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IT in a pandemic year, now and what’s ahead: interfaces, analytics, telepathology—seven weigh in

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November 2020—Information technology from a COVID-19 perspective. What has been the impact on IT, and what change is yet to come?

That is what seven people who met virtually on Sept. 10 talked about with CAP TODAY publisher Bob McGonnagle. They are James Harrison, MD, PhD, of the University of Virginia; J. Mark Tuthill, MD, of Henry Ford; Stephen Hewitt, MD, PhD, of the National Cancer Institute; Bob Dowd of NovoPath; Michelle Del Guercio of Sunquest; Curt Johnson of Orchard; and Brian Gunderson of Roche.

You will see here, in the conversation that follows, where their focus is as the crisis continues.

CAP TODAY’s laboratory information systems product guide begins on page 62.

James Harrison, how has your IT support been since the COVID crisis began?
James H. Harrison Jr., MD, PhD, associate professor and director of clinical laboratory informatics, Department of Pathology, University of Virginia School of Medicine: The crisis has focused our attention, so the scope of our activities has been less broad than it might normally be. If you looked over the past six months, people in the lab would raise supply chain issues for lab tests as more of an issue than IT, which is unusual. Our support has been good; we haven’t noticed deficits.

Brian Gunderson, how has the IT environment within Roche and how have your customers been affected by COVID-19?
Brian Gunderson, international business leader, software, Roche Diagnostics: It’s all things COVID, and it has pointed out a few things, especially in the molecular area. As we’ve been deploying our large-volume analyzers, it has shined a light on the need for the connectivity, for the IT component, and maybe where molecular was lagging behind in the past. We’re also starting to see that it’s driving more rapidly the digital adoption that is necessary in health care and in IT, and I think it will have an impact on provider consolidation too. We’ve seen this trend of consolidation for a few years, but that is going to pick up over the next three to five years.

Curt Johnson, we’re hearing reports about data reporting demands that have stressed laboratory IT operations. Have you had that experience with your customers at Orchard?
Curt Johnson, chief operating officer, Orchard Software: Yes, we have. We’ve had a lot of inquiries, and the demands on our clients made by the CDC or the state departments of health change periodically, as they dial in on exactly what information they need for the benefit of the country. The integration needs vary, and they change as they go. We work closely with our clients and offer professional services to assist them with those requirements.

Clients deal with a couple of obstacles. One is the changing criteria for the information that’s needed, and then the people requiring that information have different connectivity capabilities for how they can receive the data. Some of those state departments of health would like to have it in an interface using the 2.5.1 ELR interface method. Others can’t accept that yet and are looking for CSV files, with specific information in specific spots. So we’re working with each of the clients to meet these needs individually through our professional services team and to make sure we’re doing everything we can to support the client base, getting the information to the right people in a timely fashion.

Dr. Tuthill

Mark Tuthill, what is it like to be the head of pathology informatics in the middle of a pandemic crisis?
J. Mark Tuthill, MD, division head of pathology informatics, Henry Ford Health System, Detroit: Busy. We’ve been inundated with not only analytic report requests but also interface projects for new technology that we have been standing up for novel lab testing methods that include new test orders and results. This work is not only the LIS. Since we are integrated with our EMR for orders and results, we have to work with additional teams to build out all of that for the EMR as well. This includes development to help cohort our patients as well as gather the required information for reporting to comply with national reporting requirements. Most of this has been accomplished through a combination of ask-on-order-entry questions and basic LIS information such as patient location and admission category—ER, inpatient, outpatient, et cetera. This data is used to manage our pipeline and route samples to different testing platforms with different turnaround times, sensitivities, et cetera.

So, there has been a lot of work in the LIS and with the EMR. Ultimately, it comes down to getting the data out timely and accurately. Fortunately, we are on one LIS and one EMR across our entire health enterprise, and our interface to the state department of health has been in place for four or five years. We were easily able to add the required COVID reporting elements into our interface, so by March 16 we were sending all the requested COVID data the state needed. Over time, we have added additional elements as requested to comply with changes mandated by the CDC or Health and Human Services. For the most part, we were able to add additional HL7 segments. Occasionally, we have had to go back to the LIS vendor to have them run a stored procedure to generate data we were not getting. To sum it up, between the LIS maintenance, instrument interfaces, the EMR configuration and coordination, managing ask-on-order-entry questions, and directing samples by cohorting process, we have been incredibly busy.

This underscored to us that our efforts to create an efficient, highly integrated, up-to-date laboratory information system has stood us in good stead. This has allowed us to be extremely nimble and to deliver information to leadership that would not have otherwise been available from the EMR.

Dowd

Bob Dowd, tell me about some of the challenges that COVID may be presenting to Novo­Path’s clients and how you’ve responded.
Bob Dowd, VP of strategic accounts, NovoPath: NovoPath started off as predominantly an AP software provider, but over the years we’ve added other modalities. We can handle clinical pathology, microbiology, cytogenetics, therapeutic drug monitoring. We added all of that because of the diverse nature of our clients.

A client would rather have one system for all data, one set of data interfaces. So as we continue to develop, we integrate all of that. With more molecular COVID testing, we can accommodate that. And one of our strengths is our data management capabilities through our interface engines, our instrument interfaces. So we can integrate clinical and AP reports and give clients clinical only reports, AP reports, combined, all results for a patient on the same day.

We created a special COVID repository that each client can have that will track the patients who have been tested—negative, positive, recovered. It’s a special add-on for clients.

