Monitoring instruments online has the potential to revolutionize laboratory operations.
The AbbottLink system connects Abbott instruments to Abbott internal systems via the Internet to improve system uptime. (Illustration by Abbott Laboratories and Comstock)
Thanks to the Internet, clinical laboratories now have the ability to continuously and directly connect analyzers to their manufacturers. This communications link is known variously as remote diagnostics, remote monitoring, or embedded instrument connectivity. It consists of a secure electronic connection that is compliant with the U.S. Health Insurance Portability and Accountability Act (HIPAA). These remote monitoring systems are built on proven technology that is flexible enough to meet the requirements of individual labs as well as of the larger IVD community.
Originally developed to troubleshoot malfunctioning instruments, remote monitoring is now demanded by customers not only to quickly repair laboratory systems but also to ensure that they do not stop working in the first place.1,2 Remote monitoring also offers the ability to automate a number of tasks, including inventory replenishment, peer review of quality control data, analyzer software upgrades, test counts for cost-per-reportable invoicing, and real-time troubleshooting alerts.
Laboratorians no longer have to be in a laboratory to monitor the health of an instrument, and manufacturers can increase instrument uptime by having real-time information available for servicing. Together, these capabilities improve laboratory efficiencies, which translates into cost and labor savings.
Remote Monitoring Using the Internet
Traditionally, remote monitoring was performed using dial-up modems. Now, the same tasks can be accomplished over the Internet.3
Table I. (click to enlarge) A comparison of traditional modem-based diagnostics and modern Internet-based diagnostics.
Connection choice is key. Internet-based diagnostics holds significant advantages over its modem-based counterpart. These benefits include higher data-transfer speeds, real-time monitoring and troubleshooting, the constant availability of data, improved HIPAA protection, and a reduction in needed customer assistance (see Table I). Internet connections use proven technologies such as hypertext transfer protocol (HTTP), secure sockets layer (SSL), and simple object access protocol (SOAP) to efficiently, reliably, and securely transmit data from remote sites.
Remote monitoring brings to the laboratory some of the same electronic conveniences available in everyday life. For example, consumers can access personal banking information and conduct banking transactions from the privacy and comfort of their home. Deposits and withdrawals can be reviewed, bills can be paid, and statements can be downloaded. Remote monitoring systems leverage these same technologies to provide a similar level of access for instrument data.
During the monitoring process, a laboratory's instruments continuously transmit operational data to Web-enabled applications. The Internet provides reliable transfer protocols that ensure that the information received by the manufacturer's software application is what was sent.
Encryption technologies protect the transferred information from unauthorized access. Finally, the transport protocols allow individual operational data (such as the status of key instrument parameters) to be collected, as well as the retrieval of large amounts of data contained within instrument logs. Remote monitoring enables manufacturers to efficiently and consistently access substantial amounts of data without bothering their customers.
An additional benefit of online remote monitoring is that most laboratory networks are already configured to process traffic directed to the Internet. The technologies used by remote monitoring systems are the same as those used by Web browsers. Thus, expensive infrastructure changes are not required in order to connect an instrument to these systems.
In remote monitoring systems, the collected information can reside in a secure data center. Consequently, access to data can be limited to authorized users. Patient and physician data transmitted from the laboratory can be cleaned of any protected information before they are sent. As a result, this information remains compliant with HIPAA.
Customers and the manufacturer's customer service department can access the captured data over the Internet, just as one might access online personal bank account information. Customers can produce reports on work flow and analyzer productivity, which can be used to objectively enhance laboratory operations. When troubleshooting instruments, service representatives can also generate reports. If additional information is required, instrument logs can be retrieved on demand and reviewed in real time. Before remote Internet monitoring, customers would have to retrieve the log from the instrument and then mail, e-mail, or narrate its contents to the service representative. Not only has technology improved the efficiency of the service call, but it has also reduced the burden on the customer.
High-Level IT Architecture
Various technologies already exist to support the development of Internet-based remote diagnostics. For example, the Java 2 Platform Enterprise Edition (J2EE) defines a standard for developing Web-based applications. The resulting system is portable, scalable, and integrates easily with existing applications.
Another example is .NET. Developed by Microsoft, .NET technology enables information, people, systems, and devices to be connected through software. It provides a platform for quickly building, deploying, managing, and using connected, security-enhanced solutions with Web services. Both of these standards can aid in the rapid development of agile systems that can provide information anywhere, at any time.
Figure 1. (click to enlarge) A depiction of a multitiered model based on the Java 2 Platform Enterprise Edition (J2EE) standard.
The design pattern described by these approaches supports multitiered systems (see Figure 1). Isolating the major components of the system into tiers minimizes component coupling and leads to a system that is more flexible.
Client Tier. In this model, the client tier consists of the components that interact with the system via the Internet. These clients include the users who launch Web browsers, as well as other applications that reside on a computer. Client components that have little or no relevance to the system are called thin clients. A Web browser, for example, is considered a thin client because the information processed by the browser actually resides in one of the other tiers. A Web browser presents information based on the instructions it receives. It has not been constructed with any specific knowledge about the system.
