IFE Clinapp

Banged out another clinapp today, this one for IFE's. Victim of my own success: the client keeps finding new tasks well-suited to this code base. Satisfying to be providing value, but not the most exciting way to make a living: endlessly repeating oneself.

Cell-Dyn 4000 Automated Analyzer Interface

Today I started work on another automated analyzer interface, this time for the CD4000. I expected that instruments in the same series would be similar, but I was wrong: much like consumer electronics, the individual instruments seem to differ greatly from model to model.

I am still using the same protocol and still using the same very good framework from the client. But this time I will be adding a feature entirely my own: an automated Audit module to support the new-to-the-client feature of....autoverification! Rather behind the industry curve, the client has decided to adopt autoverification but they want strict monitoring and tight control, which is OK by me.

Cell-Dyn 3200 Automated Analyzer Interface

Today I started work on an instrument interface for Abbott's Cell-Dyn 3200 automated analyzer. Most of the work was done for me by the client, whose staff have developed a very solid framework in which to build instrument interfaces.

Automated analyzers are weird: they are sophisticated in every way but the way in which they handle I/O. This has been an introduction to some concepts for me:

• ASTM E1381/95 a rather outdated, clearly serial protocol rather reminiscent of MS-DOS block-based communication protocols of yesteryear.
• Worklists for analyzers which are derived from LIS orders
• Analyzer flags and how to present them
• Verification UIs

It has also been a pleasure to learn about automated analyzer interfaces from a master,  Steve Wardlaw, MD.

Flow Cytometry Reporting

Starting a new and interesting project: provide a web-based rich data environment to support clinicians making clinical impressions of flow cytometry results.

Flow cytometry is a new and exciting technology for analyzing cells along a number of dimensions, but that is not my area. My area is providing an environment in which the raw flow cytometry results, which are precise but not clear, can be interpreted.

In practice, this means providing the following functionality:

• a worklist for the section
• orders as they arrive (tech to-do)
• cases to be interpreted as they are run (clinician to-do)
• up-to-date patient demographics
• access to any previous reports on this patient
• access to related and support current lab results
• macros for impressions
• push-button creation of a printable clinical report as a PDF
• publishing verified impressions:
• automatic interfacing of impressions to the LIS
• automatic faxing of reports to the ordering clinician

Since the client is a large teaching hospital, there are the following user models:

• tech--can enter and edit results
• resident--can enter impressions, not results and cannot sign a report
• attending--can enter impressions, not results and can sign a report 

(This was the first app of the set which became known as "the clinapps".)

Laboratory Manual for Homegrown LIS

The client is a large hospital-based clinical lab with a homegrown LIS--the only LIS they have ever known.

Since the LIS was designed in the mid-1970s, it lacks some modern amenities, such as support for exporting test definitions to an HIS, let alone the several (!) HISes in use by the parent academic medical center.

The client developed a standalone test definitions database using an MS-DOS database management system; our first job was to port that schema to MySQL under Linux.

The client developed a library of export formats so our next job was to catalogue, document and implement exports for these formats. We did the document on-line, as a web site, for ease of use.

Since the process was laborious and manual and involved inventory (printed documents), the client was used to producing their Lab Manual only when pressure to do so became intolerable. We made the Lab Manual creation process push-button and greatly extended the range of supported formats:

• Letter-sized paper for bench use
• Pocket-sized paper for clinicians who are married to paper
• HTML for both public and internal formats
• Palm PDA format for that user base
• Palm or PocketPC format using the Castle development environment

We helped them migrate off of paper, although I keep a pocket manual on my desk to remind me of why computers are a good idea for this kind of thing.