Ground-breaking software keeps track of laboratory records
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November 2007
What do crocodiles and plovers have in common with the countless sample request forms that a microbiology department handles each year? Well, they provided the inspiration for a pioneering software company to transform document management by eliminating expensive databases.
Microbiology departments can become inundated with paperwork because they test millions of samples a year, each specimen being accompanied by a form detailing the request for analysis. Keeping track of these forms, and storing them so that they can be retrieved rapidly, is a major challenge because specimens often have to be sent away to specialist laboratories for reference tests.
Historically, microbiology departments have stored paper forms in filing cabinets. Storing and retrieving these forms is time-consuming and labour-intensive, and a backlog of forms can easily build up.
Digitising the paper documents appears to be an ideal solution, but, although storing documents electronically is relatively quick and saves space, it can be difficult to find them again and to avoid duplication when files are scattered across a computer network, This is where document management software comes in.
Document management system
A traditional document management system (DMS) acts like an A6 card index; it stores the content and location of every document in a database. Unfortunately, a database-driven DMS has its own problems. It can be expensive because a department may need, at a minimum, to buy database server software and a licence to go with it. Expensive database programming and maintenance may need to be bought and, quite often, new server hardware may be required.
Furthermore, databases are timeconsuming to install and maintain because the location and description of every file on the network must be entered in the database. This makes a DMS inflexible as it is impossible to add new hardware or software to the computer network without reconfiguring the database to recognise the new additions.
Crocodiles and plovers
So, how can crocodiles and plovers help microbiologists with data management? Crocodiles have long snouts and sharp teeth, which are difficult to clean. Small birds called plovers want an easy meal, and crocodiles let them hop inside their mouths to eat decaying meat attached to their teeth – the crocodile gets clean teeth, and the plover gets a free lunch.
The symbiotic relationship between crocodiles and plovers inspired a pioneering Birmingham-based software technology company called Folding Space to create a new type of data and document management software that uses a technique called symbiotic indexing to do away with databases. This software is being sold to pathology departments by Capula Healthcare, a company better known for the Oasis electronic patient record (EPR) system.
Symbiotic indexing
Symbiotic indexing works by attaching key word, category and other descriptive information, known as metadata, to a document, rather than storing the metadata in a centralised database. Returning to the crocodile and plover analogy, the sample request form is the crocodile, and the metadata is the plover, with the two coexisting beneficially on a computer network.
Tagging the document rather than keeping metadata in a database has several advantages. First, a database is no longer needed. Provided that files have metadata ‘labels’, they can be searched for across any size of network, on any computer device attached to that network, and even via an intranet, extranet or public website. Indexing and managing documents using Folding Space’s Pathology Finder is cheap, fast and flexible. Pathology Finder has four complementary components – Scan, Tag, Find and View – that solve the problem of digitisation and document management; from scanning forms and documents, through applying reference data, instant search and retrieval across a network.
Scan Manager digitises any pathology form or other printed material, irrespective of size or content. Scan Manager automatically reads the multiple barcodes on request forms, speeding up data entry and minimising errors – no typing is required.
Documents without barcodes (eg referral letters) can be labelled with a laboratory number in Metadata Tagger. Tagged documents are transmitted to the Document Repository, a file directory located on a Windows server. The Finder automatically recognises and indexes tagged documents sent to the Document Repository so that they can be found easily. The scanned documents can be viewed using the universal Image Viewer built into Scan Manager, Metadata Tagger and the Finder.
Both Metadata Tagger and Pathology Finder for search and retrieval are accessible instantly via a web browser by authorised users located anywhere across the network. What’s more, in addition to handling scanned documents, Pathology Finder can also deal with digital documents created with programs such as Microsoft Office. Microbiology departments, like crocodiles, are tough customers, but more than one has been impressed by Folding Space’s symbiotic software. Among the satisfied users of the Pathology Finder system are microbiologists working in the pathology departments of Worcestershire and Walsall NHS trusts.
