Delphic LIS Multilab Case Study

Shared Health, Manitoba

www.sysmex.co.nz

Case StudyContents

Executive Summary

Executive Summary

3

Manitoba Snapshot

4

Shared Health’s Multilab Solution

4

Timeline

4

The Challenges

6

The Approach

6

The Outcome

8

Solution Overview

10

Technical Overview

10Partnership

11

Established in 2002, Shared Health (formerly
Diagnostic Services Manitoba) provides publicdiagnostic health services for the Canadian provinceof Manitoba, offering a province-wide integrated andstandardised laboratory and rural diagnostic imaging
service. The services on offer encompass the full
spectrum of the healthcare system and while coveredby only 3.5% of the provincial healthcare budget, thelaboratory and imaging results can impact over 80% of
clinical decisions1.

“We knew that the Delphic LIS
was a highly scalable system,
making it the ideal solution fora province-wide LIS.”Mark Curtis - Director IT Services, Shared HealthWith a vision to continually improve the quality,
timeliness and sustainability of the diagnostic anddigital imaging services provided to Manitobans,
Shared Health is constantly seeking more effective
processes by:• integrating with the upstream and downstream
providers of patient care• standardising solutions across the province• improving the flow of images and results• delivering solutions and services efficiently2
Recognising the importance of a common technology
and testing platforms to achieve this vision, Shared
Health collaborated with Sysmex on a cornerstone
project for the organisation - the implementation of aprovince-wide laboratory information system (PLIS).
In 2018, Shared Health completed the project withall 78 labs in the province now linked to the Delphic
LIS multilab network and has realised both clinicaland operational benefits that support its vision of
improving services to the population of Manitoba.
The successful provincial LIS model is unique to
Canada and the project was closely monitored byother provinces with a view to implementing their own
provincial or regional diagnostic services1.

2 | Shared Health, Manitoba

Shared Health, Manitoba | 3

Case Study

Manitoba Snapshot

Shared Health’s Delphic Multilab Solution
649,950 square kilometres

12 urban laboratories

1.35 million people
66 rural laboratories

5 regional health authorities
Winnipeg
Interlake-Eastern
Prairie Mountain HealthNorthern HealthSouthern Health-Santé Sud

1700 staff

MANITOBA*

464 concurrent users
200+ interfaced analysers
58 HL7 ADT interfaces

Winnipeg
23%

15%

Population Age Groups3
0 - 17

62%

Population Location428%

18 - 64

72%

65 +66 HL7 results reporting

Rural
Urban

*includes imaging staff

Timeline
Pre-2013

2014

2015

2016

2017

2018

St. Boniface General Hospital
Misericordia Health Centre
Concordia HospitalGrace General Hospital
Seven Oaks General Hospital
Victoria General Hospital
Health Sciences Centre
Beausejour Hospital District No. 29
Riverview Hospital
Mount Carmel Clinic
Bethesda Hospital (Steinbach)Portage District General Hospital
Selkirk & General Hospital

Boundary Trails Health Centre
Dauphin Regional Health Centre
Flin Flon Hospital
Neepawa Health Centre
Roblin District Health Centre
Russell Hospital District No. 4
Ste. Rose General Hospital
Swan River Valley Hospital
The Pas Health Complex
Thompson General Hospital
Tri-Lake Health District
Virden Health Centre

Altona Community Memorial Health Centre
Arborg & District Health Centre
Carman Memorial Hospital
Churchill Health Centre
DeSalaberry District Health Centre
Gimli Community Health Centre
Hunter Memorial Health Centre
Morris General Hospital
Pinawa Hospital
Pine Falls Health Complex
Souris Health District
Ste. Anne Hospital
Stonewall & District Health Centre

Westman Regional Laboratory
Lakeshore General Hospital
E.M. Crowe Memorial Hospital
Grandview District Health Centre
Minnedosa Health District
Hamiota District Health Centre
Carbery Plains District Health Centre
Glenboro Health District
Tiger Hills Health Centre
Melita Health Centre
Deloraine Health Centre
Boissevain Health Centre District

Whitemouth District Health Centre
Lac du Bonnet
Lynn Lake District Hospital
Gillam Hospital
Snow Lake Medical Nursing Unit
Gladstone Health Centre
St. Claude Health District
Notre Dame Medical Nursing Unit
Lorne Memorial Hospital
Pembina-Manitou Health District
Rock Lake Health District
Emerson Hospital
Vita Hospital
Winnipegosis Lab & District Health Centre
Deer Lodge Centre
McCreary Alonsa Health Centre
Rossburn District Health Centre
Erickson Health Centre
Birtle Health Services Centre
Wawanesa & District Memorial Health Centre

