total laboratory automation for cnthu - wseas - total laboratory automation (tla) system accompanied...

Implementation of a Central Laboratory with Consolidated Laboratory Network for Central Taiwan National Hospital Union

Show-Wei Chien2,4, Yuan-Nian Hsu1, Chu-Ying Kou3, Kuo-Hsien Hunag5, Yung-Fu Chen6

1Director Center, 2Information Center, and 3Laboratory Center, Taichung Hospital, Department of

Health, Executive Yuan, Taichung 402, Taiwan 4Department of Information Management, National Yunlin University of Science & Technology,

Yunlin 640, Taiwan 5Department of Management Information Systems, Central Taiwan University of Science and

Technology, Taichung 406, Taiwan 6Department of Health Services Management, China Medical University, Taichung 404, Taiwan

[email protected], [email protected], kshuang.ctust.edu.tw,

Abstract: - Total laboratory automation (TLA) system accompanied with consolidated laboratory network has been demonstrated to be able to greatly reduce operational costs and improve clinical effectiveness and economic efficiency. Use single space. Taiwanese healthcare insurance system has undergone unbalanced income and outcome these years. In order to improve its financial problem, the central insurance agency frequently increases the insurance pensions, which, in turn, highly decrease citizen satisfaction of the government performance and efficiency. Solutions for decreasing the running costs are important for improving current financial deficit. Recently, a central laboratory equipped with TLA system has been set up in central Taiwan area as a platform for evaluation of its performance and efficiency. The outcome of this study will be used as a reference for Department of Health (DOH) of Taiwan to plan its future development on Taiwan healthcare issue. After its operation since Mar. 2006, the central laboratory with TLA system has been demonstrated to have great performance and efficiency that the specimen turnaround time has been decreased for about 60% and the number of operators has been reduced from 60 to 45. In conclusion, the preliminary investigation demonstrates that TLA accompanied with consolidated laboratory network is efficient in reducing laboratory costs which can be widely applied to regions all around Taiwan. Key-Words: - Total laboratory automation (TLA), Laboratory information system (LIS), Hospital Information System (HIS), Central laboratory, Satellite laboratory, Internet, Virtual network (VN), Healthcare 1 Introduction Total laboratory automation (TLA) is a system which integrates laboratory instruments under a unified control with little or without human intervention. It has been proposed for reducing operational costs and improving clinical effectiveness and economic efficiency (Sarkozi et al. 2003, Pansini et al. 2003, Hawker et al. 2002). In addition to regular tests, diagnostic immunology (Tomar 1999) and clinical microbiology (Weill et al. 2004) were also evaluated to be integrated into TLA system. TLA system has also been integrated with consolidated laboratory network which integrates several hospitals that the labor cost was reduced and the turnaround time was decreased (Seaberg et al. 2000).

Taiwanese healthcare insurance system has undergone unbalanced income and outcome these years. In order to improve its financial problem, the central insurance agency frequently increases the insurance pensions, which, in turn, greatly decrease citizen satisfaction of the government performance and efficiency. Solutions for decreasing the running costs are important for improving current financial situation. Recently, a central laboratory equipped with TLA system has been set up in central Taiwan area as a platform for evaluation of its performance. The study will be used as a reference for Department of Health (DOH) of Taiwan to plan its future development on Taiwan healthcare issue.

Recently The first TLA system accompanied with consolidated network in Taiwan has been setup in Central Taiwan National Hospital Union

Proceedings of the 5th WSEAS Int. Conf. on CIRCUITS, SYSTEMS, ELECTRONICS, CONTROL & SIGNAL PROCESSING, Dallas, USA, November 1-3, 2006 181

(CTNHU) which consists of 5 national hospitals, including Taichung Hospital, Nantou Hospital, Fongyuan Hospital, Changhua Hospital, and Caotun Hospital, scattering around Taichung city and Changhua and Nantou counties spanning an area of 7400 Km2 or so and serving a population of 4.4 millions. All the five participated hospitals are managed by the Department of Health (DOH) of Executive Yuan of Taiwanese government. The scales of these five participated hospitals are shown in Table 1.

Table 1. Scales of CTNHU Hospitals

Hospital Number of Beds

Out-Patients/Month

Taichung 566 55,000 Fongyuan 635 60,000 Changhua 669 21,000

Caotun 923 6,500 Nantou 404 23,000

2 Materials and Methods 2.1 Setup of TLA system In general, operation of a TLA system should consist of the following procedure: entrance and exit of the tubes, recognition of the tube and sample, measurement of sample size and color, centrifugation, decapping, aliquotting, sample

analyzing, production of secondary tubes, selection of secondary of tubes, and storage of tubes (Souverijn 2002). Fig. 1 shows the equipment and modules of the TLA system set up in the central laboratory of Taichung Hospital. The system is running 24 hours a day and is maintained by technicians and operators scheduled in 3 shifts.

