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| <div class="nonumtoc">__TOC__</div> | | <div class="nonumtoc">__TOC__</div> |
| [[File:Gamry Instruments Lab.jpg|right|350px]]
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| '''Title''': ''What role does systems integration play in the laboratory and why is this important to address?''
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| '''Author for citation''': Shawn E. Douglas
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| '''License for content''': [https://creativecommons.org/licenses/by-sa/4.0/ Creative Commons Attribution-ShareAlike 4.0 International]
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| '''Publication date''': February 2024
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| ==Introduction==
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| ==Interoperability and systems integration==
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| In order to answer this question, we first must discuss the concept of "interoperability," of which integration of other informatics systems is just one component. Interoperability is defined by the Healthcare Information and Management Systems Society (HIMSS) as “the ability of different information systems, devices and applications (‘systems’) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries” to, in the case of a [[laboratory]], ensure timely, portable, and accurate analytical results (the "deliverable" of most laboratories).<ref name="”HIMSSInterop20”">{{cite web |url=https://www.himss.org/resources/interoperability-healthcare |title=Interoperability in Healthcare |author=Healthcare Information and Management Systems Society |publisher=Healthcare Information and Management Systems |date=2024 |accessdate=27 February 2024}}</ref> While HIMSS' definition is focused on the clinical realm, their definition is robust enough that it, at least in part, can be applied to laboratory-based organizations serving most industries.
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| ==The why and how of laboratory integration==
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| Why should labs focus on interoperability and systems integration? Let's look at a few industries.
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| #In the realm of clinical laboratories, improving interoperability among clinical informatics systems is recognized as an important step towards improving health outcomes.<ref name="KunImprov08">{{cite journal |title=Improving outcomes with interoperable EHRs and secure global health information infrastructure |journal=Studies in Health Technology and Informatics |author=Kun, L.; Coatrieux, G.; Quantin, C. et al. |volume=137 |pages=68–79 |year=2008 |pmid=18560070 |doi=10.1109/IEMBS.2007.4353759}}</ref><ref name="GCHIImproving">{{cite web |url=http://s3.amazonaws.com/rdcms-himss/files/production/public/Improving-Patient-Carethrough-Interoperability.pdf |archiveurl=https://web.archive.org/web/20210913205610/http://s3.amazonaws.com/rdcms-himss/files/production/public/Improving-Patient-Carethrough-Interoperability.pdf |format=PDF |title=Improving Patient Care through Interoperability |author=Global Center for Health Innovation |publisher=Global Center for Health Innovation |date=n.d. |archivedate=13 September 2021 |accessdate=27 February 2024}}</ref> The National Academies of Sciences, Engineering, and Medicine had much to say on this topic in their 2015 publication ''Improving Diagnosis in Health Care''<ref name="NASEMImprov15">{{cite book |url=https://www.nap.edu/read/21794/chapter/7 |chapter=Chapter 5: Technology and Tools in the Diagnostic Process |title=Improving Diagnosis in Health Care |author=National Academies of Sciences, Engineering, and Medicine |publisher=The National Academies Press |pages=217–62 |year=2015 |doi=10.17226/21794 |isbn=9780309377720}}</ref>:<br /><blockquote>Improved interoperability across different health care organizations—as well as across laboratory and [[radiology information system]]s—is critical to improving the diagnostic process. Challenges to interoperability include the inconsistent and slow adoption of standards, particularly among organizations that are not subject to EHR certification programs, as well as a lack of incentives, including a business model that generates revenue for health IT vendors via fees associated with transmitting and receiving data.</blockquote><br />In particular, the National Academies discussed an additional concern, one that still causes issues today: interfaces between [[electronic health record]]s (EHR) and the laboratory and other clinical information systems that feed medical diagnostic information into the EHRs. In particular, they found "the interface between EHRs and laboratory and radiology information systems typically has limited clinical information, and the lack of sufficiently detailed information makes it difficult for a pathologist or radiologist to determine the proper context for interpreting findings or to decide whether diagnostic testing is appropriate."