Kin Place Primary Health Complex
MacGregor & District Health Centre
Grand Rapids Nursing Station
Gilbert Plains Health Centre
Shoal Lake-Strathclair Health Centre
Riverdale Health Centre
Reston District Health Centre
Baldur Health District

4 | Shared Health, Manitoba

Shared Health, Manitoba | 5

Case Study

The Challenges
Shared Health’s diagnostic services operate 78
laboratories across the province of Manitoba, following
a hub and spoke model, with larger urban laboratories
conducting more specialised analysis on behalf of smaller
rural laboratories. Differing test menus and complexity
between the levels require specimens to move betweensites, depending on the tests ordered. Results must bereported back to healthcare providers and patients in atimely manner, regardless of their location.
Services provided by Shared Health need to cover
649,950 square kilometres and an uneven population
distribution. “If you look at the map, we have pretty
remote and isolated sites - sites which you can only
fly into,” says Shared Health CEO, Jim Slater. “If you
look at our farthest northern site on the map, which is
Churchill, it is only accessible by air travel and by ship
for part of the year. So, it’s a very big challenge1.”
Prior to the roll-out of the province-wide LIS, several
different information systems were in use in Shared
Health’s laboratories across the province. Sysmex’s
Delphic LIS was used at laboratories in the Winnipeg
Regional Health Authority area; a separate LIS operated
at Westman Regional Laboratory in Brandon; smallscale analyser-based systems were in use at the rural
hub labs; while the remaining 50 rural labs relied on
manual, paper-based systems.
Shared Health Project Manager, Catherine Moylan,
explains that the use of different systems across theprovince led to a number of difficulties which madethe situation unsustainable. “The disparity between
systems meant that gathering different types of datafrom different locations was not efficient. Referring
tests and tracking specimens between laboratories wasa heavily manual process.”
Other difficulties were caused by a lack ofstandardisation; with labs across the province following
different processes, it was hard to standardise quality
or track quality problems.
In addition, the electronic delivery of rural lab results
to clinical data repositories or other information
systems was not possible. Without comprehensive
laboratory data, the province’s electronic healthrecord, eChart Manitoba, fell short of providing avaluable clinical tool. Provincial data mining for healthresearch was not possible.

6 | Shared Health, Manitoba

During planning for the provincial LIS, Shared Healthfaced a further challenge when it was announced that
15 lab sites were having their lab information systems‘sunset’ and would no longer be vendor-supported so it
was a matter of priority for these sites to be migrated
to a new system.

The Approach
A city-wide LIS ‘multilab’ network had already been
established across Shared Health laboratories in
Winnipeg using the Delphic LIS, developed andsupported by Sysmex, prior to 2009. This meant that
Shared Health already had an establised and trusted
relationship with Sysmex and was familiar with Delphic’s
ability to provide a shared service across multiple
laboratory sites using one central server.
“We knew that the Delphic LIS was a highly scalable
system, making it the ideal solution for a provincewide LIS”,” says Mark Curtis, Shared Health Directorof IT Services. Shared Health’ planned to connect theprovince’s remaining laboratories onto the existing
Delphic LIS multilab, so that all 78 laboratories would be
operating a single, shared system.
Shared Health worked closely with Sysmex during theplanning phase for the provincial roll-out, which included
a pilot project at a rural lab in Beausejour, Manitoba in
2009. This assisted in identifying how rural labs operated
compared to those in the city; information Sysmex used
to make enhancements to the Delphic LIS specificallyfor the Shared Health project. In particular, Sysmex
developed a Test Referrals module to manage thetransfer and tracking of specimens between laboratories
for referred analysis.
Mr Curtis says that having worked together successfully
with Sysmex on several large and complex projects
previously, Shared Health were confident in Sysmex’s
ability to deliver a project of this scale. “We’ve had sucha great relationship with Sysmex over the years. They
utilise strong project management practices and ourSysmex project manager is very adept at covering all
angles during the planning phases. They’ve been very
supportive knowing that from the onset of this project itwould be a marathon, not a sprint.”“Sysmex support staff have an
impressive level of knowledgeof the Delphic product suiteand understand the laboratory
business and the workflowsthat align with their products.”
Mark Curtis - Director IT Services, Shared Health
Shared Health also undertook planning to upgrade
servers and associated infrastructure to ensure capacity
for the new labs coming online, as well as the increased
volume of data which would be generated. To accomplish
this, Shared Health and Sysmex worked closely withManitoba eHealth, who are the technical service
providers for the Delphic LIS, providing support for thedata centre, network, integration engine and service
desk functions.
The roll-out of the provincial LIS got underway in 2012
and was completed in 2018. Implementation teams
travelled to Shared Health lab sites across the province
to transition them to Delphic and to train staff on the
new system. Initially, each implementation at a new lab
involved Sysmex staff travelling to the site to carry out
the installation and staff training. Engagement within theorganisation and scheduling deliberate breaks betweensite implementations to get feedback on what could
be changed and improved greatly aided the change
management and product innovation. As the roll-out
progressed, Shared Health staff gained the expertise to
manage the implementations themselves, with Sysmex
providing remote support from New Zealand.
Mr Curtis says that the time difference between
Manitoba and New Zealand as never an impediment, andSysmex as been able to provide swift resolution to any
issues during configuration and testing. “Sysmex support
staff have an impressive level of knowledge of theDelphic product suite and understand the laboratory
business and the workflows that align with theirproducts. We have become accustomed to the 17 hour
time difference, and now leverage the situation toprovide information on issues and projects to Sysmex
staff before the end of our workday, knowing they willcontinue to work on these topics through our evening.”