The operation and procedure are controlled by the laboratory automated system (LAS) for automatic tracking, specimen distribution, centrifugation, decapping, aliquotting, sample analysis, etc. After strict quality control and evaluation (Fig. 2), the analysis results (Fig. 3) are exported and stored in the database for later references.

Fig. 2. An example of quality control report.

Specimen Collection &

Storage

Storage

ServerLIS

SpecimenSorting

Centrifugationx2

SpecimenQuality Inspection Decapping Classification

SpecimenDistribution &

Barcode Labeling

Manual operation

Total AutomaticBiochemical Analysis

BeckmanLX20(x2)

Specimen Collection

Serum,Plasma,& Blood

Decapping

Total AutomaticSerum Immunology

Beckman DXI 800

LH750

Total AutomaticBlood Analysis

LH750 +Slide Marker+Slide Stainer


Abbott i2000 / Modular E170

Deposition


Specimen Collection &

Storage

Storage

ServerLIS

SpecimenSorting

Centrifugationx2

SpecimenQuality Inspection Decapping Classification

SpecimenDistribution &

Barcode Labeling

Manual operation

Total AutomaticBiochemical Analysis

BeckmanLX20(x2)

Specimen Collection

Serum,Plasma,& Blood

Decapping


Beckman DXI 800

LH750


LH750 +Slide Marker+Slide Stainer


Abbott i2000 / Modular E170

Deposition


Fig. 1. Equipment and modules of the TLA system installed in the central laboratory


(a)

(b)

Fig. 3. Examples of analysis reports based on (a) specimen and (b) patient.

A limitation of the network-consolidated TLA system is that it cannot handle tests and examinations of emergent cases for the satellite hospitals because of distance and time restriction. Hence, all the satellite hospitals still maintain their individual laboratory facilities to handling emergent cases with minimum personnel. 2.2 Network architecture As shown in Fig. 4, hospitals including a central (Taichung Hospital) and four satellite hospitals are connected using virtual private network (VPN) constructed with ADSL 2M/256K for inter-hospital communication. The network architecture of the the central laboratory and satellite hospitals are illustrated in Fig. 5 and Fig. 6, respectively.

2.3 Software development and database management

The basic requirements for laboratory information system (LIS) are as follows: 1. Automatic examination 2. Real-time modification and evaluation 3. Be able to manually input special criteria and

automatically execute them 4. Design using HL7 (ASTM1238) standard for

communication with Hospital Information System (HIS) and the information system in Central Health Insurance Bureau.

5. Embed business to business (B2B) capability for integration with other satellite Labs.

6. Simultaneously display operational status of all connected instruments.

7. Uniform graphical user interface (GUI). 8. The administrator can easily enquire the status

and location of a specimen, instruments, quality control, and HIS connection. The statistic information and administrative operation should also be provided.

9. Operation and management based on barcode for identification of patient information,

Taichung Hospital

Changhua Hospital

Fongyuan Hospital

Nantou Hospital

Caotun Hospital

Internet

Central LabSatellite Lab Satellite Lab

Satellite Lab

Satellite Lab

PVC

VPN

Taichung Hospital

Changhua Hospital

Fongyuan Hospital

Nantou Hospital

Caotun Hospital

Internet

Central LabSatellite Lab Satellite Lab

Satellite Lab

Satellite Lab

PVC

VPN

PVC

VPN

Fig. 4. Network Connection between central and satellite labs.

DB ServerP570 2 CPU

AP Server 1 & 2

LTO Library 3581

Rm. 6509

Lab CenterRm. 4503

Storage DS4000

VPNAPTG

PIX 515

FortiNetFirewall

SAN network

Backup Network

Rm. 3550

Hinet

DB ServerP570 2 CPU

AP Server 1 & 2

LTO Library 3581

Rm. 6509

Lab CenterRm. 4503

Storage DS4000

VPNAPTG

PIX 515

FortiNetFirewall

SAN network

Backup Network

Rm. 3550

Hinet

Fig. 5. Network architecture of central lab.


specimen types, instrument categories, and test results.

10. Embedded functions for analyzing and managing the test results for medical researches and epidemiologic studies.

The LIS and Database Management System were developed by Lab Trak (Australia) and DB Chahe (France), respectively, while the LAS and middleware were developed by the Information Center of CTNHU using Chahe Script and Visual Basic (VB).

A doctor at the satellite hospitals issues a laboratory order through local HIS, which is then transmitted to LIS through a middleware using electronic data interchange (EDI) protocol. The blood and urine specimens are collected by the technicians in each satellite hospital and then sent to the central hospital for testing and analysis within 2 hours by vehicles equipped with frozen facilities supported by contracted logistic companies on daily basis. As illustrated in Fig. 7, the analytical reports are stored in the central database which are divided into 5 partitions and are mirrored to individual local databases located at corresponding satellite hospitals through VPN for local access. The reports are integrated with HIS (Hospital Information System) and LIS (Laboratory Information System) for keeping data consistency.