<ref name="NASEMImprov15" /> EHR integration was also a problem at the peak of the [[COVID-19]] [[pandemic]]. In early April 2020, a report from ''Nature'' revealed that academic research laboratories wanting to assist with COVID-19 testing efforts had at times been stymied by the incompatibility between academic informatics systems and hospital EHRs. Not only were hospitals using EHRs of differing types, but many of those EHRs were not designed to talk to other EHRs, let alone to academic and research laboratories' informatics systems. Combine this with strict account procedures and the costs of developing interfaces on-the-fly, more than a few medical systems turned away the offer of help from academic and research labs during the height of the pandemic.<ref name="MaxmenThousands20">{{cite journal |title=Thousands of coronavirus tests are going unused in US labs |journal=Nature |author=Maxmen, A. |volume=580 |issue=7803 |pages=312–13 |year=2020 |doi=10.1038/d41586-020-01068-3 |pmid=32273619}}</ref> Had there been greater systems integration across these two essentially disparate lab types, it's possible even more academic laboratories with the necessary testing equipment could have assisted with running patient-based clinical testing.<br /> <br />While this constitutes an extreme example, it's possible that a push for improved interoperability across the systems used in commercial clinical diagnostic labs and more academic clinical research labs could have other benefits, for example with improving the state of interdisciplinary research, diagnosis, and treatment of cancer.<ref>{{Cite journal |last=Bellah |first=Md Motasim |date=2017-11-28 |title=The Emergence of Interdisciplinary Research in Cancer Diagnostics |url=https://medcraveonline.com/JNMR/the-emergence-of-interdisciplinary-research-in-cancer-diagnostics.html |journal=Journal of Nanomedicine Research |volume=6 |issue=3 |doi=10.15406/jnmr.2017.06.00161}}</ref> A similar case can be made for clinical diagnostic systems and academic researchers seeking to conduct translational research using de-identified clinical patient data found in EHRs.<ref name="ZhangSemantic19">{{cite journal |title=Semantic integration of clinical laboratory tests from electronic health records for deep phenotyping and biomarker discovery |journal=npj Digital Medicine |author=Zhang, X.A.; Yates, A.; Vasilevsky, N. et al. |volume=2 |at=32 |year=2019 |doi=10.1038/s41746-019-0110-4 |pmid=31119199 |pmc=PMC6527418}}</ref>
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| # In the realm of manufacturing, laboratories play an important role in ensuring the safety and quality of produced goods, as well as participating in their development and optimization.
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| While there are viable options for labs (including [[laboratory information system]]s [LIS] and [[laboratory information management system]]s [LIMS] capable of extensive instrument and data system integration), the "how" of interoperability and integration in today's labs remains challenging. A 2019 article in the American Association for Clinical Chemistry's ''CLN Stat'' addressed remaining roadblocks, including lack of standards development, data quality issues, clinical data matching, lack of incentivizing health IT optimization, text-based reporting formats, differences in terminology, and HL7 messaging issues. They add that proposals from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services include possible fixes such as standardized [[application programming interface]]s (API). They also note that middleware may pick up the slack in connecting more laboratory devices, rather than depending on the LIS to handle all the interfacing.<ref name="AACCStrength19">{{cite web |url=https://www.myadlm.org/cln/cln-stat/2019/february/21/strengthening-the-chain-of-interoperability |title=Strengthening the Chain of Interoperability |author=American Association for Clinical Chemistry |work=CLN Stat |date=21 February 2019 |accessdate=27 February 2024}}</ref> As it turns out, the implementation of [[HL7]]- and other standard-based interfaces in LIS and LIMS historically has been expensive for many vendors to implement.<ref name="John3504HL7_11">{{cite web |url=https://community.spiceworks.com/topic/175107-hl7-interface-cost-and-maintenance |title=HL7 Interface cost and maintenance |author=John3504 |work=Spiceworks |date=07 December 2011 |accessdate=27 February 2024}}</ref>
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| ==Conclusion==
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| ==References==
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| {{Reflist|colwidth=30em}}
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