Shared Health, Manitoba | 7

Case Study

The Outcome
Shared Health has made a considerable investment in the province-wide laboratory information system which has
seen enormous benefits1.

Operational Data

Specimen Workflow“Fifteen years ago, we used to have limited data thatwas very fragmented and we couldn’t use it aseffectively for decision making. We can now look at
costing data, utilisation data, stocking data in an
integrated way that allows us to make rational
decisions, particularly when we’re talking toshareholders,” says Dr Amin Kabani, Shared Health
Chief Medical Officer. “All our provincial sites are linked
up to our information. It doesn’t matter which site
you’re talking to, you’re working from the same system.
This allows us to actually be cost-effective andeconomic, but more importantly in our minds, it helps
us make good decisions1.”

The implementation of the Delphic LIS has enabled
specimens to be registered at source, and tracked
as they arrive at other labs, using the Test Referrals
module. The enhanced specimen tracking has eliminateda significant amount of manual logging and provides
additional confidence in accounting for each specimen.

Standardisation
Mr Curtis says that one of the biggest impacts has been
the increased level of process standardisation to thelabs running the Delphic LIS and the ability for theselabs to fully adopt Shared Health’s standard operatingprocedures, helping to ensure compliance withaccreditation processes. “Smaller sites can now takeadvantage of functionality that was previously only
available in larger centres, such as auto-verification,
serum indices review and electronic result reporting.”

Population Health
Shared Health can also share an anonymised version of
the information it holds with the Manitoba Centre for
Health Policy, where it is linked with data from otherpopulation databases and used for population-based
health research. Catherine Moylan says that key to thesuccess of the roll-out has been keeping a focus on
the purpose of the project.

“It’s all about patient care andmaking sure we do things
properly and safely; always.”
Mark Curtis - Director IT Services, Shared HealthElectronic Results Reporting
The establishment of a provincial LIS also means that
Shared Health has been able to significantly increase
the volume of test results that electronically populate
the provincial lab result repository, which is accessedby clinical providers across the province. The amountof manual logging and transcription has decreased
significantly, reducing the risk of error inherent inthose processes.
Lab results can now be delivered to the province’s
eChart Manitoba, helping to create a more usefulpatient record, as well as to cancer registries, theemergency department information system (EDIS), andthe physician office electronic medical records (EMR),
providing valuable information for medical staff acrossthe province.

Provincial LIS(Delphic Multilab)

eChartManitoba

CancerCare
Manitoba

Hospital &Emergency
Department
Information
System (EDIS)

Manitoba
Centre for
Health Policy

eHealth-hub(EMRs)

Fig 1: Enabling the electronic delivery of lab results to external systems.

8 | Shared Health, Manitoba

Shared Health, Manitoba | 9

Case Study

Solution Overview
Delphic Provincial LIS

Improved Processes

Benefits

Multilab

Delphic multilab enables multiple
laboratories to run off a single instance of
the LIS.

