24/7 Monitoring and Tracking
MileWATCH is a 24/7 monitoring system that allows to connect, monitor and control Milestone units continuously through day and night. Status information is collected from units installed in both the Surgical Theatre and Pathology Laboratory. In this way, MileWATCH offers the possibility to create a unique samples’ “chain of custody”, starting from the collection in the Surgical Theatre and until the tissues arrive to the Pathology Laboratory. MileWATCH is Milestone’s solution to increase biospecimens’ traceability and to document the different processes of the laboratory.Read More
MileWATCH is a 24/7 unit surveillance appliance that continuously monitors and controls Milestone units throughout day and night. Status information is collected from units installed both in the Operating Theaters and Pathology Laboratories. This, in turn, also helps having better planning of Laboratory daily work. Compatible with existing Laboratory PC and Server, MileWATCH works without the need of an internet connection: all the related information is securely stored within the local LAN. The Milestone MileWATCH consist of three software packages: Server, Viewer and Batch.
The Server software collects the data from the Milestone units within the MileWATCH database and is desired pushes it to the LIS (Laboratory Information System). It also can be configured to end notifications to the appropriate users including management via e-mail, text message and phone call.
The Viewer software allows management to monitor each unit connected to the server and allows for viewing and downloading save processes and events log. This eliminates the need for download information from the Milestone units to a USB stick and uploading to a PC.
The Batch software allows the grossing technician to scan each cassette into a rack cluster, assign clusters to a rack batch and track each cassette per rack batch within the tissue processing phase. Clusters can be created at each grossing station then combined into a rack batch for tissue processing. When creating a cluster each barcoded cassette is scanned into the MileWATCH Batching software. When creating a rack batch only one cassette from each cluster is scanned into the Batching software prior to loading onto the Milestone unit for tissue processing. The Batching software allows for a rack batch to be created and the tissue processing completed on processors not purchased from Milestone decreasing bottlenecks associated with tissue processing. At the completion of tissue processing the MileWATCH software will send a notification via text, email or phone call letting the manager know that the tissue processing is complete.
MileWATCH offers the possibility to create a unique samples’ Chain of Custody, from the Operating Theater, preserving evidence of the case ID, formalin ratio used, temperature and time of the transportation, until tissues have arrived to the Pathology Lab. Tissue processing protocol details and final storage information info will also be collected by the MileWATCH and sent to the local LIS (Laboratory Information System).
MileWATCH software provides extended instrument control from outside the laboratory with live view of unit screens. This allows remote monitoring of every process including tissue processing during night and day. An instant audio-visual alert provides assistance 24 hours a day, 7 days a week. Moreover, all units connected to the server for a prompt transfer of process documentation. All documentation is related to the hospital Patient-Case ID.
MileWATCH can be set to send live e-mail notifications to interested parties including management providing all necessary information for a prompt action to assure trouble-free operations. Recipients can be customized based on notification type. At the end of a program, such as tissue processing, an e-mail notification is automatically sent to management and other assigned personnel of major occurrences (events log and log file) to service personnel and protocol status.
Accurate and precise process documentation can be automatically collected and directly transferred by interfacing MileWATCH to the LIS (Laboratory Information System) through local LAN connection. This information can be stored, retrieved and sorted by Case ID.
The incredible intuitive MileWATCH software further enhances the innovative features of the Milestone units and makes this tool the best choice to answer the need for documentation and tracking.
The MileWATCH database can be fully accessed from the LIS (Laboratory Information System), but MileWATCH doesn’t require any access to the LIS’s database. Avoiding access to the LIS database from external applications is very important for IT management and IT security.
Avoiding access to the LIS from MileWATCH means that: It is not possible for the MileWATCH software to modify the data in the LIS. It is not possible to acquire and sensitive information from the LIS. It is not possible to cause any unwanted action within the LIS database through the MileWATCH software. It is not possible to the MileWATCH to cause any malicious actions within the LIS.