Michelle Del Guercio, if you’d like to comment on the current state of affairs for your customers and LIS initiatives, please do. In addition, I’d like to have you comment on the multiple platforms labs are adopting, in part in response to supply chain difficulties. This means extra work on interfaces and reporting at Sunquest. Am I right?
Michelle Del Guercio, VP of marketing, Sunquest Information Systems: That’s correct, and I agree with what the others have said about the complexities, the many moving parts that laboratory organizations have, and how they are turning to technology to help support that.

The reporting has continued to fluctuate. There are other federal and state reporting requirements, and as that all shifts, the nimbleness that Dr. Tuthill mentioned is extremely important. And we have found it helpful to talk to our customers in a town hall call, to which our customers can dial in for assistance or product availability updates or to provide us with feedback.

There were also the issues related to the patient locations that were added—tents in parking lots, for example. The technology had to be able to help support where that patient is, where that report goes, and getting the information into the EHR.

As our customers stand up additional tests, they often need new instrument interfaces to manage the workflow. We’ve introduced rapid deployment options of our solutions to help customers start and scale their testing—from order capture, test performance, and results delivery—to help them manage connectivity, capacity, and volume demands.

Johnson

Curt Johnson, in April or so we heard about some people from laboratories sitting at home, from the surgical pathology area of the lab, for example. Now I’m hearing from laboratories that they can’t get enough personnel. Are your customers now under strain to get the work produced?
Curt Johnson (Orchard): They can be, and your information is correct. We have a diverse client base at Orchard—physician offices, hospitals, independent reference labs, and public health. In April we did see a test volume drop in our physician office customers, when the patients stopped coming in for routine visits. Our anatomic pathology volumes decreased as well. Our hospital volumes stayed fairly even. But our reference lab business started to pick up right away and has been exploding ever since. And for our department of health clients, both receiving data and testing, one effective COVID-19 testing strategy that many labs are employing is to use multiple platforms. The more platforms they have to bring in, the more integration is needed from us. One of our reference labs is now managing 20,000 accessions a day and another one is testing more than 12,000 a day, and it’s 98 percent COVID-19.

Our physician office business has picked up since the summer. All of our business is starting to pick up, but predominantly we’re dealing with COVID-19, helping get analyzers online, getting the integrations and the HL7 2.5.1 interfaces in place.

The CEO of another health care information company, who is not directly in the LIS business, said to me today that lab data has become the universal language of health care. It’s interesting because for the first time in a long time, the laboratory and laboratory information are in the spotlight in a way that shows how valuable they are.

We’ve known the value, and now the rest of the country is coming to see that because of the COVID-19 crisis. I think we will see laboratory testing stay at the forefront even as the crisis passes and COVID-19 becomes another mainstream test.

Brian Gunderson, I am sure you’re hearing some of the same things about renewed prominence and appreciation for laboratories. Is that right?
Brian Gunderson (Roche): Yes, it is. We’ve had a lot of interactions that we have never had before as a company, with governments, with CEOs of health systems across the world. Typically in the laboratory you fly a bit under the radar, but in the last six to nine months it’s been anything but that.

Roche began to speak a lot about the digitization of health care and diagnostics and it became a prominent theme in its communications two or three years ago. I am assuming you’re glad you emphasized that direction at Roche and continue to implement solutions in that direction. Can you tell me more about that?
Brian Gunderson (Roche): A few years ago we started to put a focus on what we call digital diagnostics and driving that forward. As laboratorians we’ve done a great job of understanding the sample flow, the automation of the laboratory from instruments through large track systems, and now we’re moving into this area of understanding the data flow that parallels that sample flow.

The investment we put into that is paying dividends today. It’s allowed us to quickly develop new dashboards and new reports specific to COVID, and it has allowed us to get instruments up and running faster than we ever had to do in the past. I expect that this is going to leapfrog us into the future when it comes to digitization of the laboratory.

Michelle Del Guercio, Sunquest is not a barebones LIS product. You have a lot of arrows in your quiver, so to speak, at Sunquest. Can you talk about how that diverse portfolio is helping you and your clients during the pandemic?
Michelle Del Guercio (Sunquest): The suite of solutions that Sunquest provides very much supports that value of laboratories as they look to support the strategic initiatives of their health care organizations, and that has lifted the laboratory out of the basement. If you think about disease management and population health and COVID, the laboratory is in all of that, and the ancillary components of the Sunquest offering are helping to drive some of it, specifically with the orders and results management, the integrated reports, the connectivity with instrumentation, and extending through to the molecular laboratory. It has helped drive our customers forward quickly and efficiently as they deal with this new paradigm.

Stephen Hewitt, how has the pandemic affected your world, particularly as it regards IT, at the National Cancer Institute?
Stephen Hewitt, MD, PhD, CAPT U.S. Public Health Service, head of the Experimental Pathology Laboratory, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute: The pandemic has had an enormous impact on my group and all the technologies I work with. It put the surgical pathologist off on the side and inactive, and we turned down our in-house services to just bare minimum because we did not have specimens coming through in our in-house service. Our consultative services continue at full steam, and one direct impact on us was the request to digitize slides for our pathologists to review in consultation for the consult material that was coming in the door.

We have a number of older pathologists for whom it isn’t safe to be out, and we were able to digitize and support them to perform telepathology, and they were delighted.

What you see when you go to telepathology is that there’s such a distinct learning curve that sometimes the simpler and older systems that they’re comfortable with are a better environment for this because you don’t have the time to bring them up to speed with learning sessions and everything else. We were working with limited staff, so we were doing this on a shoestring.

On the other side of the coin, NIH has performed 21 COVID autopsies. As an experimental pathologist, I was one of two attending pathologists for those autopsies. We built an immediate biobank, so I already have 1,500 COVID tissue samples in my laboratory as a part of our ongoing pathology research. And we’re already bringing up assays and doing correlative studies to understand COVID.

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