European laboratories are using middleware to ease the process of “rationalization”—known
in the U.S. as consolidation. But middleware products just gaining a
foothold in the U.S. have long been more commonplace in Europe. In the
mid-1990s, “when we acquired our LIS we also acquired middleware,” says
Eric Carlyle, clinical director of laboratories for Lanarkshire Hospital
And since then, “We have had more than 20 different instruments connected using the Technidata middleware, and we have developed a rules base to allow us to embed conclusions from results and use criteria to cascade, or reflex test.”
The sample management and autoverification that middleware enables have brought significant staff savings to the hospital. “Our gross workload continues to double every six or seven years, but middleware allows us to accommodate that workload without adding staff,” he says, so the cost per test has been reduced.
“Probably across the world, but certainly in the U.K., laboratory information systems are collecting data from all laboratory specialties. Blood transfusion has special requirements because of blood products legislation, and HIV testing has special requirements because of security and confidentiality. And you had attempts to build everything into the LIS, but there are too many processes in the laboratory to be able to do that. What middleware does is give the flexibility needed for optimal operation of these different areas.”
In North Brittany, France, several private laboratories used a Technidata middleware solution for two purposes: to centralize immunoassay testing in a core laboratory starting in 1993, and later (2000–2006) to merge nine laboratories into two entities.
Denis Crochette, laboratory director and managing director of Biorance SA in St. Malo, says Technidata’s Dispatcher middleware and its instrument connectivity solution TDC made it possible for the laboratories to interconnect eight different LISs, after which they added more tests to the core laboratory and integrated an additional laboratory.
To consolidate to a single core laboratory for all testing, “we used once again our Dispatcher middleware to create a ‘Fault Tolerant Virtual Core Lab’ and a homogeneous and autonomous production system independent of the LIS,” Crochette says. The consolidated entity merged nine LISs into two LISs, which contain identical information to provide secure backup protection.
As a third phase, Biorance plans in 2007 to install a new LIS, and the Dispatcher middleware “will allow proceeding with this major transition without having to redo any parameterization of our technical work, training of our technical staff, or interfacing to instruments.” When new instruments are acquired, they will always be interfaced via TDC, “thus eliminating the need for training or rewriting of the LIS interface,” Crochette says.
Anne Paxton is a writer in Seattle.