What criteria should head their lists as laboratories consider middleware solutions?
Data Innovations’ Gregory Vail says a vendor’s track record is a prime consideration. "Look for an established system by somebody who’s actually been doing middleware. Unfortunately, as with a lot of buzzwords, people jump on the bandwagon and throw the term around, but do they really have a middleware solution, or are they just trying to say they do and really using something else they already had? A couple of LIS vendors are starting to call their LIS middleware, and unfortunately that’s only adding confusion because they’re really not."
Middleware came into being, he cautions, because the real-life business needs of laboratories were not being met. "So it’s unrealistic of us to think those needs are not going to change again. Laboratories should make sure their middleware can be tailored to meet their business needs of today but also continue to grow and adapt to meet their needs tomorrow."
Jon Wearly of Roche Diagnostics stresses customer-friendliness. "Look at the logic the software uses. Does it use Boolean logic or do you have to know Java script or a programming language to use the core functionality of the software? A laboratory doesn’t want to add expense—they want to do as much as they can with the staff they have."
A second concern should be that the lab’s IT department and its middleware provider are communicating and understand each other’s objectives. Third, Wearly says, "Make sure you have a project manager or internal team within the laboratory to write the rules and set realistic timelines and assign responsibility for the project up front."
The training and support environment is also key. "Can I get somebody on the phone when I go down at 2:00 AM? Has your vendor interfaced with your LIS before? That’s important, because if the LIS has unscheduled downtime, you want a middleware product that will pick up the plate and run," Wearly says.
Laboratories considering middleware should explore what level of functionality they need first, Dawning Technologies president John Selmyer says. "I would not necessarily jump ahead, but I would discuss on a consulting basis with suppliers what they can provide, how to integrate it with existing systems, whether it will be compatible or will cause some difficulties."
"If you’re going to produce a lot of new data in the middleware, you need to be sure your LIS or whatever system you want to get it into can handle it all."
With most connections now being HL7 or ASTM-based, that’s getting easier, Selmyer adds, because both data communication protocols are broadly supported and sufficiently robust to handle any data that might need to be exchanged with the laboratory instruments.
Abbott’s Keith Chaitoff cites the "Three T’s": tailored solutions, technical excellence, and total integration. "Laboratorians don’t know when the administration may be considering buying the hospital down the street, so having a system that is really tailorable, in terms of scalability, is really important," he says.
One of the chief assets of Abbott’s Decision Manager, Chaitoff says, is that it can work with a single workstation, perhaps in the hematology laboratory, or it can work in a networked solution across multiple sites. "That in itself is a valuable capability."
In addition, the software uses an Oracle database, "the most secure database on the market" to ensure that data are safely retained in a HIPAA-driven environment. And it boasts "total integration" across disciplines: For example, it employs a single-folder icon—the same as on some Abbott instruments-to access all laboratory results, whether hematology, immunoassay, or clinical chemistry.
Making a thorough assessment of the laboratory is the best first step, recommends Technidata’s Jacques Baudin. "What are the problems, the bottlenecks, the really major practical issues in the laboratory? To make this assessment is essential. Then you can start to look at the fit between the problem and the kind of solution you need, whether it’s in specimen management or quality control. And of course you’ll want to look for a modern system, and a graphical user interface that is appealing, user-friendly, and intuitive."
Start with the needs of the laboratory, then talk to vendors about how the software or middleware they provide with instruments will integrate into the laboratory’s computing environment, agrees Bruce Friedman, MD, of the University of Michigan Medical School. He advises not just working with vendors but getting them to talk with one another to help the laboratory integrate interfaces.
It’s not like the early days, when a laboratory had one LIS vendor to deal with and one or two IVD manufacturers, he adds. "Now your IT processing needs are way more complicated."
Anne Paxton is a writer in Seattle.