When your business depends on processing 20 million lab tests every year and delivering quick results to physicians, sometimes conventional approaches and existing technology aren’t enough.

Consider Health Line Clinical Laboratories. From its single testing location in Burbank, Calif, Health Line performs lab tests for service centers and client physicians across the southwestern United States. The reference lab offers a full range of clinical and anatomic laboratory testing, and counts physicians, hospitals, and medical clinics among its clients. The lab is accredited by the College of American Pathologists, and it has been designated a molecular center of excellence.

But facing a rapidly expanding customer base and recent federal mandates on security, Health Line needed technologies to improve remote reporting. It found them at LabDat, a pioneer in laboratory-results reporting. The lab also discovered a palm-sized print server that could act as the system’s traffic cop.

Fast and Secure Reporting
The ability to deliver lab-test results faster to its physician customers was a key concern for Health Line, according to Suren Avunjian, Health Line’s privacy officer. But there were other, equally critical concerns. He points to the 1996 Health Insurance Portability and Accountability Act (HIPAA) and mandates requiring that health care providers ensure that private patient information—including patient-demographic data and laboratory test results—were protected from inadvertent disclosure.

“Subsequent regulations defined data-communication requirements to include data-encryption protocols that could not be performed with most commercial remote printer systems available on the market at the time those regulations were published,” Avunjian says. “Most systems use telephonic modems and “push” technologies to send unencrypted ASCII data over standard telephone lines to remote print servers in physician offices.”

That common modem “push” approach, he says, fell short of what Health Line expected from its reporting. That approach would require each print session at Health Line to involve the sending of unencrypted data at a rate of about two reports per minute. “This meant that we had to employ a bank of many modems operating simultaneously at peak transmission times,” Avunjian says. “The resulting high overhead on the laboratory information system (LIS) would cause drastic slowdowns at the peak operational time for the laboratory.”

To get reporting up to speed, LabDat urged the use of Internet access to a database server that held all laboratory results ready for transmission. Instead of pushing, the strategy called for deploying “pull” technologies through which remote print servers, stationed at each client, could access the database via the Internet and pull all reports ready for transmission in a real-time mode. And all of that would be done with required data encryption and secure socket layering to provide optimal security.

For Health Line, the net result was full compliance with HIPAA regulations and drastically reduced overhead on the LIS, with transmission times of nearly 400 reports per minute. “With simultaneous transmission capability now possible, turnaround time for laboratory results to our physician-clients is dramatically reduced,” Avunjian says. The system also gives Health Line the capacity to offer customization based on how frequently and at what time of day physicians wanted reports delivered to them.

Overcoming Modem Problems
According to Avunjian, Health Line began using modem-based printers, which used “push” technology to dial into each site and push the results. Customer sites far away from the Telco POP or sites with faulty lines tended to get bad data, since modem-based printers do not have any error checking, he says.

Then the lab found another technological edge: the palm-sized SX3100 print server available from silex Technology America Inc, the US affiliate of a long-time Japan-based technology pioneer.

How It Works
The SX3100 supports basic TC P/IP protocol. “The print server authenticates to the reporting server, checks for available results (or any available document that needs to be printed at that location); the server then assigns correct report templates supporting rich text format, which are applied on the fly (based on the physician’s preferred layout), and the documents are encrypted and sent directly to the print server,” Avunjian says. Once the print server has completed printing, it sends a message back to the print server with the specific report number to be marked off as printed on the client side. This technology is more robust and redundant; it is 128-bit encrypted and can work at any location with Internet access.

“The new system completely eliminates the transmission errors such as missing lines or blocks of data that were commonplace with the modem-based printers. Also, the main advantage of ‘pull’ technology is easy setup and maintenance, because there are no firewall and static IP limitation issues,” Avunjian says.

The silex print server continually checks the server for test results; and when pending and final results are available, it automatically prints out the results on the physician’s secure printer.

“Doctors don’t like to work with e-mail, and they want a hard-copy print of the results to go over with patients and keep on file,” Avunjian says. “Our system gives doctors as near to real-time results as possible.”

According to Avunjian, technology has always been an important issue at Health Line. Its laboratory was the spawning and proving ground for LabDat, the first clinical laboratory Internet ASP provider to offer patient-centric result reporting. “Both companies believe IT can solve many current and future clinical laboratory problems.

Both have invested heavily in new products and services that they hope will revolutionize clinical laboratory operations—with reporting being the most notable to outside clients,” Avunjian says.

Health Line has completed several enhancements to its reporting system, and silex SX3100 print servers have been rolled out to scattered Health Line customers: 2,000 or so physician-clients, nearly 100 patient service centers in California and Arizona, where Health Line employees collect specimens for referral to the central laboratory and distribute reports to their physicians—and more than 400 private clinics and physician offices who get reports delivered to them every day. In all, Health Line performs and reports more than 20 million test results each year.