• Ensures redundancy in the system by providing
back-up in the event of instrument failure or staff
shortages• Ability to re-route specimens to another site fortesting without the need for re-registration

Standardisation of test codes andprocesses across all lab sites.

• Improved quality control• Enables accreditation compliance

Reporting database

Management reporting functionality.

• Ability to monitor turnaround times, identify
bottlenecks and manage staffing levels

Test Referral module

Manages the referral of specimens andtests between sending and receiving
laboratories, e.g. rural to regional hub.

• Removes the need to re-register specimens• Reduces manual data entry• Immediate electronic reporting by originating lab
on completion of analysis at referral lab

End-to-end tracking of lab specimens.

• Improved specimen identification• Fewer lost specimens• Easier follow-up on delays

Electronic upload of test requests toanalyser and download of results to LIS.

• Reduces manual data entry and transcription errors

Directs testing to the appropriate
instrument depending on workload.

• Reduces processing time

ADT interfaces toDelphic LIS

Directly updates the LIS, automating
patient demographic entry.

• One time data entry ensures accuracy of patient
information at the outset• Improved specimen identification

Fax server

Centralised management for automatedfax delivery of reports from the LIS.

• Ensures accurate delivery of faxed laboratory
results to providers

Electronic reports

Management and monitoring of HL7
reporting from the LIS.

• Enables fast, accurate results distribution toexternal information systems

HL7 order receipt

Electronic lab test order requests arereceived directly into the Delphic LIS from
hospital patient administration systems.*• Improves accuracy of orders received• Reduces manual data entry• Reduces processing time

Decryptic analyser
interfaces* In use for inpatient biochemistry and haematology requests at Westman Laboratory in Brandon.

Technical Overview
Hardware

IBM x3650 M4 8C, dual-2.6GHz CPU, 384 GB RAM, SAN connected

Operating System

Red Hat Enterprise Linux V5.7

Database Software

Oracle 11gR2 X86_64 RDBMS for Linux

Application Server

Micro Focus Application Server V4

Environment

Data centre hosted by Manitoba eHealth for production environment
Separate hosted data centre for test environment
VMWare Sphere V5

PC ClientIntel Pentium 4 3GHz 1 GB RAM
Microsoft Windows XP (32 bit) SP2, Windows 7 (32 or 64 bit)Internet Explorer 7/8/9 .NET framwork V4

10 | Shared Health, Manitoba“One of the biggest impacts
has been the increased level ofprocess standardisation to thelabs running the Delphic LIS
and the ability for these labs
to fully adopt Shared Health’s
standard operating procedures,
helping to ensure compliancewith accreditation processes.”
Mark Curtis - Director IT Services, Shared HealthPartnership
Reflecting on the working relationship between Shared
Health and Sysmex, Mr Curtis said, “Sysmex has been
helpful to Shared Health in planning and executing
this large and complex project, utilising strong project
management practices, and involving appropriatetechnical, programming and application resources as
required.
Sysmex continues to be responsive to Shared Health’s
requirements, provide a great level of support, andare strategic partners with us as we plan futureenhancements to our LIS environment.”
Sysmex and Shared Health continue to innovate
together and actively work on new health IT projects
to enhance the laboratory services from a businessand healthcare perspective.

Shared Health, Manitoba | 11

Delphic LIS
Total Laboratory Information Systems
The Delphic LIS is the backbone for the medicallaboratory streamlining all processes with accuracy,efficiency and realiability.
Delphic optimises the workflow of the lab and is suitable
for single-site facilities through to multi-site regional
systems across integrated networks.
Delphic’s core system is complemented by a range of
specialised work area managers offering ‘Total Laboratory
Information Systems’ across all medical laboratory andpathology disciplines.

References
Staff Writer. “Diagnostic Services Manitoba: Providing the results that matter.” Healthcare Global, 8 Nov. 2017, https://www.healthcareglobal.com/company/diagnostic-services-manitoba-providingresults-matter# Accessed January 2019.
2
Charles Conway and Catherine Moylan, “Manitoba’s Provincial Lab Information System, The Clinical and Operational Benefits of Bringing a Province Together” (Powerpoint presentation), August 20153https://www.gov.mb.ca/health/quickstats/demographics.html (Accessed online January 2019)4https://www.statista.com/statistics/608702/population-distribution-of-manitoba-by-rural-urban-type/ (Accessed online January 2019)1

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