LIS panel talks middleware, wish lists, workflow

November 2019—Middleware, result reporting workflow, consolidation of labs, and IT and laboratory labor were the center of discussion when CAP TODAY publisher Bob McGonnagle convened a panel in September to talk about lab information systems. Part one of the roundtable begins here; part two, on consolidation and labor, will be published in the December issue.

On the panel were J. Mark Tuthill, MD, of Henry Ford Health System, Curt Johnson of Orchard Software, Wally Soufi of NovoPath, Michelle Del Guercio of Sunquest Information Systems, Nick Trentadue of Epic, Sepehr Seyedzadeh of Siemens Healthineers, and Tony Barresi of Beckman Coulter.

Curt, can you tell us what is top of mind at Orchard as you finish out 2019 and look forward to 2020?

Curt Johnson, chief operating officer, Orchard Software: We’re coming off of two large growth years and we’re excited to continue through the end of 2019 and into 2020. The laboratory information system market continues to be an exciting place. We’ve seen a lot of activity across the spectrum of our market base, from regional to national reference laboratories and from small critical-access hospitals to 500-bed hospitals. Integrated delivery networks throughout the U.S. are realizing the impact of laboratory information as we move to a value-based system.

The other area we’re excited about and we’re looking forward to is the continued expansion of point-of-care testing and point-of-care management, and the role it plays within a health care organization and its affiliation with the laboratory itself. Addressing the nuances of managing this data, assisting the care coordinators, lab managers, point-of-care coordinators—anyone who is having to manage large amounts of data spread over an enterprisewide system through point of care—is an exciting opportunity that we’re looking forward to continue to assist our customers with.

Sepehr, in your press conference at the AACC meeting this year, there was discussion about the importance of point-of-care testing within networks, standardizing systems and platforms, whether in core labs, clinics, or ancillary testing sites. Do Curt’s comments parallel some of the concerns you have as you look for automation and IT within the Siemens diagnostic enterprise?

Sepehr Seyedzadeh, senior director, global marketing and product management for automation and diagnostics IT, Siemens Healthineers: Yes, operationalizing POC workflows through informatics and optimizing data management across lab networks have also been a core focus for Siemens Healthineers. This is evident through the recent launches of several POC informatics and central lab diagnostics IT products.

What Curt said about consolidating point-of-care and lab diagnostics is a request we are also hearing. In fact, at the middleware level, there has always been a question whether it would make sense to integrate POC testing data with central lab testing data. This is a question we are debating—what is the value added in having such data integration at the middleware level? It definitely makes a lot of sense at the LIS level.

Dr. Tuthill, if someone asks you, in an elevator ride at Henry Ford, what is the state of middleware in the Henry Ford laboratories today, what would you tell them?

J. Mark Tuthill, MD, division head, pathology informatics, Henry Ford Health System: I would say middleware has become less of an ancillary tool that one would bring in to help manage data and more of a core tool in the way we do our work. In fact, the question of what is middleware and where does the LIS begin and middleware end has become increasingly blurred.

For example, if you look at tools like automation lines, the middleware or the automation line control software is almost its own instrument. Middleware has become front and center in the way laboratories produce their data and how those data interact with the laboratory information system, and then ultimately downstream of the electronic medical record. Middleware is not restricted, in my view, to the clinical pathology laboratory and the world of chemistry. Middleware is also used in managing images, and it’s a toolset that is important to molecular pathology as well.

Michelle, Sunquest is an important LIS provider and platform and has been for years. Its sister company is Data Innovations, which is probably the single leading vendor of middleware. How do you view middleware now?

Michelle Del Guercio, vice president of marketing, Sunquest Information Systems: The term middleware, though it’s pretty much industry standard, has evolved a little. The importance of the connectivity between the instruments, the LIS, and other systems throughout the lab or the enterprise has shifted a bit. The importance is on what occurs not just with what I’ll call a simple connection between the instrument and the LIS, but everything that goes on to manage the verification and validation of the rules and the overall instruments, many times from different instrument manufacturers, not just one. And many laboratory information systems—and instruments—are being replaced, so it’s important to have a central area of the rules, where, regardless of the instrument or the LIS, that vendor-agnostic middleware remains largely the same.

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It’s a popular topic. We just hosted our annual user group meeting last month, and two of the three main topics of discussion with our customer base were Data Innovations’ products and the instrument middleware solutions. Many of those people were not already users of the product, which tells us just how important that piece of the laboratory structure is today and will continue to be.

Nick, what role does Data Innovations play in Epic installations?

Nick Trentadue, product manager, Beaker, Epic: We have taken a different approach. We haven’t developed middleware but instead focused on making the LIMS, Beaker, the best it can be. All of our domestic Beaker installations use Data Innovations. It has allowed us to focus on what the middleware platforms do well—connectivity—and what we do well—the LIS—so we can be sure the two work in tandem. That has allowed our customers to have a lot of freedom with their instrumentation. If a customer wants to swap out manual microbiology to bring in a Kiestra or a WASP, for us to do that connection through a partner like DI has been relatively easy for customers.

Wally Soufi is our fourth informatics vendor on the panel. We have begun to include NovoPath in our LIS product guide, even though it is well known as an anatomic pathology system. Wally, what role is the clinical pathology lab playing now in your customer engagement? And what kind of middleware are you finding it necessary to arrange for your customers across the board?

Wally Soufi, chief executive officer, NovoPath: We’re seeing clinical pathology come into play with our clients, who are expanding their focus from anatomic pathology to provide a more complete service to their clients. Our anatomic pathology clients are telling us they need to expand their offering to include clinical pathology, to do more on the molecular side, to do microbiology, to do specific clinical tests. That’s where we’re helping them with our modular solutions. Our clients have come to rely on the quality and service we provide. We recently got our ISO 9001 certification for quality management, reflecting our focus on quality across all of our solutions and services.

Regarding middleware, the term itself can be a little confusing because it can be used in the instrument interfacing context. That’s the middleware we’re talking about, similar to what Data Innovations does, for example. But in our space, we also use the term middleware to refer to electronic medical record interfacing solutions. We’ve been able to address all of the EMR-facing needs of our clients, by and large, with our in-house capabilities. For instrument interfacing, we have in-house capabilities as well; however, when we don’t have a solution of our own, we work with partners with proven solutions to meet our needs.

Tony, what is your wish list at Beckman Coulter? What would you like to see from LIS vendors that you may not be seeing today? How can they help you help your customers and their customers better through better coordination with the instrument systems? Beckman Coulter and Siemens Healthineers have large installs of large core laboratory automation. That’s an impressive business, but it requires a lot of IT and IT support from the LIS.