On the other hand, a thick client is a component that contains logic and processing specific to the system. For users, thin clients are preferred because they are more generic and often can be used with more than one system. It is precisely the generic capability of a Web browser, for instance, that makes it so useful.
Web Tier. The components in the client tier interact with components in the Web tier, which manages client interactions and the presentation of system information to users. The Web tier serves as the interface to the system components that reside at the business, or enterprise, which hosts the remainder of the system. At this level, specific instructions can be distributed to the thin-client Web browsers that allow user access to the requested information. In addition, data can be transferred to and from the thick clients for further processing by the thick client or the enterprise components.
Business Tier. The business tier comprises the components that process business rules. For example, when a Web browser is used to access checking account information, it is the business tier that ultimately handles the requests. The necessary logic to transfer funds between accounts and pay a bill resides in this tier. The business tier also handles interfacing to the remaining components of an abstract system, which are collected in the enterprise information system (EIS) tier.
Enterprise Information System Tier. Databases and legacy applications are just a few of the components considered part of the EIS tier. Necessary information is stored in a database so that it can be retrieved by multiple applications. In addition, many existing applications can be reused with the Web-based system. For example, a Web application may be designed to provide Web browser access to banking information, but an existing legacy system that processes written checks may be reused with new business tier components.
The multitiered architecture of a Web system provides a suitable model for Internet-based analyzer monitoring. The client tier consists of analyzers and the individuals who want to remotely monitor analyzer information. The Web tier provides the Internet interface so that the analyzer data can be easily collected. The business tier provides the necessary logic to automatically monitor the analyzer data, produce reports, and interact with existing systems. Finally, the EIS tier can be used to securely store analyzer data so that they are available to a wide range of applications and so that customer-support legacy systems can be integrated into the total solution.
A Multitiered Internet System
Figure 2. (click to enlarge) A view of the AbbottLink PC by Abbott Laboratories (Abbott Park, IL) and the entire AbbottLink multitiered system.
AbbottLink is a multitiered Web-based system developed by Abbott Laboratories (Abbott Park, IL) that provides remote monitoring of Abbott analyzers (see Figure 2). Within the client tier, the system uses a small personal computer—called an AbbottLink PC—to act as a gateway to instrument communication over the Internet. The AbbottLink PC does not require a monitor, keyboard, or mouse, the lack of which provides an additional level of security. Once installed, the PC collects information from the instruments and transmits it over the Internet to an Abbott enterprise system, which is composed of Web, business, and EIS tiers. The PC requires an Internet connection, which typically can be provided by the laboratory's local-area network. If not, a DSL or cable Internet connection will also suffice. The AbbottLink system makes use of software firewalls, hardware firewalls, and other security technologies and settings to protect against hostile threats.
The AbbottLink PC initiates all communication to the enterprise system and maintains a heartbeat by contacting the enterprise system at regular intervals. As part of this communication, the enterprise system replies to the AbbottLink PC with requests for information. The AbbottLink architecture makes use of Internet-accessible Web-tier components, but does not require the AbbottLink PC to be accessible over the Internet. Because the PC does not need to be addressed from behind a facility's firewall, the host facility's network remains private. This communication approach is referred to as “firewall friendly” because it limits necessary firewall changes and maintains the security of the host facility's network.
Security is a major consideration of the system. Each message transmitted by the AbbottLink PC is encrypted using block-cipher technology. Likewise, the responses sent by the enterprise application are also encrypted. In addition, authentication technologies are used to confirm the identity of the PC messages.
As illustrated in Figure 2, authorized users access the information collected by the system through the Web tier. By pointing a Web browser to the AbbottLink Web site, an authorized user can gain access to a particular instrument's information. When necessary, additional instrument information, such as a log file, can also be requested and retrieved.
The AbbottLink PC and analyzer connection are the parts of the AbbottLink system most visible to a laboratory, and arguably the most important to a host facility. Rather than connecting to the Internet directly, the instruments communicate with the PC, which multiplexes the heterogeneous instrument communication that is transferred to and from the Internet. The PC sends analyzer-generated messages to the enterprise system and retrieves user-requested information from the analyzer; then, it forwards this information to the enterprise system. All communication occurs via a proprietary protocol. AbbottLink does not interfere with the performance of the analyzer; communication with the PC is considered secondary to the testing performed on the analyzer.
AbbottLink leverages common technologies for instrument communication. For some instruments, RS-232 connections are established, while for others, transmission control protocol/Internet protocol (TCP/IP) socket connections are used. When multiple instruments are connected to the same PC using RS-232, serial– to–universal serial bus (USB) devices are used to increase the number of PC RS-232 communication ports available. If RS-232–based instruments are geographically separated from the AbbottLink PC, then terminal servers are used to provide a TCP/IP connection for the RS-232 message traffic.
