connections needed Begin rule writing / testing / testing / testing Education for Pathology Informatics team

38 Second Steps Chemistry / Immuno Installation of new Architect analyzers at all CZ laboratory sites while maintaining connections to old Beckman analyzers New ports/connection Routing parameters Rule writing Education and training for staff

39 Phased Approach to Go-Live Sysmex hematology analyzers Architect Chemistry analyzers at district sites Phased-in implementation Architect Chemistry analyzers at VG site in temporary space Architect Immunology analyzers at VG site in temporary space IM Middleware used as pass-through to Millennium IL Top 700 Coagulation Analyzers installed and validated in temporary space On-board rules developed and tested

40 Meanwhile in the Core Lab

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43 Core Lab and PInG Construction finished Port installation and connectivity KVM switches UPS room Had major power outage in Mackenzie PInG involved in planning and implementation Location of analyzer installation Location of preanalytic modules PInG representation on all implementation committees at all levels.

44 Core Lab and PInG Core Lab equipment installed Chemistry/Immuno/Coagulation Core Lab completely turned over to PInG for 3 months for testing IM Middleware DMS Middleware controls track, aliquoter and storage modules Hundreds of hours of testing and retesting Setup of input modules Extensive testing of aliquoter module

45 Go-Live Day

46 Post-Live Chemistry/Immunology consolidated on IM at all sites IM now controlling most rules Millennium acting mostly as pass-through and result reporting software Includes Microbiology immunology tests Coagulation on track IM Middleware used for track analyzers Direct interfaces to Millennium used at district sites Sysmex track moved to Core Lab but not yet connected directly to Abbott APS 3600 Utilizing WAM middleware and rules

47 Post-post live Abbott supplies robotic arm and hardware to connect Sysmex hematology line to Abbott track Routing changes needed Sysmex tube sorter removed and Sysmex track repositioned All routine priority work transferred to Core Lab from CQ and DG sites TAT actually improves More and more rule writing and changes needed as staff/section heads reviewed data from new analyzers More utilization rules put in place in Millennium to deal with new workload reality

48 Statistics Instrument Manager rules ~569 rules written and implemented across various IM connections. H-I-L rules (Hemolysis, Icterus, Lipemia) Dilution rules Result held rules / Result release rules egfr calculations (age/gender dependent) Rerun rules / Delta Checking Calculation rules Sorting rules Aliquoting rules Quality Control rules

49 Statistics WAM (Hematology) Rules Numerous rules written by WAM specialist and PInG Analyst Patient specific rules WBC/RBC/Platelet specific rules Delta parameters No previous results Operator alerts Historical lookbacks in WAM database Critical rerun rules Reflex orders (Smears, Reticulocyte Counts) Additional orders in Millennium (Millennium rules) based on outcome of WAM rules complex interaction

50 Statistics Autoverification Hematology approximately 85% are autoverified Coagulation approximately 90% are autoverified Chemistry approximately 80% are autoverified Immunology approximately 90% are autoverified Completely automated Preanalytical Analytical Autoverification Storage Storage Retrieval and/or Disposal Allows highly skilled technologists to concentrate on outliers, quality control, and quality assurance

51 Lessons Learned Plan, plan, plan and then plan again Realistic timelines for resources available Construction timelines Vendor installation timelines Education timelines for middleware, new technologies and procedures Creating usernames and privacy profiles for middleware Realistic testing timelines same staff supporting dayday operations are doing this major project Space planning other equipment moves District wide planning PInG involvement Support connectivity from vendor is mandatory

52 Outcomes achieved Improved staff and patient safety Managing increasing workload with reduced resource availability in the entire Zone Total laboratory automation including preanalytics, Chemistry, Hematology, IA, Coagulation, Storage Improved operational efficiencies/improved TAT for Urgent and Routine specimens Standardized analyzer platforms and methodologies across entire Zone

53 Outcomes achieved Integrated cross-functional Core Lab staff ongoing project Consolidation of large proportion of non-urgent testing in Core Lab. Core Lab workload increased 30% DGH workload reduced by 50% CQ workload reduced by 75% Not even noticed in Core Laboratory due to transfer lists, preanalytics and autoverification Built in potential capacity for future growth Smart, integrated rules across Millennium and all related Middlewares

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55 The Let s Talk Informatics series meet the criteria outlined in the Manipro+ Certification guide for 1 credit by providing content aimed at improving computer skills as applied to learning and access to information. A certificate of attendance will be sent to you to personalize, along with the link for the evaluation. Thank you for attending today s event.

56 This Group Learning program has been certified by the College of Family Physicians of Canada and the Nova Scotia Chapter for 1 Mainpro+ credit.