Madeline Wiegman, tell us how you’re enhancing middleware, particularly for the purpose of suggesting and implementing reflex testing.
Madeline Wiegman (Werfen): HemoHub has laboratory decision support that provides the ability for a customer to configure customized rules. They can use HemoHub software to automatically execute reflex tests. HemoCell, our dedicated hemostasis automation, provides additional capabilities for tube sorting and rerouting without manual intervention. Whether you need to rerun a PT or APTT or add on a test because of a different result, HemoHub is able to add tests to samples and automatically execute, or give a directive to a lab technologist to add a test or run this test next. All of these important capabilities were the result of listening to our users and developing solutions to make their lives easier.
Krishna Ram, how is Sysmex implementing middleware for coagulation with the new instrumentation?
Krishna Ram (Sysmex): Our Caresphere WS, known as WAM [Work Area Manager], used to be a remote IPU [instrument processing unit] that would be kept at certain institutions. We’ve come a long way since then. Many of our customers now prefer it to be cloud based because it provides contingencies.
Result viewing, result validation, and the ability to build in rules for hematology has always been there, as is having the ability to see scatterplots on your middleware solution. We’re working on the same workflow for hemostasis. We recently launched the next generation of hemostasis analyzers, the CN-Series. The reflex, reanalysis, and redilution rules are built into and are customizable on the CN. So it leaves the choice to each customer because not every lab technologist likes the idea of having or needing a separate WAM for coagulation. In those situations, all the rules can remain on the instrument. We are working on how we can have a WAM that encompasses hematology, urinalysis, and hemostasis, all from Sysmex. So a lot more to come.
Kristi Smock, you have great challenges with middleware at ARUP generally and probably within the coagulation and hemostasis labs. Tell us about your setup and how important it is that your coagulation vendors offer middleware.
Dr. Smock (University of Utah): We appreciate the middleware that’s available to us. Because we have dedicated hemostasis and thrombosis technologists, we do a lot more decision-making manually. But as instruments and middleware are becoming more sophisticated, we’re seeing opportunities to utilize that instead of manual decision-making. For some tests, like our laboratory-developed tests, we often develop in-house, with our own IT, various middleware to help facilitate calculations and things like that.
Chris Gillespie, tell us about the challenge of connectivity for HemoSonics. You have units in different places—the bedside, OR, et cetera. How do you keep track of the various point-of-care devices?
Chris Gillespie (HemoSonics): In general, most hospitals have a middleware provider they’ve selected for their point-of-care devices. Our technology integrates with the middleware the hospital has, whether it’s a RALS, Telcor, UniPOC, or any of the common middleware solutions. We’ve worked with those companies to develop drivers so our technology can be integrated through those middleware platforms.
We see many hybrid deployments for viscoelastic testing in which analyzers are in the laboratory and at the point of care. In those situations, the point-of-care devices can be integrated via the middleware and the laboratory devices can be connected with Data Innovations Instrument Manager. Overall, our connectivity strategy is flexible based on the needs of the hospital.
Andrew Goodwin, do you have a final comment?
Dr. Goodwin (University of Vermont): Regardless of all the automation and middleware, it doesn’t satisfy testing for every patient sample. You still have to have that level of expertise to understand how the systems and testing work and what the results really mean. I see instances where we’ve become so reliant on what the instrument or output of the algorithm told us to do that we forget to stop and critically assess what’s truly happening.
All of us participating in this roundtable discussion live and breathe coagulation every day. Yet for our pathology colleagues working in a medium- or small-size community hospital and who are primarily responsible for anatomic pathology, it becomes challenging to stay up to date with coagulation testing and anticoagulant drug interferences, among other things. That’s where we need to continue to push hard on education and support our physician colleagues who are in charge of coagulation laboratory testing. We need to pay attention to the education component.