CEO SUMMARY: Middleware is a growing component in the market for laboratory information services. Labs are asking vendors to provide targeted software solutions to address a growing list of needs and functions. To fill this demand, specialty software companies and IVD firms are introducing new middleware products. It remains unclear whether traditional LIS vendors will compete vigorously with their own middleware.
HOWEVER YOU DEFINE IT, middleware is the hot topic in laboratory informatics. That’s one reason why middleware rated a special session at the third annual LabinfoTech meeting, held March 1-3 in Las Vegas. In its simplest definition, middle- ware is software acting as an intermediary between systems software and an application. Clinical laboratories are using middleware to accomplish a wide range of functions.
In some cases, middleware is used to supplement a hospital lab’s LIS (laboratory information system) and provide the functions needed to support a laboratory testing outreach program. These range from courier/logistics and pre- analytical needs to post-analytical reporting, billing and collections. In other settings, labs are using middleware to support automation, direct specimens, manage operational services like QA/QC, and for autoverification.
Within the market for laboratory information services, there is a lack of clarity and consensus about how laboratories will use information technology in future years. Both informatics vendors and laboratory customers have differing views on this subject.
One reason for this confusion is the proliferation of companies selling middleware solutions to laboratories. In today’s marketplace, laboratories can buy middleware from IVD manufacturers, from specialized software development firms, as well as the nation’s largest healthcare IT corporations. In fact, this proliferation of middleware sources is a new phenomenon.
Speakers at LabinfoTech recognized this new development. “One way to view middleware is to classify it as a short-term path that plays a long-term role in a variety of laboratory functions,” stated Rob Bush, President of Orchard Software. “From this perspective, middleware has emerged in recent years as a way for laboratories to solve a problem for which there was no prior solution.
“Laboratories are using middle- ware to serve a specific need that isn’t being met,” he continued. “Most frequently, these solutions are tailored to specific instruments and specific LIS products being used by a laboratory.”
As a provider of LIS products, Orchard is being asked to write soft- ware to address specific tasks within the laboratory. Labs want LIS manufacturers to provide software that can solve these same issues.
Helping MT’s To Multi-Task
“Middleware is often needed because medical technologists are being asked to manage multiple processes during the same shift,” observed Ron Berman, Worldwide Director of Automation and Information Systems at Beckman Coulter Inc. during his presentation. “Med techs may be also managing multiple types of testing. Middleware is one solution to helping med techs meet these multi-tasking needs.”
Berman noted that Beckman Coulter offers middleware designed to help med techs in these types of situations. “Further, there is middleware available that labs can use to advance patient safety,” he said. “Increasingly, labs need to implement systems that capture and document receipt of all tests ordered by clinicians, as well as the timely delivery of lab test results to referring physicians. Middleware can meet these needs.”
Three Types Of Competitors
During a panel discussion that included Bush and Berman, LabinfoTech’s Founder and Director, Bruce A. Friedman, M.D. observed that “I expect to see three types of firms compete in the middleware marketplace: LIS vendors, IVD manufacturers, and middleware vendors.
“With new competitors entering the field, some type of shake-out is inevitable,” continued Friedman. “Also, the drive to develop an enterprise-wide EMR is likely to cause some traditional LIS functions, like lab test ordering and lab test resulting, to migrate from the LIS to the EMR.”
Jaques Baudin, General Manager of Technidata America Medical Software, told the LabinfoTech audience that labs are turning to middleware as a way to generate and update information in real time. “To better manage work processes, laboratories want a single-screen view that incorporates all the data necessary for the operator to make decisions. They want this data in real time and in only two mouse clicks.”
Baudin observed that, when laboratories test specimens in batches, the data needed to effective decision making often comes too early or too late. “This is why labs want middleware to produce information in real time,” he explained. “Rules-based middleware solutions, operating in real time, allow labs to make timely interventions while reducing the complexity of man- aging laboratory operations.”
New Product Category
Collectively, speakers at this year’s LabinfoTech recognized that middle- ware is already an established product category in the laboratory market- place. The debate and differences centered around how experts predict that middleware will evolve.
Laboratory administrators and pathologists should recognize another fact about middleware. Laboratories are driving this new product category. As laboratories look for ways to make labor more productive, to automate manual work processes, and to guide med techs in their decisions, they are turning to middleware solutions.
This year’s large crowd at LabinfoTech bears powerful witness to the growing importance of middleware. It should be no surprise that IVD manufacturers and specialty middleware vendors are stepping forward to meet this demand.