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Advantages of Integrated (Homogenous) Systems John Gilbertson MD Associate Chief of Pathology Director of Pathology Informatics Massachusetts General Hospital.

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Presentation on theme: "Advantages of Integrated (Homogenous) Systems John Gilbertson MD Associate Chief of Pathology Director of Pathology Informatics Massachusetts General Hospital."— Presentation transcript:

1 Advantages of Integrated (Homogenous) Systems John Gilbertson MD Associate Chief of Pathology Director of Pathology Informatics Massachusetts General Hospital Associate Professor of Pathology Harvard Medical School HARVARD MEDICAL SCHOOL

2 John Gilbertson: Monday September 20Pathology Informatics 2010 Integrated System: An expansion of a basic information system achieved through system design of an improved or broader capability, by functionally or technically relating two or more information systems, or by incorporating a portion of the functional or technical elements of one information system into another.

3 John Gilbertson: Monday September 20Pathology Informatics 2010 Integrated (Homogeneous) System: An information system, that supports multiple, horizontal activities and is sold and maintained by a single company The degree and method of the integration can vary There are other was to integrate: third party, open standards

4 John Gilbertson: Monday September 20Pathology Informatics 2010 Integration Homogeneous Integration can be achieved by vendor product, a third party or by the customer It is OK to run a single vendor shop It is impossible to run a single vendor shop Integration is in the eye of the beholder

5 John Gilbertson: Monday September 20Pathology Informatics 2010 Thesis When the workflows and data structures of two laboratory activities become similar there are compelling reasons to integrate under a single system AP and CP are converging in a number of ways, and it is time to think about integration of the LIS systems. Both the convergence and the integration will take time We have moved our AP and CP platforms to a single vendor to facilitate this convergence While not the only approach, homogeneous integration allows departments to focus developmental resources in other areas

6 John Gilbertson: Monday September 20Pathology Informatics 2010 The MGH – Sunquest Co-Development MGH and Sunquest have established a long term collaboration agreement for the co-development of aspects of future versions of the Sunquest Copath AP LIS Under the terms of the agreement, both MGH and Sunquest will provide resources to the development of LIS modules that will be commercialized (generally available) and maintained by Sunquest. MGH will receive a revenue stream back from Sunquest based on the resources provided and the commercial success of the modules

7 John Gilbertson: Monday September 20Pathology Informatics 2010 There will never be infinite systems

8 John Gilbertson: Monday September 20Pathology Informatics 2010

9 John Gilbertson: Monday September 20Pathology Informatics 2010 System of Systems BillingHIS APCPBBHLA *** PACS DM

10 John Gilbertson: Monday September 20Pathology Informatics 2010 The case for (homogeneous) integration

11 John Gilbertson: Monday September 20Pathology Informatics 2010 Sometimes activities are so different, that an “integrated” system is not needed or is too complex to be effective… …. or even to be understood

12 John Gilbertson: Monday September 20Pathology Informatics 2010 As long as best of breed is providing significantly better performance there is no case for integration There is real value in specialization…. … “Best of Breed” CP LIS AP LIS

13 John Gilbertson: Monday September 20Pathology Informatics 2010 If the differential performance begins to decrease, combining the systems begins to have real value CP LIS Microbiology Chemistry Heme

14 John Gilbertson: Monday September 20Pathology Informatics 2010 AP LIS CP LIS AP LIS When the performance of homogenous integration approaches the value and cost of best of breed it is time to consider homogenous integration

15 John Gilbertson: Monday September 20Pathology Informatics 2010 Operations x 3 The value of (homogeneous) integration Disaster Recovery Hardware Upgrades Patches, Security Management Reports Dictionary Maintenance OS, DB, Development Kits Licenses Meetings APTMCP None of this adds value

16 John Gilbertson: Monday September 20Pathology Informatics 2010 Interfaces Interface maintenance “Handoffs” x 3 Data Models / Relations Timings HIS Imaging APTMCP The case for (homogeneous) integration

17 John Gilbertson: Monday September 20Pathology Informatics 2010 Subsystems Pyramids of sub-systems x 3 Image APTMCP HIS The case for (homogeneous) integration

18 John Gilbertson: Monday September 20Pathology Informatics 2010 Subsystems Device Interfaces x 3 Image APTMCP HIS The case for (homogeneous) integration

19 John Gilbertson: Monday September 20Pathology Informatics 2010 Personnel Call Admins x 3 PACS APTMCP HIS The case for (homogeneous) integration Training Backup Succession

20 John Gilbertson: Monday September 20Pathology Informatics 2010 Societal Feudalism x 3 The case for (homogeneous) integration

21 John Gilbertson: Monday September 20Pathology Informatics 2010 The cost of castles Strategic: Enterprise Leverage Project Leverage Opportunity Cost of Projects Medical: Data and Operational Fragmentation Intellectual Schism Limits the pathologist as an integrator and interpreter of laboratory data The opportunity cost of consultation great-castles.com/index.pl?official.html

22 John Gilbertson: Monday September 20Pathology Informatics 2010 AP LISCP LIS AP LIS When the performance of a homogenous integration approaches the performance of best of breed it is time to consider homogenous integration None of this matters if the best of breed system is providing better performance We think we are getting very close

23 John Gilbertson: Monday September 20Pathology Informatics 2010

24 John Gilbertson: Monday September 20Pathology Informatics 2010 There is a limit to homogenous integration BillingEMR APCPBBHLA *** PACS DM

