DELIVERY OF TM LAB SERVICES S A N D R A F A Z A R I I M M U C O R - PowerPoint PPT Presentation

IMMULINK: IMPROVING THE DELIVERY OF TM LAB SERVICES S A N D R A F A Z A R I I M M U C O R U S E R G R O U P M E E T I N G J U N E 1 8 T H , 2 0 0 5 A N N A P O L I S C I T Y , M A R Y L A N D

OBJECTIVES • ImmuLINK • Function and capabilities • Local Health Integration Networks (LHIN) • Hamilton Regional Laboratory Medicine Program (HRLMP) • Our organization and services • HRLMP vision and model(s) for ImmuLINK

EVOLVING TECHNOLOGY

TRANSFUSION MEDICINE TECHNOLOGY THEN Now

IMMULINK • Technology has changed the way we live and the Transfusion Medicine lab is also impacted • Many TM labs are transitioning to automated instruments and now have the opportunity to enter the virtual world • ImmuLINK is virtually linking TM labs and introducing innovative lab process • Instruments and systems in hospitals are becoming more intelligent

What is ImmuLINK™? An data manager designed specifically for donor centers, reference lab & transfusion medicine. First of its kind in Blood Bank Designed specifically for:

Data Middleware Interface Methodology Manager LIS

SINGLE FACILITY LIS

MULTIPLE FACILITIES LIS

WORKLIST MANAGEMENT

WORKLIST STATUS ICONS Tests names can be customized Order Received from LIS Already received result for selected test(s)- Everything complete Combination of different status based on each sample Sample is running No current orders for this sample Green = Test Completed Done Blue = Test Running Test hasn’t started

RESULTS

RESULTS MANAGEMENT • Group tests that you want to see together • All test group column headers are customizable • Customize views

Sample loaded on the instrument Sample transferred to LIS Sample ready to be approved (no warnings by the instrument) Attention required for this sample Sample approved by authorized user

LHIN- FUNCTION AND PURPOSE • The Local Health System Integration Act, 2006 changed the way that our health system is managed in the Province of Ontario. • 14 Local Health Integration Networks (LHINs) to plan, integrate, and fund health care based on local needs. • LHINs do not provide services • Their role is to ensure the right services in the right place at the right time. • Covering Hamilton, Niagara, Haldimand, Brant, Burlington and most of Norfolk the HNHB LHIN is home to a diverse population of more than 1.4 million people and over 200 providers to include: • 80 Community Support Services • 45 Community Mental Health and Addictions Programs • 7 Community Health Centres (including 10 sites) • 1 Community Care Access Centre • 87 Long-Term Care Homes • 9 Hospitals (including 22 hospital sites)

LHIN – 14 NETWORKS ON pop ~13 million; SON pop ~ 12 million, ~53000 sq miles • Maryland pop ~ 6 million, ~13000 sq miles •

HNHB LHIN NETWORK • HNHB LHIN covers ~2700 sq miles • Population ~ 1.3 million • Hamilton population ~ 600,000 • ~439 sq miles • Baltimore population ~620, 000 • 92.2 sq miles

HRLMP – LAB SERVICES Hamilton Regional Laboratory Medicine Program (HRLMP) provides comprehensive • laboratory testing for Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, as well as providing reference laboratory services for Ontario and across Canada. More than 700 staff members including 50 medical and scientific staff with cross • appointments at McMaster University. Laboratory Services Anatomic Pathology • Clinical Chemistry and Immunology • Core Laboratory • Genetics • Microbiology • Special Hematology • Specimen Collection • Transfusion Medicine and HLA •

CENTRES OF EXCELLENCE

HRLMP – TRANSFUSION MEDICINE • ECHO & NEO • ECHO • 17482 BP Trxn • 20156 BP Trxn • 22758 samples • 12596 samples resulted resulted HGH JHCC WL MUMC STJ • ~2600 samples ~1000 BP Trxn • • ECHO • ECHO • 11341 BP Trxn • 3884 BP Trxn • 12773 Samples • 9703 samples resulted resulted • 9.5 FTE MLT

IMMULINK - THREE MODELS 1. Hub-Satellite Model 2. Consolidation Model 3. LHIN model

