1. Presented by: University of Rochester Medical Center
Down Time Rhapsody
Presented by: University of Rochester Medical Center
Project Overview – Dave Niggli, Project Lead
Technical - Chris Van Vranken, Programmer

2. Summary

3. URMC Current Annual Volume
Clinical Pathology
3 Sites
2.3 million patients orders
3.5 million specimens received per year
5 million tests performed
Anatomic Pathology
114,500 Cases
51,000 Surgical Pathology Cases
89,000 Surgical Pathology Specimens
63,000 Cytology Cases & Specimens
Courier Services
350,000 specimens pick ups and deliveries per year

4. Automation in the Lab Sysmex (Hematology)
XE-2100 automated instrument line
MOLIS WAM middleware
Roche (Chemistry)
Modular Analytic Instruments
Modular Preanalytic Automation
Data Innovations Middleware (DI)

5. When down time was unnecessary
Those were the days
In the past three years we have gone through three SOFT upgrades that required a 10hr+ downtime each.

6. Previous Solution Pre printed sheet of barcoded order numbers
handed out blocks of order numbers to 4 separate departments
Manually enter patient demographics into a database that would print a demographic label
Make a copy of the requisition for every area of testing.
Manually prepare sample for testing.
Use a combo of analyzer printout and req copy for resulting.

7. Issues With Previous Solution
Triple the staff needed to process samples
Wrong Barcodes labels on tubes
Needed locally installed printers
Could not use preanalytic automation
Very Large paper trail
Multiple bottle neck areas
Multiple areas for patient identification errors
Manually enter orders into middleware

8. Major Challenges Order placement in middleware
Barcoded sample with patient demographics
Assurance of proper test ordering for automated recovery
Switching from an automated live system to a manual downtime system.
Interdepartmental coordination and communication
Minimize recovery time from downtime
Improving recovery efficiency has the largest impact in terms of mitigating the adverse effects of being down.

9. Technology used Microsoft Visual Studio-C# Microsoft Sql Database
AutoIt
HL7

10. Components The Sql Database
A daily synch tool that copies Soft setup data
The downtime application
Launched from a link
SharePoint
Web page
Desktop

11. Downtime

12. Modules Respiratory Therapy (Blood Gases) Lab Micro Molis Entry
Specimen Tracking
Query
Recovery

13. Respiratory Therapy Module
The Respiratory module is the simplest, it has a place to enter the patient’s name, a dropdown to choose a labeler, and a button to print the label.
Prints a Specimen label and a Demographic label

14. Lab Module Lab Order Entry provides fields to
order tests
Identify the patient
record collection/receive times
Tests are compared to a copy of the Soft setup tables to make certain that they are valid, orderable tests.
Patient data is checked for proper formatting before printing labels.
Ability to look up test mnemonics to provide standardization.
Sends HL7 messages to our DI middleware.

15. HL7 Reduced the time of ordering tests in DI middleware by 100%
HL7 is sent to our DI system immediately after the order is placed in our Downtime system.

16. Lab Module

17. Micro module
The Micro module is effectively identical to the Lab module but with extra fields.
Provides the ability to capture Source, Site, and Plated time.
Standardized test ordering to ensure smooth recovery.

18. Micro Module

19. Aliquot Module
Aliquot Module provides the ability to quickly reprint labels
Has the ability to reprint pre-downtime labels
Orders that exist in Soft and not the Downtime System
Provides flexibility in processing options

20. Aliquot Module

21. Molis Entry
Molis Entry is a scripted interface that transfers orders form the downtime program to the Molis middleware.
Eliminated the potential for users to enter patient data incorrectly.
Reduced order entry time by 95%

22. Molis Entry

23. Specimen Tracking
Specimen tracking n easy way to track and locate samples
Old tracking tags are automatically placed in the comment section
Live system tracking can be added in order to find samples tracked prior to downtime
Only applicable to a planned downtime

24. Specimen Tracking

25. Downtime Query

26. Recovery
Recovery is a scripted interface that transfers the orders placed in downtime to our live system using the order numbers assigned by downtime.
If the billing number is not in Soft Live the system will notify the user.

27. Recovery
Recovery is a scripted interface that transfers the orders placed in downtime to our live system using the order numbers assigned by downtime.
If the billing number is not in Soft Live the system will notify the user.

28. Length of Recovery
Prior to our Downtime system we had a recovery time of 150% of the actual time spent with the LIS down.
Our last downtime was 12hrs, that would have been an 18hr recovery.
Using our downtime system it only took us 90min to recover from our last downtime.
Lab can not start the results recovery until all the Downtime orders have been placed in soft

29. Recovery

30. Improvisation
The Demo

31. Any Questions?

32. Final Notes
Contact Information
Chris Van Vranken
Dave Niggli