Professional Documents
Culture Documents
Disclosures:
No financial relationships
Mostly satisfied customer
Have previously served as a member of IMPAC PowerPath Advisory Board
Anatomy of the laboratory information system
General lab
resulting
Anatomy of the laboratory information system
Inbound integration
orders, ADT
Phlebotomy/
specimen collection
General lab
resulting
Outbound integration
EMR, fax/print, outreach
Billing
Anatomy of the laboratory information system
Labs
Inbound integration
orders, ADT
Anatomic
pathology
Phlebotomy/
specimen collection
Transplant/HLA
General lab
resulting
Microbiology
Outbound integration
EMR, fax/print, outreach Transfusion
Billing Cytogenetics
Molecular diagnostics
Flow cytometry
Proteomics
Anatomy of the laboratory information system
Cross-cutting Labs
features Inbound integration
orders, ADT
In-lab workflow Anatomic
pathology
Digitization Phlebotomy/
specimen collection
Transplant/HLA
Data analysis
General lab
Image analysis resulting
Microbiology
QA/QI
Outbound integration
EMR, fax/print, outreach Transfusion
Procedure/EDM
Integrated reports
Molecular diagnostics
Synoptic data
EMR
Radiology Flow cytometry
Asset management
Clinical notes
Proteomics
Automation
Pharmacy
The allegorical elephant
• Break up problems
into their constituent
elements
• Classify and
subclassify
• Compartmentalize
and subspecialize
BM report
Test requisition
Mostly hand-
filled, includes
Slides from CBC data
hemepath
BM diff
Data from
outside system
(institutional
ADT database)
Terminal scripting
• For terminal/host based LIS integrations
• Programmatically emulate a set of keystrokes
imitating what a user would do at a terminal
keyboard
Terminal scripting
Terminal scripting
• Intelligent
• Read host response and react appropriately
• Handles branching logic
• Handles delays on the part of the host
• Handles errors gracefully with logging and alerting
• Can abstract data from host windows (“screen scraping”)
Terminal scripting – uses at MD Anderson
• Provide “single sign on” functionality for
pathologists – lightweight
• Runs as a
Windows
service
– Unattended
– Auto start
– No direct user
interface
• Incorporates
logging and
alerting logic
MAK to CERNER Test Harness
Terminal scripting lessons
• Founded 1987, versions 2.1, 2.2, 2.3 from 1990-1999, in wide use for
communicating lab and pathology results (version 2.x)
• ANSI standard
MSH|^~\&|ESI|LAB|INVISION_PMS|HIS|20050331155000-0600||ORU^R01|2980822|T|2.1
PID|1||000000000999999|00000|TEST^MICKEY^N||19400313|F||W|||||||UNK|000010501880256|428827901
PV1|1|O|DICT^DICT|||||||731||||HIS|||0000361^WALTERS, RONALD S. M|R||||||||||||||||||||||||||20050301144200-
0600|20050402155000-0600
OBR|1|5500280|01014775200001550550028025032847925032847900000000101|5500312^CBC^COMPLETE
BLOOD CNT/DIF/PLT|RT|20050331152000-0600|20050331154200-0600|||PCCGS^SO, CELIA
G.||||20050331154300-0600||0000361^WALTERS, RONALD S.
M||1||0000509003089|G|||LA|P||^^^200503311520^^RT
OBX|001|NM|5500009^WBC^WHITE BLOOD CELL COUNT|| 2.4|K/UL| 4.0-
11.0|L|||F||00000000000000225200|20050331155000.0000-0600|IIM^INSTRUMENT PERFORMED
ID|PCNDA^ACOSTA, NOEL D.
OBX|002|NM|5500018^RBC^RED BLOOD CELL COUNT|| 3.03|M/UL| 4.00-
5.50|L|||F||00000000000000225200|20050331155000.0000-0600|IIM^INSTRUMENT PERFORMED
ID|PCNDA^ACOSTA, NOEL D.
HL7 version 2.x strengths (weaknesses)
• ADT interfaces
– Allow systems to get a direct copy of patient
demographic data and hospital/outpatient status
• Orders interfaces
– Allow intersystems direct creation of orders
– For instance, order entry in the EMR for lab draws with
transmission to the LIS
• Results interfaces
– Communication of lab test status and resulting to
systems connected to the LIS
HL7 between lab information system components
Pathologist
Self, transcriptionist,
resident entry
DIAGNOSIS
Format conversion
to ASCII text Metastatic adenocarcinoma.
HL7
“Native” Interface
pathology engine
report HL7
Ref: http://en.wikipedia.org/wiki/Service-oriented_architecture
XML
• eXtended Markup
Language
• Self-describing
SPiDR at MD Anderson –
Shared pathology information data repository
• Fully relational
• Process-aware
• Temporal
• Problems
– Multiple data analysis packages are required by lab…
CellQuest, FloJo, Excel, Diva, etc.
– LIS not designed, nor should it be, for raw list-mode
data or complex analysis
– This dichotomy results in separation of the original
diagnostic data from the LIS and cumbersome and
error prone transcription from the analysis data to the
LIS
• Conclusions
– Even if acquisition and analysis resides outside the
LIS, there should be automatic import of both the
original analysis results and the structured data from
the analysis
– The LIS should be the place where the data comes
together
Sample CellQuest analysis
Multidimensional
scattergrams
Sample CellQuest analysis
• Functional integration
– Bar coding support cross-application
– Automatic initiation of common tasks
• Accessioning a case
• Starting a dictation
• Functional build-out
PathStation at MD Anderson –
An enterprise application integration
engine for the laboratorian/pathologist
Design considerations for a unified
multi-vendor environment