“We have been testing with new technology that works using cellular connections (GPRS and/or EDGE) allowing access to areas where DSL is not available or for mobile units,” Avunjian says. “We have had a very high success rate.”

The silex print server is an integral element to Health Line’s “pull” reporting system, Avunjian says. After several years spent on product development, LabDat expects to begin marketing its remote reporting solutions to the clinical laboratory industry next year.

Useful Features
According to Avunjian, useful features of the system include:

• Fully HIPAA-compliant hard-copy reporting. All data (including remote printer data) is transmitted in secure-socket layered 128-bit encryption, security equivalent to banking transactions.

• A unified reporting template for all delivery options (hard-copy internally generated laboratory reports; remote printer laboratory reports; computer-to-computer laboratory reports; facsimile (fax) reports; and Internet-based reporting systems reports).

• Unique “pull” technology allows complete client control over report availability with exquisite reporting efficiencies. Transmission-system monitors ensure lost or garbled data is never present on reports.

 • Dynamic IP support for remote printers/computers provides nearly infinite scalability, facilitating vastly simplified installation, troubleshooting, field replacement, and system monitoring.

• Comprehensive laboratory reports (microbiology, pathology, cytopathology, and clinical testing) are all presented on a common report, even when separate LIS systems or modules are used for each laboratory discipline.

 • Client-customization features allow each requesting physician, even in large group-practice clients, to design his or her own reporting format. Customizable options include report-generation times and frequency; report structure (display order of laboratory discipline on hard-copy reports); toggle report interpretive messages on or off; and designation of where reports are to be printed (separate printer, central office printer, or remote printer at home).

• An HIPAA-compliant audit trail for each report generated documenting the contents, date, time, and location of each printing. (Complete image copies of each report are available for review or printing.)

• Data can be input from nearly any data-transmission protocol. Systems will accurately display and print data sent via any current communication protocol (HL&, ASCII, XML, HTML, PCL, and TIFF image). Different LIS servers can be integrated from other facilities or stat laboratories, and from different departmental LIS systems.

• Plain-paper reporting is available. Plain (white) paper reporting applies laboratory headers automatically, which allows fully compliant laboratory reporting from any printer. Plain-paper formats can be overridden when preprinted forms are used, and client printers can be used (instead of laboratory-supplied printers). Reports are fully customizable by requesting physician-option settings.

All remote reporting systems can be managed from a central technical-support area. The system notifies staff when toner or paper is out at any given reporting-system printer, and when a phone line is nonoperational for any reason. In addition, complete and instantaneous error-identification reporting and troubleshooting provides automated phone calls to clients’ offices to alert personnel of reporting failure and solution, and e-mails or fax notices can be generated to notify clients of local reporting errors. Electronic ordering integration with this reporting system makes possible monitoring pending reports; tracking use history; Medicaid, Medicare, or private insurance test-frequency limitation violations; and automated Medi-Cal Laboratory Service System reservations.

Clients have instant client access to an automated fax system for Internet-based control of central fax server and client-driven report faxing to any secure facsimile machine.

Keith Sugawara, general manager of the silex Wireless and Connectivity Division, says the SX3100 is the world’s first print server to be certified to the IPv6 benchmark. The IPv6 is the newest-generation Internet standard; it offers superior performance to the IPv4 protocol that has been in use worldwide for the past 20 years.

It features a dual-stack (IPv4 and IPv6) architecture, which makes IPv6 available in your current IPv4 environment. The 3100 supports the smooth migration to IPv6.

About the size of a cigarette pack, external, multi-protocol SX3100 print servers are compatible with virtually all major printers using their parallel interface. The embedded solution can monitor for typical printer status such as paper out or error conditions. Also, the SX3100 can retrieve e-mail from the mail server and print to the printer—no personal computer is needed. It also can send an e-mail message when any error occurs with the printer.

Sugawara says the only thing that never changes when it comes to technology is the regularity with which things change. “IPv6 enables growth of the Internet by expanding the current IP address standards, clearing the way for a virtually unlimited number of user addresses,” he says.

silex provided enhancements tailored specifically to Health Line’s reporting-system needs. Another important SX3100 feature is its compatibility with a wide range of other technologies.

“With the SX3100, compatibility is never an issue,” Sugawara says. “It is configured with all the protocols necessary to connect in almost all network environments and is compatible with every common client operating system. In fact, this palm-sized, multi-protocol print server is compatible with common network system platforms and virtually all major printers using a parallel interface.”

 While Health Line adapted the print server to clinical laboratory remote-reporting tasks, silex officials say the product was not initially targeted to clinical laboratory use. “It is applicable to a much wider commercial and communication sector,” Sugawara says. “Many of our customers are in the manufacturing, supply chain, and business-automation industries.”

NOTE: On July 1, 2006, Health Line was acquired by Westcliff Medical Laboratories Inc.