Dick Edgington, King's Daughters Medical Center

Dick Edgington, King’s Daughters Medical Center

When integrating laboratory information systems and middleware into daily operations, getting team buy-in can be a lab’s biggest challenge. “My coworkers are quite receptive to change. But as scientists, they want evidence that ‘newer is better’—and so do I,” says Dick Edgington, microbiology supervisor at King’s Daughters Medical Center, Ashland, KY.

“The early version of our middleware didn’t offer any advantages over our previous workflow, so integrating it seemed unnecessary,” says Edgington. “Employees could perform their jobs as they did before we had the middleware, so rather than modifying their workflow they developed work-arounds to minimize their contact with the system.”

But now that his lab will be implementing Vitek MS, an automated mass spectrometry microbial identification system from bioMérieux, Durham, NC, incorporating new software solutions is unavoidable. “I will have no problem getting buy-in at that point,” Edgington says.

Edgington explains that the King’s Daughters lab was a pilot site for development of an interface between the Myla microbiology middleware solution by bioMérieux and SoftMic, the microbiology module of the laboratory information systems suite by SCC Soft Computer, Clearwater, Fla. Development of the interface was a joint effort between bioMérieux and SCC.

“We had our eye on the Vitek MS system as early as 2011, just waiting for its approval by FDA,” says Edgington. “We knew that using the Myla system would be necessary, so we agreed to be an alpha site and assist in the interface development in order to get a jump on the MS project.

Shawn Boggs, King’s Daughters Medical Center

Shawn Boggs, King’s Daughters Medical Center

Shawn Boggs, laboratory director at King’s Daughters Medical Center was in full support of the interface development project. “We knew that acquiring the Vitek MS system would put our microbiology lab at the cutting edge of technology,” he says. “So even though the alpha-site project required a good bit of effort on our part, we feel it will be well worth it in the long run.”

“I think this will help in implementation of the MS,” says Edgington. “Even though my team’s interaction with Myla has been minimal, they are familiar with it, which will shorten the learning curve when we implement the MS.”

Myla 3.3 will offer some advantages over the previous version and over the old workflow. According to Edgington, most of the new advantages will be seen more at the administrative level than at the bench level. “Still, I can convince my team that we need to fully utilize this middleware based on those advantages. As long as there is some upside, they will accept the use of the software.”

When adopting a new LIS or middleware solution, laboratories frequently overlook the need for communication and training, says Edgington. “A lot of training may be done upfront, but it may not be adequate due to a lack of familiarity with the system,” he says. “In addition, the training given to new team members may not be nearly as extensive as the initial pre-go-live classes. Training needs to be ongoing, addressing issues as they arise. A seemingly very small mistake, such as the omission of certain information, can have big consequences down the line.”

Promotional character provides a friendly face for the Myla microbiology middleware solution by bioMérieux.

Promotional character provides a friendly face for the Myla microbiology middleware solution by bioMérieux.

As an example, Edgington cites instances when the lab has spent many hours trying to obtain correct source information about specimens submitted from an off-site location, in many cases days after the specimens arrived. “Sometimes this resulted in improper processing and the need to retest, and, most importantly, a delay in the delivery of proper care,” he says. “Of course, if we had received the correct information upfront, the specimens could have been processed correctly the first time around, and hours of effort could have been saved.”

For labs considering the implementation of LIS or middleware solutions, Edgington advises first making sure there is a good reason to do so. “Don’t add something that you don’t need,” he says. “Do your homework. That is, make sure you’re deeply involved in the pre-go-live work, and that you have thoroughly tested the systems. Train your team well before implementation, and point out the systems’ strengths and weaknesses. If you’re honest upfront, they’re much more likely to buy in. Get feedback from your staff. You may be able to resolve issues before they become serious, either through more training or by working with your vendor to make changes. It’s a partnership more than a customer-client relationship.”

Information systems at King’s Daughters Medical Center have been fully integrated for quite some time. The center’s current LIS by Softlab went live in 1998, and its current health information system (HIS) by Epic Systems Corp, Verona, Wis, went live in 2008. But even before the current systems, the center has enjoyed a high level of integration. “Our HIS and LIS have been connected for more than 20 years,” notes Edgington. “We haven’t used paper in the microbiology lab since 1992.”

“Since going with Epic, our entire system is paperless,” says Edgington. “Softlab and Epic are available in both of our hospitals, and Epic is used in all of our health system’s facilities. That means that any doctor in the healthcare system has access to a patient’s records.”

Through Epic’s MyChart application, patients also have secure access to their own records, says Edgington.

With such integration in place, the processes of gathering, storing, recalling, and using patient data to guide therapy are essentially seamless, says Edgington. In the case of a patient who has acquired an infection, for instance, test results are available in both the HIS and LIS on a real-time basis. The system’s TheraDoc application (TheraDoc Inc, Salt Lake City) pulls information from the LIS and HIS and alerts physicians and the pharmacy of any needed antibiotic changes, while also alerting the infection control department of any identification concerns.

“Although we’re not finished, we are pretty far along in the integration of our information systems,” says Edgington. But new issues may arise at any time. “This weekend, we’re upgrading our LIS to meet the new meaningful use requirements.”