Immucor's ECHO machine

[csongbird]

Hi everyone,

I'm doing research on Immucor's ECHO and wonder if anyone out there has, or knows anyone who has, experience with this new automation machine. I'm new to the industry, so any insight would be much appreciated.

Thank you!

[Franklyn]

Nobody really "has" the instrument as it is too new. But my facility did the clinical trials and we have two of them in the lab used by the Immucor reps for demos (we are a market site). Once the ink dries on the contracts we will have a Galileo and an Echo. If you have a specific question I may be able to answer it.

Franklyn

[John C. Staley]

Actually I have one and we are three weeks into the validation and should be reporting out patient results in the next 3 or 4 weeks. If you have any specific questions I would be happy to try to answer them as best I can.

[csongbird]

Hi Franklyn and John,

Thank you for your offer to help me research the ECHO. The main questions I have are:

- why did you choose to automate in the first place (Franklyn - I assume the ECHO is your backup?) (John - were you doing manual test tube or gel card or using another automation machine?)

- any problems with the ECHO installation, machine?

- is the ECHO performing as Immucor had promised?

- what kind of maintenance/service support does Immucor offer?

- any initial reactions to the ECHO machine in general?

Franklyn - since your site was used for the ECHO clinical trials, it would be great to hear how the machine performed.

Thank you in advance.

[John C. Staley]

We started automation in 1999 with the Immucor ABS2000. At the time it was the only fully automated, walk-away instrument for transfusion services. Our ABS2000 is getting old and ready to retire. I don't like gel (personal bias) so Ortho was not an option and the Tango, in my humble opinion, still has a ways to go.

The ECHO was an easy install, it has a realatively small foot print and does not weigh very much so it is much easier to find some place to put it.

So far my techs are very surprised and excited on how fast it is. Type and screens in 22 minutes and a 14 cell ID panel in 22 minutes.

The service/support is first, a call. Second, a direct computer connect from service. They call this BLUD direct. Third is a vist from the closest service person within 24 hours. This is not free but it is reasonable. We have not had to go to step 3 yet. All problems, mostly operator error, have been delt with either over the phone or the modem.

Immucor spent 4 days here training my 2 "super users" who are doing the bulk of the validation and all of the training for the rest of the staff.

So far we are very happy with it. It is a little more complicated to operate than the ABS2000 but by no means difficult. It just can do more and doing more is always more complicated to one degree or another.

[Franklyn]

We were originally a gel site using the Tecan and Reader SA - but we really wanted a higher level of walk away automation. Ortho offered the ProVue and after three separate evaluations of the instrument, we decided it was not for us. Then Immucor started talking about the Galileo and we flew to Atlanta to look at it prior to its FDA clearance. We became the first north american installation of the Galileo after it received FDA approval and published our validation data as an AABB abstract if you really want all the gory details. Our Galileo is pretty long in the tooth now and we are having mechanical failure issues with it on a more frequent basis, but service has been prompt.

The Echo is being marketed as a "mini-Galileo" but it is really a completely different breed of cat. It uses the Capture technology, but is manufactured by a completely different contractor and runs on a completely different and unique software application. The Echo has a convection style incubator that nearly halves the incubation time and we are really looking forward to the promised retro-fitting of the new incubator into the Galileo.

Serologically, the Echo and Galileo have the same strengths and weaknesses. The Echo is faster (at present) than the Galileo but doesn't have the same through-put. Our validation studies put Capture on a par with Peg (our back-up or alternate method) rather than gel.

While we plan to use the Echo, in part, as a back-up but we really plan on using it for alternate flow testing (single STAT samples or first level antibody panels). At present all of our patient testing is routed through the Galileo and when there is a problem with the instrument the impact to workflow can become a real issue.

Only time will tell if the Echo is more mechanically sound than the Galileo. According to our Immucor rep there are 17 Echos in place now with 70 on the books. A much larger install than the Galileo, so I am confident that information about dependability and performance are forthcoming. We have two of the first Echos in the lab at present, one will become ours when the contract is complete. Neither instrument has required repair in a year (since placement) but there isn't much being run through those machines either, so the data doesn't really have much value.

