July 2010

Editors:
Raymond D. Aller, MD
Hal Weiner

At one lab, reflex testing tipped scales when weighing LIS choices

When Mark Catlin, MD, was shopping for a laboratory information system for a new regional clinical laboratory, he knew what functionality he wanted—and reflex testing capabilities were paramount.

Dr. Catlin, medical director for the St. Paul, Minn.-based toxicology laboratory Medtox Scientific, chose the AutoLims LIS from NetLims in part because users can create “if-then” statements that automatically set up a sequence of additional testing when results for an initial test are positive or abnormal. Medtox installed the system in its clinical lab when it opened 1½ years ago.

“One of the things that was a source of frustration for us with other LISs,” he says, “was the inability to do reflex testing with our Pap smears. And NetLims does that very well.”

With some other LISs, “if you have a large volume of Pap tests, you’d have to go through all those tests, look for the ASCUS [atypical squamous cells of undetermined significance], then look at the client and see how they want it handled,” Dr. Catlin explains. “All this is done automatically behind the scenes by the software.”

The system allows reflex testing to be customized to a physician’s needs or wants, as well as by clinic, patient age, and other parameters, instead of forcing clients to adapt to Medtox’s testing protocols. “With respect to cytology,” Dr. Catlin says, “many doctors have specific preferences—some want HPV testing on all patients, some on patients over 30, some only on ASCUS results.”

“Say you have a client that automatically wants reflex testing to HPV and they might automatically want genotyping of the HPV results,” Dr. Catlin continues. “We can set up if-then statements. If it’s this client and the result is ASCUS, then it automatically goes to HPV. If the HPV is positive, that result triggers a reflex to genotyping so we can report out the genotype for HPV.”

Medtox has found its LIS’s reflex testing capabilities to be helpful with other types of specimens as well. “The if-then technology allows you to direct cases, such as all your bone marrows, to a certain pathologist,” he says. And the cassettes and slides for each type of specimen can be color-coded because the cassette printer offers multiple colors. “The system provides the ability to define default work items per procedure, source, and/or client,” he adds, “after which, the items can be printed on different colored blocks for better organization of the workflow.”

Medtox also chose its LIS because the system uses bar coding to track patient specimens. When the laboratory receives a specimen, a staff member scans the bar code linked to it into the LIS, which confirms receipt, and then generates additional bar codes if necessary.

For surgical pathology, Dr. Catlin scans the bar code on the specimen he is examining, which automatically triggers the lab’s cassette printer to print a cassette with a bar code label, along with the patient’s age and Medtox’s surgical number. The histotechnologist uses the bar code to create the slide, which also contains the bar code. “Then,” he continues, “when I’m reading the sample, I scan the bar code and the case pops up in the system. So from the time the specimen is created and labeled at the clinic to the time it’s resulted, it’s all by bar code. It potentially eliminates some of the risk of misidentifying or signing out the wrong cases and confusing cases.”

Medtox can also embed into its LIS external consultation reports and electronic images taken from cameras attached to microscopes, as well as record audio reports through the system.

Because Medtox’s regional lab is a new entity, “it could establish state-of-the-art technology right from the start,” says Dr. Catlin. “Older labs would have to deal with legacy systems and weigh the cost of obtaining new technology—they would have to justify the expense.”

Allscripts to purchase Eclipsys

Allscripts has announced a definitive agreement to purchase hospital vendor Eclipsys Corp.

The combined company will merge Allscripts’ electronic health record and post-acute care products with Eclipsys’ enterprise solutions for hospitals and health systems and offer a single platform of clinical, financial, and connectivity solutions to hospitals and physician offices.

The merger is intended to boost the companies’ ability to benefit from the meaningful use provision of the American Recovery and Reinvestment Act of 2009, which is expected to significantly boost sales of electronic health record systems.

Thermo Fisher Scientific offers SaaS-based LIMS

Thermo Fisher Scientific is marketing LIMS-on-Demand, a software-as-a-service-based laboratory information management system.

Users of the new Web-based product, which is geared toward labs of all sizes, have access to all the functionality provided by a client/server-based LIMS, including the ability to create workflows and map sample lifecycles, at a lower cost.

Three LIMS-on-Demand licenses and online consultation for six months is approximately $10,000. A monthly subscription after the six months have elapsed is $375 per user. “All installation, software configuration, management, and maintenance are supported by Thermo Fisher Scientific,” says Kim Shah, vice president of marketing and new business development, Thermo Fisher Scientific Informatics. “No additional hardware, databases, operating system licenses, or IT staff are needed.”

Laboratories traditionally have purchased their own LIMS hardware and software and configured the products to meet their workflow requirements. However, advances in Web security in recent years have led to a shift toward less costly Internet-based options.

