Focus

Automated Integration

Super Religare Laboratories Limited is reaping benefits of its IT system that ensures timely and error-free reports to patients, reports Sonal Vij

Super Religare Laboratories Limited (formerly SRL Ranbaxy Limited), one of the largest and most trusted pathology laboratory networks in India, serves nearly 4,000 hospitals/ path labs and over 50,000 doctors. SRL performs over 34,000 tests per day and caters to approximately six million patients in a year offering a comprehensive range of over 3,500 tests, from the routine to the highly specialised tests. The expansion plans include 40 labs by the end of 2009. The diagnostic chain—Super Religare Laboratories Limited (SRL) attributes this controlled growth to the robust IT system.

The diagnostic chain has always realised the advantages of a good IT system. "It is one of the earlier adopters of IT in lab operations. Since its inception in 1998, it has used Lab Information System (LIS) for various areas like specimen, registration, processing and reporting of test results," says Radhakrishna Pillai, CIO, SRL Limited.

Going In-House

Until late 2002, the diagnostic chain made use of a vendor-based LIS. Initially, the development of the original LIS was outsourced, but later all further development was done by a dedicated in-house team. "We initially used an LIS system which was not Y2K (2000) complaint and therefore felt the need for replacing the same. Also SRL needed an enterprise-wide system to manage and control all operations," he says.

Evaluation of various LIS systems available in the market found that most of them were more tuned towards hospital requirements. "As expansion was on the cards, we required a more flexible, scalable system so that all the process could be automated to take full advantage of using IT. So, we decided to have a home-grown solution to enable us to configure and develop as per our best business practice," he explains.

Since 2003, SRL makes use of Centralised Lab Information Management System (CLIMS) which has evolved from its earlier version of LIS that functions as an ERP for SRL, integrating all business processes into a single system. CLIMS includes various modules like lab-operations, material management, billing, financial accounting, customer care, sales and marketing, logistics, clinical trials, instrument interface and security module.

Currently, SRL has implemented CLIMS in more than 35 labs. "The latest version 3.0.4 uses latest technologies — Oracle 10g as backend database, PowerBuilder 11 as front end and for last couple of years we are using .net technologies for internet platform. CLIMS has been developed as per SDLC guidelines and is compliant as per US FDA 21CFR part 11," says Pillai.

Automation

Explaining the relevance of a robust IT system, Dr Ashok Rattan, Director- Gurgaon Clinical Reference and NCR Laboratories, SRL Limited says, "CLIMS application completely automates lab operations and it is a backbone for our business. It is very critical for our operations as without CLIMS we will not be in a position to process the specimens because the whole operation right from specimen registration to report delivery completely depends on IT."

Daily operations in a diagnostic laboratory include three phases—pre-analytical, analytical and post-analytical. CLIMS is involved in all the three stages and helps in maintaining traceability of each and every sample from registration till lab report generation. All the specimens received at the laboratory are accompanied by 'Test Requisition Form' (TRF) which contains all the information regarding patient identification and tests requested. Specimen received from different collection centres are accepted in the lab. Registration of the specimen takes place with generation of a unique accession ID and bar-coding for identification and tracking. The information is entered into CLIMS. The barcode is pasted on vacutainer and sample is sent to various departments of the laboratory.

Explains Dr Aparna Jha Ahuja, Head Biochem and CLIA, Head CRS, Gurgaon Clinical Reference Lab, "Worksheet is generated for specimen routing them to different sections like biochemistry, haematology, flow-cytometry etc based on the test requested. CLIMS tracks bar-coded specimen and locates them accurately." The interfaced instrument reads the bar-coded specimen and questions the database for test parameters prior to performing the tests requested.

Majority of analysers are bi-directionally interfaced for better accuracy and faster reporting. With barcode scanner available on the automated analysers, the instrument accesses the information from the CLIMS like the tests that need to be performed. In case of interfaced instruments, direct transfer of data takes place between the analyser and CLIMS thus minimising transcription error. She adds, "The interfaced instruments provide total automation thereby minimising manual errors and ensuring accuracy of test results. "

The patient results are electronically entered and reviewed by two different scientific officers/ pathologists. CLIMS flags values which are low or high in red and very abnormal values requiring critical call out, in blue. This ensures that no abnormal value is missed and critical call out is made to the referring doctor/ patient as soon as possible. Results are delivered in the form of e-mail reports/ web-based reports/ fax/ hard copies (courier).The dangerous result values are informed to the doctors.