This means the LIS has to query MileWATCH, MileWATCH doesn’t push anything to the LIS.
Please read the following portions from published an article that details the benefits of monitoring and tracking specimens in the Anatomical Pathology Laboratories.
Tracking begins with associating each asset to be tracked with a machine-readable identiﬁer. Trackable assets in the laboratory include requisitions, patient specimens, and their derivatives such as tissue blocks (cassettes) and glass slides. Machine-readable identiﬁers are typically bar codes. Bar codes allow rapid, accurate entry of an asset identiﬁer into a tracking system, recording the person doing the scanning, date/time, and potentially, the location at which the asset was scanned. When scanning is associated with a change in asset status (i.e. marking a block as embedded), the asset can be tracked through its production and use in the laboratory. There are several good reasons to implement tracking. Tracking data can be used to locate the history of any asset, making it possible to investigate any problems associated with its production or use. It can provide up-to the-minute information about the current status of an asset. Moreover, tracking assets in the laboratory can provide real-time detection of workﬂow bottlenecks. Another beneﬁt of tracking technology is its ability to help maximize workﬂow efﬁciency. For example, individual user productivity can be monitored, if needed, by determining how many assets that user processes and over what period of time. Laboratories are increasingly trying to improve their turnaround time while coping with increasing test volumes, fewer staff, and more complex cases and testing. The capabilities and complexity of the tracking software affect the results that can be obtained. Essentially, all tracking solutions provide auditing capabilities, posting events for each asset, generating audit trails, and allowing for subsequent workﬂow analysis. More sophisticated tracking solutions can control (constrain) and/or drive workﬂow. For example, workﬂow can be controlled by only allowing assets to progress to a new status from an appropriate old status, and in the correct context. Using bar code–driven protocols (i.e. the number of levels that need to be cut when a tissue block bar code gets scanned) can help drive and standardize workﬂow. In this regard, the status of an asset (and perhaps associated assets) can be used to determine the next process step for that asset, independent of asset history, generating dynamic to-do lists that move the work forward and identify real-time assets that are falling behind. However, there is a trade-off between higher levels of control and complexity: the more the tracking solutions seek to control the workﬂow, the greater the complexity needed to allow users to deal with the exceptions, which inevitably surface in the daily operations of a histology laboratory. One of the major advantages of a tracking system is its ability to help eliminate labeling errors and maintain optimal patient safety, thereby reducing medical-legal liability. Errors from misidentiﬁcation in the laboratory may result in an adverse event that causes serious patient harm (i.e. a sentinel event). Studies have shown that up to 0.7% of specimens have problems related to specimen identiﬁcation. Laboratory misidentiﬁcation errors may be due to pre analytic (i.e. mislabeled specimen), analytic (i.e. mixing up tissue blocks or slides), or post analytic (i.e. incorrect report sent) errors.15,16 A Q-Probes study in 2011 involving 136 institutions provided information on a total of 1811 mislabeling occurrences, showing that overall mislabeling rates were 1.1 per 1000 cases (1.0 specimen, 1.7 blocks, and 1.1 slides). The work locations at which these errors occurred were as follows: 21% before accessioning, 12% at accessioning, 22% at block labeling, 10% during gross pathology, and 30% at tissue cutting. These error rates are not that surprising given the fact that mislabeling is known to be associated with manually labeling items, hand matching items, and batching of tasks. To overcome these problems, laboratories formerly incorporated additional time-consuming steps to ensure proper asset identiﬁcation, such as the use of multiple identiﬁers and/or the introduction of many cumbersome checkpoints into their workﬂow. However, these extra steps unfortunately often remain error prone and ‘‘work-arounds’’ may result when problems remain unﬁxed. Implementing a tracking solution to support work process standardization in the AP laboratory has been shown to resolve such issues. For example, at Henry Ford Hospital in Detroit, Michigan, pathologists reported a 62% decrease of overall misidentiﬁcation case rate, 92% decrease in slide misidentiﬁcation defects, and 125% increased technical throughput at their microtomy workstations after bar codes were introduced. Similar successes attributed to implementing bar codes in the AP laboratory have been reported at other institutions including the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania,20 and Yale University School of Medicine in New Haven, Connecticut Other potential reasons for a laboratory to implement a tracking system may include improved logistics (i.e. better management of inventory, such as reagents) or to ensure chain of custody (i.e. for forensic laboratories). Scanning assets is not only easier and more accurate than manual key entry, but by automatically capturing data with a time stamp directly into the LIS, these metrics can be analyzed as part of an overall quality management program.