“Several companies, Thermo Fisher included, have been working on a SaaS model for a number of years, even introducing a pilot version as long as eight years ago,” Shah told CAP TODAY. “Unfortunately, eight years ago, the Web security systems were either not in place completely or were not completely trusted by users of laboratory software, so the acceptance of this solution was not as enthusiastic as it could have been. However, over the past several years, with Internet technology not only becoming more secure but a standard business tool, and with the success of SaaS projects across many industries, like SalesForce.com, the time is right for smaller nonvalidated laboratories especially to explore the real options available with on-demand LIMS solutions.”

Halfpenny Technologies acquires Laboratory Management Services

Halfpenny Technologies, a health information exchange solutions provider, has purchased Laboratory Management Services, which markets clinical data acquisition and reporting tools to clinical laboratories and health plans.

LMS will be integrated with Halfpenny’s core health information exchange business and operate as a division of Halfpenny. The acquisition will expand Halfpenny’s services to include clinical data capture of all member data points within a health plan or product, clinical data normalization through Logical Observation Identifiers Names and Codes mapping, and plan leakage management for health plans and laboratory service providers. Halfpenny also acquires LMS’ technology to manage shared capitation reimbursement.

“In combining LMS’ management tools with Halfpenny’s specialized interface engine, Halfpenny will be able to securely and cost-effectively facilitate data exchange between health plans and clinical labs,” sums up Mike Snyder, president of LMS.

Medicity to release platform for information exchange

Medicity plans to introduce next month its iNexx platform, which will be available at no cost to physicians.

The platform is designed to securely exchange information between authorized providers while creating a virtual care team record that provides a view of patient information to all members of the team. Providers that download the iNexx platform will be able to securely automate referrals with any other provider using the platform and receive updates on care administered to their patients by other providers. INexx users share and manage patient data via a private social network consisting of members of the care team, regardless of institutional affiliation or differences in electronic health record or practice management systems used.

“The iNexx platform makes it possible for care teams to coordinate care in a patient-centered, virtual environment by eliminating the boundaries and silos of health information while simultaneously improving core referral workflow functions performed in the practice every day,” says James K. Lassetter, MD, CEO of Medicity.

CAP becomes sponsor for IHE Laboratory Domain

Integrating the Healthcare Enterprise International has named the College of American Pathologists as the primary sponsoring organization of the IHE Laboratory Domain.

The IHE-CAP collaboration is designed to accelerate the process for defining health information technology standards and promote health IT interoperability for the laboratory, complementing efforts in many countries to create national electronic health record systems. The mission of IHE, which is composed of health care information technology stakeholders from various countries, is to improve the global health care community’s ability to share information electronically.

The College, as the primary Laboratory Domain sponsor, will be responsible for supporting domain operations, including the development, publication, and maintenance of IHE technical frameworks. These frameworks are specifications for implementing standards to achieve systems interoperability. The domain group plans to address in 2010 and 2011 the next generation of laboratory device automation.

“The CAP’s clinical and technical expertise in health IT, paired with our long-standing relationships with key stakeholders worldwide, will greatly enhance the development of the Laboratory Domain,” says Kevin Donnelly, CAP SNOMED Terminology Solutions vice president and general manager. “Our goal is to ultimately improve patient outcomes through interoperable health IT systems that provide data to assist in diagnoses, clinical decision support, and improvements throughout the health care system.”

IHE is sponsored by the Healthcare Information and Management Systems Society, Radiological Society of North America, and American College of Cardiology.

CCHIT chooses test tool fromIgnis for EHR certification

The nonprofit Certification Commission for Health Information Technology is using Ignis Systems’ lab result test suite as part of its effort to certify electronic health records.

The test tool is being used in the CCHIT’s preliminary program to qualify EHRs for reimbursement under the meaningful use provision of the American Recovery and Reinvestment Act of 2009 and the CCHIT Certified 2011 program. The test suite is designed to confirm that an EHR can import laboratory results correctly.

CCHIT chose Ignis Systems because of the company’s expertise in EHR-lab integration, says Dennis Wilson, CCHIT’s certification technology director. “They’ve given us a really cool tool, which reflects a deep understanding of how lab information needs to be packaged, transmitted, and presented in the EHR.”

Cove introduces new version of inventory management system

Cove Laboratory Software has released InvMan, Inventory Manager, version 6.0.

The latest version of the reagent-and-supply inventory management system provides electronic output of purchase orders and a new instrument and equipment management application.

The software tracks all instrument service and maintenance visits and alerts users to pending service and maintenance. It can also generate comprehensive service and maintenance reports that detail the life history of all instruments in the laboratory.

Contracts

BioImagene has signed an agreement to equip Dartmouth-Hitchcock Medical Center, Lebanon, NH, with its complete suite of digital pathology solutions, including its Virtuoso digital pathology application software and iScan Coreo Au slide scanner.

Aurora Interactive Ltd. has signed a contract for its mScope Education communications platform and viewer with the Association of French Quality Assurance in Pathological Anatomy and Cytology. AFAQAP will use the platform for its quality enhancement and continuing medical education programs for pathology practices.