CLIMS has also been successfully interfaced with Hospital Information System (HIS) wherever the hospital labs are managed. The CLIMS-HIS gateway enables data flow between HIS and CLIMS. "After a patient test order is accepted in HIS, the test order data flows to CLIMS and then the result is transferred to HIS on real time," tells Pillai.

Advantages

"Home-grown solution enabled us to configure and develop as per our best business practice" - Radhakrishna Pillai CIO SRL Limited

"The interfaced instruments provide total automation thereby minimising manual errors" - Dr Aparna Jha Ahuja Section Head Biochem and CLIA & Head CRS Lab, Clinical Reference Laboratory, SRL Limited

The robust IT system ensures complete automation at every stage from the receipt of specimen for testing to printing of test results and delivery to test results digitally. "CLIMS can identify the expired stocks. Reagents are expensive and carry fixed expiry dates and have to be used prudently. CLIMS' deployment immediately reduced inventory and monitoring of expiry items which has helped to reduce the reagent expiry to bare minimum level," informs Pillai.

It also has features for identifying the quantity of reagents/ chemicals used for performing a test. IT facilitates comparison between expected test cost and actual cost, thus enabling better pricing and analysis of performance efficiency. Most of the labs are connected using secure VPN connections. The remaining labs are under centralisation process. There is connectivity between different lab locations. The CLIMS handles bi-directional/ uni-directional interfaces with analysers.

All labs are inter-connected— so that results of satellite lab can be viewed by a centralised lab. "If a sample is collected in one branch and it is moved to the referral lab for specialised testing, it can be easily monitored with CLIMS," says Dr Sanjeev K Chaudhry, CEO, SRL Limited.

Truly Gen Next

With the increasing influence of web-based media, IT has helped SRL to connect to its patients with real-time technologies. "It has revolutionised lab reporting using web, e-mail and SMS technologies. As soon as the result reports are ready, they are uploaded on the website and can be downloaded instantly saving courier costs," he adds. Reports are also auto e-mailed to patients in encrypted form without any manual intervention. The web-based Electronic Data Capture (EDC) that captures the patient demographics and test-orders, are available for international clients and is being extended to domestic clients.

Critical application transactions have audit trail reports as per the healthcare security standards. All patients and doctor's queries are monitored and tracked by CLIMS CCG modules for best customer service.

Challenges

Training and implementation were two major roadblocks. "When we implemented CLIMS, we faced the problem of training the users who were familiar only with the DOS environment, to use GUI-based application as users were not familiar with mouse," recalls Pillai. It was totally a cultural change for the end-users, not only because the interface was different but also because there was a lot of business process re-engineering. To overcome this and to make them feel comfortable, extensive training was held not just in classrooms, but also at the bench level. "The people who resisted initially are now adept users and appreciate it,"exclaims Pillai

Users

Now that the results were reported by introducing web-reporting, there was reluctance from the users to adapt to the new system, but presently it has become an accepted practice, so much so that patients now push the lab to start this facility from day one. "In earlier days, connectivity was an issue for rolling out application. In recent years, however, it has improved and getting consistent quality of connectivity is not a problem," informs Pillai.

Any home-grown application, unless and until it can be upgraded technically or enhanced functionally from time to time, scalability and user acceptance is always a tough task. So technology upgradation, validation and deployment without affecting the production system and at the same time to cater to the regulatory compliance requirement are a constant challenge.

Through the Looking Glass

The diagnostic chain plans to introduce a lot of customer centric initiatives like call centre, Customer Relationship Module etc. "We are currently in the process of migrating the CLIMS application to .net," he informs. There are around 20 centralised labs and remaining 20 are under centralisation process. Pillai remarks, "We are rolling out SAP as a back office transaction system which will get integrated with our operational system- CLIMS."

Truly, the diagnostic chain is reaping the benefits of IT. Seems, the expansion of labs and IT will go hand-in- hand.

sonal.vij@expressindia.com