Worcestershire variations
The pathology department at Worcestershire Acute Hospitals NHS Trust tests specimens for almost a quarter of a million people visiting GPs and hospitals in Kidderminster, Redditch and Worcester. Prior to installing Pathology Finder, the 1.5 million specimen request forms received each year were kept in filing cabinets. This manual storage system was complex because, according to pathology system manager Peter Meadowcroft, “not only do all test results have to be authorised before completion, but they also have to be linked correctly to each patient throughout the testing process”. He explained that the department now uses Folding Space’s Pathology Finder because it provides “a highly costeffective, high-performance solution”.
The pathology service in Worcestershire was particularly impressed by the Scan Manager software, which, unlike other scanning software, does not charge for scanning millions of images, and the department saved over £10,000 in scanning costs during the first year alone. The Scan Manager software reads the multiple barcodes on each request form and links forms automatically to their laboratory number for identification and tracking. The microbiology department now retains its paper request forms for a month, rather than for more than a year, thus saving on storage space. Subsequently, the forms can be found and retrieved directly using Pathology Finder, and also through the laboratory information management system (LIMS) because it has been integrated in the CliniSys WinPath LIMS package that supports pathology in Worcestershire. “It’s a lot easier for department staff to find forms because they are linked to specific patients,” explained Peter Meadowcroft.
Digitising the request forms has also improved clinical commentary because they can now be viewed in the microbiology laboratories. Previously, only information from the request forms that had been entered manually on the LIMS was accessible in the laboratories, which often excluded additional notes useful for diagnosis and testing. Following the success of its request form scanning programme, the Worcestershire service is now considering widening the range of documents that it keeps electronically to include reference reports received from specialist laboratories such as the Health Protection Agency.
Scanning the Black Country
The pathology department at Walsall Hospitals NHS Trust receives around a thousand specimen requests per day from a medium-sized district general hospital and from GP practices located in Walsall, near Birmingham.
Walsall had spent eight years looking for a system such as Pathology Finder. Head biomedical scientist Steve Fell said: “We spent a lot of man-hours filing request forms and had a storage problem.” Walsall installed Pathology Finder in 10 locations spread over four departments, including the microbiology department, after seeing it running in Worcestershire.
Initially, staff were swayed by Pathology Finder’s cost-effectiveness – it is almost 50% cheaper than two database-driven alternatives, and there were no hidden scanning costs. After they installed the system, however, other benefits became apparent. Steve Fell explained: “Because filing took a long time, we had a 14-day backlog when we implemented the system. This was cleared within a few days of installing Pathology Finder, just by scanning the forms.” The request forms are destroyed once they have been scanned, which frees considerable physical space. Steve Fell continued: “It’s much faster than filing because the request forms can be scanned at multiple locations.”
The department receives at least one call a day to ask whether or not specific tests have been requested. This used to occupy a member of staff for an hour, particularly if they had to search the backlog of unfiled paper forms. Now, using Pathology Finder, they can access the request form using any of the department’s PCs in less than 15 seconds. Furthermore, said Steve: “The system is fantastically simple to learn and use. It’s very intuitive. We can train someone to use it in five minutes. Scanning requires a couple of clicks, and we just have to type in the sample ID number to recall information. We can then print out, fax or email the request form.”
Innovative alternative
Information management remains a real challenge for software developers, but, by drawing parallels with the symbiotic relationship between crocodiles and plovers, and then relating these to the handling of specimen request forms, Folding Space has created an innovative alternative to traditional database-driven document management systems. Symbiotic software permits faster, simpler and more accurate data logging and retrieval. It is also much faster and easier to install, and is reported to be more costeffective than comparable systems.
For further information about Folding Space’s Pathology Finder software, contact Capula Healthcare on +44 (0)20 7819 044, email enquiries@capulahealthcare.com or visit Capula’s website (www.capulahealthcare.com).
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