1. HUB-SATELLITE MODEL • Site A is the Hub(MUMC)where all the resulting and test approval occurs; Site B is the satellite (WL) where the sample resides and is loaded on the instrument • Live date was June 6 th , 2014 • Distance between WL and MUMC = ~ 27 miles (30 min)

1. HUB-SATELLITE MODEL – SCREEN COMPARISON

1. HUB-SATELLITE MODEL • Process before ImmuLINK • Group and Screen and Crossmatch testing performed by gel methodology • Lab not licensed to perform antibody investigation • Stat investigation shipped to MUMC site Full GS and AI performed by Capture methodology • • Routine investigation shipped to Canadian Blood Services • Process After ImmuLINK • Satellite site loads the instrument • MLT/MLA can leave and perform other lab work • GS that have Neg ABS and no discrepancies will auto verify • ABS Pos and/or further testing is required – Hub site reviews investigation via ImmuLINK and directs the completion of the investigation to include final results

1. HUB-SATELLITE MODEL - EFFICIENCIES • Since live date processed 1436 samples • 1288 Screen Neg; 148 Screen Pos • Year estimate – 2208 Screen Neg; 254 Screen Pos • Only 6 samples required to be shipped to Hub site • Warm auto Ab and mixed field discrepancy

1. HUB-SATELLITE MODEL - EFFICIENCIES • What are the realized savings and efficiencies? • Transport – saving shipping of 254 individual samples • Autoverify of Neg results produces significant tech time efficiencies • Preliminary data = 66 days of GS work • Reduction in error – no manual entry of results into LIS • Improvement in TAT – MLT can devote time to other work • Improvement in work life • Replacing MLT with MLA – wage savings • With the samples that have Pos Screen • Savings in reagent cost as there is no need to repeat entire testing at Hub Satellite • Gain in access to expertise • Improvement in TAT – shipping time would delay TAT

2. CENTRALIZATION MODEL • The TM labs within the HRLMP are four labs that perform all TM lab testing and functions • Four years ago we were in the midst of a centralization model • One main testing site (Hub) at the HGH with satellite sites at the remaining sites • Purchased a NEO in order to accommodate centralization of all T+1 GS to one site • The majority of staff would be working at the Hub site with rotation to the satellite sites • Budget cuts resulted in a loss of funding for our new labs space • Currently all sites ship GS for T+1 or greater transfusion to the HGH • The Centralization Model was put on hold and never resurrected until ImmuLINK

2. CENTRALIZATION MODEL • Evaluating our processes utilizing Lean Six Sigma • Current state: • Samples are being shipped to multiple sites • Inbalance of workload and staffingImmuLINK allows for a more efficient process • Centralize test resulting to one site eliminating shipping of samples • Increase in MLA skill mix • Better staff utilization; ability to eliminate certain shifts at certain sites (ex: MUMC site)

3. LHIN MODEL • Similar Hub-Satellite model but involves hospitals in our LHIN • Example: Brantford General Hospital • Distance to Hamilton is approximately 25 miles (30-45 min drive depending on traffic and weather conditions • Community hospital; population of ~100000 • Original LHIN Agreement was to ship T+1 GS specimens to HHS • Obstacles or challenges with this approach? Maintaining competency with infrequent stat testing • Maintaining a manual method for infrequent use • Transport of specimens • With an increase in retirement experiencing a decrease in expertise • • Benefits ? • Opportunity for Revenue

IMMULINK FACILITATES …. • Standardization of testing platforms across a region thereby promoting standardized SOPs and access to the results from any computer. • Decrease in transportation cost • More efficient tracking of specimens and patient results • Decrease in test redundancy across a region. • Improving Quality Control • Tracking QC reagents and usage • Troubleshooting • Education • Promotes integration, efficiency in staffing and centralization of expertise.

ImmuLINK improves the quality of service we provide thereby improving patient care and allows for the operation of lab in a cost efficient way.

CHALLENGES • As pilot site we are charged with identifying improvements and testing Immulink • Challenge: as with any process troubleshooting can take time but the benefit is an improvement to the system • Accreditation and Proficiency testing • No other comparable process within the copuntry or province • Worked with our accrediting body on proficiency samples and licensing requirements for ub-Satellite model • LIS build • Because of the way we have some of our tests built in Meditech created some glitches • These glitches have nothing to do with ImmuLINK but how we have our system set up which created challenges at times with validation

QUESTIONS? THANK YOU