Any combination of the following analyzers can be connected to
AbbottLink, although the services available vary by instrument type:
Each AbbottLink PC can support a maximum of eight instruments. For instruments that cannot support the proprietary protocol, AbbottLink passively listens to instrument–to– laboratory host traffic used within the laboratory information system (LIS). This activity does not interrupt the normal LIS traffic flow between the analyzer and the host.
Remote Monitoring System Capabilities
Remote monitoring system features vary among manufacturers depending upon the requirements of their analyzers and customers. Described below are just a few of the capabilities that can be provided by an Internet-based remote monitoring system.
Proactive Operation Monitoring and Troubleshooting. By continuously monitoring analyzer function, a service representative can notify a lab before a critical error code is displayed. Proactive instrument operation monitoring (POM) is a service paradigm shift for instrument performance management. It can increase instrument uptime and extend instrument life through real-time monitoring and analysis of operations. It can also use stored data to improve service through more-accurate instrument and component failure modeling. The system can then generate automatic notifications when unfavorable conditions are detected and make available the necessary parts and support. The net result is a reduction in instrument service and mean-time-to-repair expense. In addition, POM can improve customer perception of the manufacturer's customer service center, as well as create metrics to support business decisions.
Predictive Instrument Maintenance. Preventive analyzer maintenance is similar to preventive maintenance for automobiles. A car manufacturer specifies maintenance activities after a certain number of miles or a certain period. For an analyzer, preventive maintenance activities can be specified after a number of tests have been performed or after the system has been operating for a given length of time.
Predictive instrument maintenance (PIM) represents another service paradigm shift for analyzer management. It helps increase instrument reliability through routine maintenance and uses information to generate automatic notifications when service is required. Longer intervals between planned maintenance visits and a reduction in unplanned service calls decreases instrument maintenance expenses. As a result, PIM offers many of the same direct benefits as POM.
Automated Services. Automated cost-per-reportable billing can be supported by a remote monitoring system. Information on reagent usage can be collected automatically from the instrument and used for billing purposes. The need to fax or call in reported test counts on a monthly basis is eliminated, and because the test counts are collected automatically, customers and manufacturers can be assured that the data are accurate.
The automatic inventory monitoring of reagents and the ability to order new reagents is an automated business application improved by an always-connected analyzer. Exact reagent usage can be tracked, and this information can be correlated with enterprise systems that manage customer inventory. When shipped inventory falls below predetermined levels, automatic shipments can be made before the reagent is depleted.
Remote monitoring can also be used to perform analyzer software updates. Customers can be notified when new updates are available and ready to install. This eliminates the need for a service technician to visit the site and perform the installation, and results in significant cost savings for the manufacturer. For the customer, instrument uptime is improved because the update can be performed in a timely manner, and at the discretion of the laboratory.
There are many other automated services enabled by Internet-based analyzer connectivity. These include peer quality control reviews, instrument maintenance tracking, laboratory work flow analysis, and live instrument training.4 The always-on connection to the analyzer is what makes these services possible.
The Future of Remote Monitoring
The reader is cautioned that the capabilities described here may not be available from all instrument manufacturers and may not apply to all systems produced by a manufacturer. However, remote monitoring is rapidly developing and offers intelligent troubleshooting as well as active and predictive instrument service management. Troubleshooting and problem resolution become more efficient and accurate because service representatives can view instrument history, logs, and real-time data on demand, which lowers the cost and frequency of on-site service visits. In addition, this can be done without customer interaction, reducing the burden on the lab. Other services beneficial to the customer are also available, such as automated reagent replenishment, improved cost-per-reportable accuracy, and work flow productivity reports.
Considering the many advantages offered by remote monitoring of analytical systems, there is no reason to doubt that manufacturers will routinely offer it in the future, and that laboratories will welcome, if not demand, it. As an example of the popularity of such systems, AbbottLink, which was released in 2004, has been installed worldwide, in Europe, Latin America, Asia-Pacific, and the United States. Currently there are more than 1000 instruments connected to AbbottLink, and the connections are growing daily.
The true benefit of remote monitoring through the Internet is that manufacturers have an avenue through which to stay connected with their worldwide customers in a real-time, transparent manner. By establishing an always-on connection to a customer, a manufacturer is able to provide higher levels of service to the laboratory. Although the manufacturer benefits from the connection, it is the customer who ultimately benefits the most—through increased instrument uptime, improved laboratory efficiency, and decreased operating costs. And, in the end, patient care is improved.
Edwin Heierman, PhD, is AbbottLink lead scientist at Abbott Laboratories (Dallas). He can be reached at ed.heierman
Deborah Anderson is director of service marketing at Abbott Laboratories (Abbott Park, IL). She can be reached at deborah.anderson
Dave Armbruster, PhD, is scientific affairs manager at Abbott Laboratories (Abbott Park, IL). He can be reached at david.armbruster
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3. F Davis, J Palander, and J Bussell, “Automated laboratory analyzers analyzed,” IVD Technology 8, no. 6 (2002): 37–47.
4. H Morihara et al., “Introduction of the XD-2100 online QC system,” Sysmex Journal International 10 (2000): 13–17.