Installation is no big deal - it is a table top machine and has a waste container if you don't have ready access to a drain. Under the hood it is really pretty simple, which I hope translates into "dependable" - but again, time will tell.

Once the contract is done, we will have to "re-validate" the instrument as we cannot re-use the clinical trial data for that but based on the clinical trial data, we do not expect any surprises.

The biggest issue to me is the interface from the Echo to Misys/Sunquest. We will come up live with our Galileo interface this year and having the same functionality on the Echo would be a plus. But I don't really have any information on that because I haven't asked. Too many other irons in the fire at present.

[hmust1]

csongbird,

Hi. I'm really glad you posted this thread. I, too, am new and looking into automation. I've been comparing the Immucor ECHO and the Ortho ProVue for a few months now. Additionally, I just flew to Mr. Garland's hospital on Monday (care of my Immucor sales rep!) to see his ECHO.

I'm very impressed with the ECHO's turn-around-time. There is a third-party published report (from Nexus Global Solutions, Inc.) comparing ECHO and ProVue. The paper specifically addresses size, TAT, and process steps. We're using tube now, so the reason to automate is obvious. :-) For a small tranfusion service (100-bed hospital based), we transfuse almost 200 units of blood per month and have lots of antibody patients. We're a single hosptial...not part of a healthsystem. So, we like to stay competitive and keep as much in-house as possible. For this reason, I'm particulary interested in the automation turn around time. The Nexus report shows that the ECHO has a Ab ID TAT of nearly 1/2 that of the ProVue (1 hr 10min compared to 2 hr 21 mins, respectively.)

I need to look into this further, but...I think on my last CAP survey, it looked like Immucor's "capture" methodology scored better than Gel as far as sensitivity of Ab detection...something else to consider.

I'll be interested to see more discussion on the ECHO once it gets more into the market. Again, thank you. Good luck in your investigation!

Heather Mains, MT (ASCP)

Hanover Hospital

Hanover, PA

[csongbird]

You all are the best! Thank you so much for your feedback. As I poke around, I will be sure to post my research findings.

Quick q - has any ECHO user experienced any software issues? I know that the Galileo had some s/w probs which the company says they fixed. Not sure if the ECHO is having similar issues.

Also, Immucor says that in the US, they can install 20 ECHOs per month. Does this number seem high to you all, based on your sense of what the target market (i.e., small-mid sized hospitals) is like?

Thanks again for all your help.

[John C. Staley]

So far, 3 weeks into the validation, we've seen no software issues.

Installing 20 per month might be a little ambitious but they are only onsite for about 5 days so 20 /mon is 5 /week. That would require 5 installers that are working or traveling all the time. I'm fairly certain they have more than 5 installers so I would think 20/month is possible if a little optimistic. Now selling 20 per week is a whole other issue.

[csongbird]

Hi John,

Thanks for the detail. Sorry to be dense but are you saying it only takes a day to install one ECHO? And does someone from Immucor have to be onsite to install, or can you unpack the box and plug in the machine yourself? Any clarification would be helpful, thanks so much.

[John C. Staley]

I was on vacation happily romping in the fields of central Saskatchewan hunting birds when it arrived so I got the following after the fact from some one who was here.

If I remember correctly, the shipping company actually took it out of the crate, and placed it on the counter. This was on a Wednesday. On the following Monday two delightful gentlemen from Immucor showed up and began setting it up. On Tuesday at noon these same two gentlemen started training my 2 "super users". That training was completed on Thursday afternoon. Friday we started our validation.

We did not touch the instrument until after the folks from Immucor arrived and instructed us on the proper touching.

[jhaig]

I haven't actually considered the ECHO due to my patient load and transfusion volumes, but I may reconsider. We transfuse around 2000 units of packed cells a year and have had an increasing amount of complex antibody patients. As a smaller transfusion service, we send out complex antibody problems that we don't have time to deal with (warm auto's, more than 3 antibodies, etc.).

Does the ECHO gear itself to larger institutions or can it be justified in smaller hospitals as well?