Deployment of a tracking solution is becoming common practice in AP and research laboratories. These informatics tools enable automation, improve efﬁciency, facilitate traceability, standardize workﬂow, and enhance patient safety. For pathology laboratories even one sentinel event, in which a labeling error could translate into a false-positive cancer diagnosis, is too high of a price to pay. In practical terms, some realized beneﬁts of an asset-tracking solution are that slides come out earlier, there is near complete elimination of logs in histology, paper-based work can be eliminated, there is a marked reduction in labeling errors, there are fewer ‘‘arguments’’ between gross room staff and histology staff, and histology staff feel more ‘‘hi-tech.’’ There are also direct (i.e. reduction in overtime hours) and indirect cost savings (i.e. staff spend less time looking for missing assets and managing paperwork). It is important to remember that tracking systems track the bar codes, not the specimens themselves. It is crucial that appropriate procedures and processes be in place to assure that the correct bar codes are used and remain associated with the asset they are to represent. No bar code or tracking system can prevent specimen laterality or specimen content identiﬁcation errors. A label with a bar code could still be afﬁxed to the wrong requisition form or incorrect container. Also, bar code identiﬁcation methods are not fail-safe. Investigators have shown that identiﬁcation errors previously occurred owing to bar code imperfections, failure to control for bar code scanner resolution requirements, and less than optimal printed bar code orientation. Implementation of specimen tracking can be logically divided into 3 technical domains: methodology, technology, and most importantly, but often overlooked, the culture of the laboratory. People and not technology or devices are usually the driving force behind quality. A variety of tracking solutions may be available—they are not all created equal. Laboratories should go with a tracking solution that does not lock them in; for example, their bar codes should work with future devices they may want to acquire. Implementation is not as simple as purchasing hardware and/or software and installing it. Associated costs and hidden practices need to be considered. Also, preparation by analyzing and standardizing workﬂow is crucial. Variability in workﬂow breaks the association between status and location, defeating the tracking system. Therefore, careful examination of the workﬂow with elimination of inappropriate variability can signiﬁcantly improve the success of a tracking solution. While 90% control can be achieved relatively easily, 100% control is far more difﬁcult to accomplish. One of the major setbacks at present is that a universal bar code to support interoperability in the laboratory is not available on the market. Further advances in this ﬁeld are anticipated, with better collaboration among vendors and tracking solutions to begin at the time of specimen procurement. Finally, additional literature is needed to hear from diverse laboratories about their tracking implementations, beneﬁts, and setbacks. (1)
Tracking in Anatomic Pathology Liron Pantanowitz, MD; Alexander C. Mackinnon Jr, MD, PhD; John H. Sinard, MD, PhD Arch Pathol Lab Med—Vol 137, December 2013
One of the common limitations of today’s tracking systems is that the Laboratory Manager cannot check the specimens’ situation in the Operating Rooms in real time. MileWATCH addresses this specific challenge: through the software, the Lab Manager can exactly check and track the specimens, right from the moment they are collected from the patients. The Case ID and all necessary information such as formalin ratio used, temperature and time of the transportation are saved.
In the Histology Departments, MileWATCH also identifies the critical steps, such as data from the tissue processors. In this way the Lab Manager will be able to track which operator has performed a particular process, and which specimen has been processed in a specific moment. Through MileWATCH, tissue processing protocol details and all data information are also collected and they are instantly available for the integration with the local LIS.