3 Preliminary Outcome The TLA system setup has been started operating since early April, 2006. Table 2 compares the turnaround time before and after the TLA system was introduced. The periods sample collected used for analysis are 4 month (Apr. 2006 to July, 2006) and 12 months (Apr. 2005-March 2006), respectively, before and after introducing TLA system. The number of operators before introducing

TLA system is 60 and is reduced to 45 after TLA introduction, which greatly eliminate personnel costs for five hospitals. The goal is to reduce the total number of operators to 38 within two years. Table 2. Average turnaround time of various test items before TLA system has been introduced

Code Test Item Sample Number

Turnaround Time (hour)

T06 Urine Test 35622 29.27 T07 Stool Test 4763 57.38

T08 Hematology Test 45774 41.48

T09 Biochemistry Examination

80772 185.42

T10Element, Drug, and Toxicology Examination

1011 94.87

T11 Pre-transfusion Exam

256 8.13

T16 Fluid Exam 133 151.15

T30 Allergy and Other Tests

300 107.17

Total 168631 Table 3. Average turnaround time of various test items after TLA system has been introduced

Code SampleNumber

Turnaround Time (hour)

Improvement(%)

T06 3337 20.73 29.16%

T07 1426 45.08 21.43%

T08 10794 4.25 89.75%

T09 17041 13.45 92.75%

T10 633 12.38 86.95%

T11 904 3.95 51.43%

T16 268 9.90 93.45%

T30 115 92.07 14.09%

Total 34518 Mean 59.88%

4 Discussion and Conclusion After its operation since Mar. 2006, the central laboratory with TLA system has been demonstrated to have great performance and efficiency that the specimen turnaround time has been decreased for about 60% and the number of operators has been reduced from 60 to 45. In conclusion, the preliminary investigation demonstrates that TLA accompanied with consolidated laboratory network is efficient in reducing laboratory costs which can be widely applied to regions all around Taiwan.

AP/DB Server 1

Core SW

PIX 515

Hinet

VPNAPTG

Central Lab

AP/DB Server 2

Cluster

Other Satellite LabsAP/DB Server 1

Core SW

PIX 515

Hinet

VPNAPTG

Central Lab

AP/DB Server 2

Cluster

Other Satellite Labs

Fig. 6. An example of network architecture of satellite lab.


In conclusion, the preliminary investigation demonstrates that TLA consolidated with laboratory network is efficient in reducing laboratory costs which can be widely applied to regions all around Taiwan. References: [1] L. Sarkozi, E. Simson, L. Ramanathan, The

Effect of Total Laboratory Automation on the Management of a Clinical Chemistry. Retrospective Analysis of 36 Years, Clinica Chimica Acta, Vol.329, 2003, pp. 89-94.

[2] N. Pansini, F. Di Serio, M. Tampoia, Total Testing Process: Appropriateness in Laboratory Medicine, Clinica Chimica Acta, Vol.333, 2003, pp. 141-145.

[3] C.D. Hawker, S.B. Garr, L.T. Hamilton, J.R. Penrose, E.R. Ashwood, R.L. Weiss, Automated Transport and Sorting System in a Large Reference Laboratory: Part II.

Implementation of the System and Performance Measures over Three Years, Clinical Chemistry, Vol.48, No.10, 2002, pp. 1761-1767.

[4] R. Tomar, Total Laboratory Automation and Diagnostic Immunology, Clinical and Diagnostic Laboratory Immunology, Vol.6, No.3, 1999, pp. 293-294.

[5] F.X. Donay, D. Mathieu, P. Fernandes, C. Pregermain et al., Evaluation of the Automated Phoenix System for Potential Routine Use in the Clinical Microbiology Laboratory, Journal of Clinical Microbiology, Vol.42, No.4, 2004, pp. 1542-1546.

[6] R.S. Seaberg, R.O. Stallone, B.E. Statland, The Role of Total Laboratory Automation in a Consolidated Laboratory Network, Clinical Chemistry, Vol.46, No.5, 2000, pp. 751-756.

[7] J.H. Souverijn, Assay on FAQ’s on Total Lab Automation, JALA, Vol.7, No.6, 2002, pp. 41-46.

DB ServerHIS/LIS& DB Backup

Central Lab

Satellite Lab1 Satellite Lab2


LocalHIS/LIS and

DB Mirror

Mirroring

VPN

ClinicalRoom

ClinicalRoom

ClinicalRoom

ClinicalRoom

ClinicalRoom

LocalHIS/LIS and

DB Mirror

LocalHIS/LIS and

DB Mirror

LocalHIS/LIS and DB MirrorDB ServerHIS/LIS

& DB Backup

Central Lab



LocalHIS/LIS and

DB Mirror

Mirroring

VPN

ClinicalRoom

ClinicalRoom

ClinicalRoom

ClinicalRoom

ClinicalRoom

LocalHIS/LIS and

DB Mirror

LocalHIS/LIS and

DB Mirror

LocalHIS/LIS and DB Mirror

Fig. 7. Mirroring the central database into local databases by dividing the central database into 5 partitions for mapping to individual local databases located at satellite hospitals through VPN.


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