College of American Pathologists
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  If your lab’s AP system ain’t broke, just tweak it


CAP Today




March 2010
Feature Story

Emily Stone

As many a home-repair weekend warrior knows, pantyhose are a handy tool for household maintenance. For example, a bit of nylon stretched over a shower drain prevents the drain from clogging with hair.

In much the same way, adding innovative functionality to an anatomic pathology system, or any other lab system, can keep it operating smoothly for years to come and prevent laboratorians from having to reprogram or replace the system prematurely.

The goal of modifying an AP system, says Raymond Aller, MD, director of automated disease surveillance for the Los Angeles County Department of Public Health and CAP TODAY’s information technology contributing editor, is “to make it do things it was never designed to do. You’ll get more value out of what you already own. You’ll be able to do a better job as a lab.”

While an AP system may not benefit from the versatility of pantyhose, it can benefit from equally creative measures that offer information systems longer lifespans. Such measures can be grouped into two categories. The first involves having the software manufacturer or a third-party vendor modify the original AP system. The second involves such enhancements as wraparound tools and noninvasive interfacing, which allow the system to perform new tasks or do existing tasks faster or more accurately without modifying the software.

Software modifications

The first and most obvious step to obtaining system enhancements is to ask the information system vendor to add existing functionality to its product, says J. Mark Tuthill, MD, head of pathology informatics at Henry Ford Health System, Detroit.

If the company won’t do it, hire a third-party vendor. Introduce the two companies to each other and encourage them to “play together,” Dr. Tuthill advises. Involving the information systems vendor minimizes complications over issues such as sharing proprietary code, he adds.

Dr. Tuthill helped broker such a deal between Sunquest Information Systems and mTuitive approximately four years ago. The focus of the endeavor was to extend the functionality of Sunquest’s CoPathPlus LIS, which Dr. Tuthill’s lab used, by integrating a synoptic reporting module, which his lab needed. Working together, mTuitive and Sunquest were able to meet Dr. Tuthill’s needs, as well as those of other customers. Today, mTuitive’s xPert for Pathology synoptic reporting module is offered as a standalone package or as part of Sunquest’s LIS. “In my opinion, it strengthens the product of both sets of vendors,” Dr. Tuthill says.

Many health care information systems companies also have a fee-for-service development team that will help laboratories create tools for their software. Another option is to use an outside consultant or a knowledgeable colleague to develop tools. However, Dr. Tuthill suggests starting with the software vendor’s development team to avoid code-sharing problems and the hassles of obtaining technical support from different sources.

Wraparound tools and noninvasive interfacing


Shoehorning involves innovatively adapting the standard functionality in an information system to perform tasks for which that functionality was not intended. This typically is much less costly than developing new tools. For example, an AP system user may be able to use external software to scan reports and other documents and then attach them to a case in his or her AP system using the standard attachment functionality. In a similar manner, Dr. Aller took a hematology differential counting application from a lab information system and converted it into a cytology data-entry tool for an anatomic pathology module integrated with the same LIS. The conversion simply required adding entries to dictionaries within the lab information system.

Input automation

Input automation usually entails programming common keystroke sequences into function keys on a workstation or into a bar code. This means, for example, that a user can program a sequence to quickly jump to the proper field for entering results. “Having to ‘mouse around’ to every field is inefficient, error prone, and exacerbates repetitive stress disorders, such as carpal tunnel,” Dr. Aller says.

Output adaptation

Output adaptation is a PC-based utility that taps into the print image output file from a lab system and then mines select data and integrates it into other reports or spreadsheets. For example, a lab could program its anatomic pathology system to grab information that appears on the top left-hand corner of page 35 of a 150-page report and then merge it into an Excel spreadsheet for analysis. An example of this type of technology is Monarch Data Pump Pro from Datawatch.

Screen scraping

Screen scraping, also called scripting or screen animation, works in much the same manner as output adaptation, except it focuses on the computer screen instead of the system’s printed output channels. Users first determine from which screens on their lab system they want to obtain information. They then program a PC that can access their lab system and that is running a special-purpose terminal emulator, such as Boston WorkStation from Boston Software Systems, to enter the necessary keystrokes to retrieve the information on the lab system’s screen. The software tool then enters the information into a separate file for users to manipulate or incorporate into a report.

Repurposed interfaces

Repurposed interfaces tap into an interface data stream between a lab system and another system, such as the transmission of all lab results to a hospital information system. Laboratories can program an intermediate system, which sits between the aforementioned systems, to gather from this data stream specific information that requires further action. Taking this concept one step further, software developers created interface engines, such as Ensemble, from InterSystems; e-Gate, from Sun Microsystems; and Rhapsody, from Orion. Interface engines are helpful when, for example, a clinician wants all results faxed to her as soon as they’re available. In this case, the laboratory could program the engine to send that doctor’s results to an autofax box.

Comprehensive wraparound packages

Some third-party vendors, such as Seacoast Pathology, specialize in software packages that offer a combination of the aforementioned tools. These packages, often referred to as surroundware, can improve a laboratory’s outreach and billing efforts in particular by moving data to and from a laboratory system. Such packages sometimes involve software modifications as well.

“Every LIS manager facing a new client or operational need,” says Dr. Aller, “is familiar with the vendor response of, ‘It will take 18 months and cost $50,000 to provide that capability.’ Wraparounds permit the laboratory staff to accomplish an equivalent task in weeks for several hundred, or perhaps a few thousand, dollars.”

Emily Stone is a freelance writer in Chicago.
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