25 John Gilbertson: Monday September 20Pathology Informatics 2010 Will it the integration be homogenous or will you do it yourself? Do you have the resources to do it - –Time –People –Money –Test –Train If integration is possible and worth the cost… Who is in charge? Will you be able to maintain it? CP LIS AP LIS

26 John Gilbertson: Monday September 20Pathology Informatics 2010 Do you have nothing better to do?

27 John Gilbertson: Monday September 20Pathology Informatics 2010 Clinical Laboratory for Research and the Bio-repository (CLR)

28 John Gilbertson: Monday September 20Pathology Informatics 2010 Clinical Laboratory for Research and the Bio-repository Need for a laboratory to do clinical pathology work and tissue banking for clinical trials and translation research projects Work had been done in the clinical lab but this proved inefficient and expensive Initial software was home grown, was not scaling and developers had left the institution ??? LIS Clinical Lab CLR

29 John Gilbertson: Monday September 20Pathology Informatics 2010 Clinical Laboratory for Research and the Bio-repository CLR did clinical testing for clinical trials and tissue banking Additional (special) functions required Data exchange with the main clinical lab for 24/7 and full test menu Accept discarded clinical specimens (for banking) in future Tissue (blood) bank Extra Data Collection Consent Status Aware Research Billing Batch Accessioning Special research reports Requisitions consistent with protocols Selected results to EMR Integration with “EMSI” and “RFDR”

30 John Gilbertson: Monday September 20Pathology Informatics 2010 We decided to use an second instance of our CP LIS

31 John Gilbertson: Monday September 20Pathology Informatics 2010 LIS MULHOS (CP LIS) BillingADT Results Batch EMSI R-EMR HL7 Specimen Inventory Straw Aliquoter Clinical Lab Tissue bank front end Tissue bank Inventory Consent Status Aware Research Billing Special research reports Batch Accessioning Requisitions consistent with protocols Selected tests to EMR Integration with “EMSI” and “RFDR” Data exchange with the main clinical lab CLR LIS

32 John Gilbertson: Monday September 20Pathology Informatics 2010 LIS MULHOS (CP LIS) LIS BillingADT Results Batch EMSI RPDR HL7 Specimen Inventory Straw Aliquoter Training Interfaces Personnel Maintenance D.R. Hardware Dictionaries No castles Upgrades Upgrade Cycles Patches Priority Clinical Lab CLR A Vendor

33 John Gilbertson: Monday September 20Pathology Informatics 2010 “Infrastructure”

34 John Gilbertson: Monday September 20Pathology Informatics 2010 LIS BillingADT Results Batch EMSI RPDR HL7 Specimen Inventory Straw Aliquoter Clinical LabCLR Accession “Done Racks” ? Large scale clinical discard banking

35 John Gilbertson: Monday September 20Pathology Informatics 2010 No Developers Used

36 John Gilbertson: Monday September 20Pathology Informatics 2010 APCP TM

37 John Gilbertson: Monday September 20Pathology Informatics 2010 AP CP Integration

38 John Gilbertson: Monday September 20Pathology Informatics 2010 How about AP LIS and CP LIS APCP Sharing Data Integrated Reporting Common Specimens Integrated Protocols Today The integrated AP CP LIS is important technology for the future of pathology We have begun this integration with our vendor We will not lose our informatics card

39 John Gilbertson: Monday September 20Pathology Informatics 2010 AP CP Integration APCP EMR AP CP EMR We will work with our vendor It will take a long time We will not lose our informatics card Today

40 John Gilbertson: Monday September 20Pathology Informatics 2010 It is not that we can’t do it, put that we chose not to There is an opportunity cost to every project The integration is more of a technical as opposed to a domain expertise initiative We think that departmental developmental resources are better focused elsewhere AP CP

41 John Gilbertson: Monday September 20Pathology Informatics 2010 It is used by hundreds of physicians who increasingly require guidance Order Interpretation LIS Pre-analytic Analytic Reporting The clinical laboratory is perhaps the most powerful, most complex diagnostic tool on earth We need better tools for clinical context & “presence” at ordering and interpretation

42 John Gilbertson: Monday September 20Pathology Informatics 2010 Anatomic Pathology is beset buy –Increased volume –Increased Complexity The AP Laboratory high “variation” and very low efficiency

43 John Gilbertson: Monday September 20Pathology Informatics 2010 Meanwhile over the next several years ~ 3 Billion people will be looking for pathology services

44 John Gilbertson: Monday September 20Pathology Informatics 2010 The pathology department has three missions…. …The LIS only supports one

45 John Gilbertson: Monday September 20Pathology Informatics 2010 The will likely be a fight for resources sometime in the future Understanding and documenting the value of pathology in health care…

46 John Gilbertson: Monday September 20Pathology Informatics 2010 Enterprise Systems AP CP LIS POEEMRADTPACS 70/70/3/0 Communication Efficiency Quant Value Teaching & Research Departmental Sub Systems PACSMOLDASHLH

47 John Gilbertson: Monday September 20Pathology Informatics 2010 Summary When the mission, workflows and data structures of two laboratory activities become similar there are compelling reasons to integrate under a single system AP and CP are converging in a number of ways, and it is time to think about integration of the LIS systems. Both the convergence and the integration will take time We have moved our AP and CP platforms to a single vendor to facilitate this convergence While not the only approach, homogeneous integration allows departments to focus developmental resources in other areas

48 John Gilbertson: Monday September 20Pathology Informatics 2010 Integration, systems and standards The importance of open AMSI standards in the integration of AP / CP and the LIS of future The model of DICOM and IHE Asset IDs Report (data) Archives Image Archives HIS – LIS, Device Interfaces….


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