[csongbird]

My understanding is that the ECHO is geared to small/mid sized facilities, meaning 50 to 400 beds or depending on the number of type/screens per day. But will someone please tell me how many t/s per day would justify the ECHO? I'm told the range is 5 to 20 t/s per day but that's a big range!

Also, for all the people using/considering an ECHO, do you know how much the machine costs if you buy outright, or how much per month if on a reagent rental?

Thanks again.

[huntilla]

We did not touch the instrument until after the folks from Immucor arrived and instructed us on the proper touching.

I have a few questions regarding your choice of the Echo and what your protocols for extended testing will be on antibody identifications, eluates, etc.

1. Was solid phase testing your original platform before conversion to the ABS instrument?

2.Do you plan to keep reagents for performance of tube testing for ER trauma or STAT surgical samples?

3. Also, for the performance of eluates, PEG testing in the tube, or enzyme treatment can these processes be incorporated onto the ECHO?

We are a 260 bed facility and transfuse about 3600 units a year of pRBC's and we currently use gel for antibody screens and antibody identification. We are looking to go automated within the next two years and look forward to your response.

Barr Antilla, MT(ASCP), Coordinator

Texoma Medical Center - UHS

[John C. Staley]

Huntilla, here is my attempt to answer your questions. We are very close in size to your facility. We have just over 300 beds (depends on who's counting and why) and last year we transfused just over 5000 RBCs. We ran about 6500 Type and Screens on the ABS2000 and expect to do more on the ECHO because it's faster and easier.

1. Was solid phase testing your original platform before conversion to the ABS instrument? No. PEG is our primary manual method. We have never done solid phase manual testing.

2.Do you plan to keep reagents for performance of tube testing for ER trauma or STAT surgical samples? We will maintain our ability to perform manual testing but the STATs from OR and ER are not the reason. The ECHO TAT for a type and screen on the analyzer is 22 minutes. That's fast enough for us. This is an instrument, it will have down time, we must have a backup method to do the testing. Until we get a second analyzer we will keep the manual testing available.

3. Also, for the performance of eluates, PEG testing in the tube, or enzyme treatment can these processes be incorporated onto the ECHO? Currently it appears that eluates or enzyme treatment are not available. I don't understand what you mean by the PEG testing in the tube since the instrument is designed for solid phase testing why would they put PEG on it?

[hunb]

The PEG was just an oversight ( I have never used or seen solid phase in a demo), so upon receipt and install of the second ECHO will you do away wih the tube testing reagents and methodologies since you will have an onsite backup?

Also, did you have to wait for budget approval in a fiscal year outside of the initial purchaseof the first ECHO or was it all bundled into one purchase for the same fiscal year?

We are looking at purchasing only one unit and keeping the tube testing as the fail-safe backup for our future methods.

[Franklyn]

We also use PEG as our alternate manual method for capture (ECHO and Galileo) and, while we do have a manual capture capacity, prefer that over reading the plates manually.

However, getting rid of PEG as an alternate is not really a good idea. Capture is very sensitive and you will get positive screens on patients for whom you do not identify an antibody. Repeating the screen in PEG after eliminating the presence clinically signification (and manually detectable) antibody and getting a negative result is the best way to resolve those patients that we have found. Oddly enough, a number of those mystery antibodies occur in patients with anti-cardiolipin (sp?) antibodies OR end up with an identifiable antibody later. We are looking at this for possible abstract fodder.

[nat martin]

We are scheduled for an install of the Echo is Jan, 2008. We currently have an ABS 2000 that seems to have ongoing issues. Are the strips used on the Echo the same as those used on the ABS 2000?

Thanks

Nat Martin

Jxn, MS

[John C. Staley]

Our second ECHO at the moment is only a possibility if the first one can't keep up. Since it's a new instrument that does more testing we are not sure how it will handle our total work load if we are having it do everything it can. The second one is just a back up plan if needed.

Currently I have no plans of ever completely doing away with manual testing. The paranoid hysteric, blood banker hidden deep within me is not quite ready for that leap.

The strips are complete different on the ECHO and can not be used interchangably with the ABS2000. Functionaly they are essentially the same, solid phase is solid phase but how they are identified by the instrument is very different.

[Mark S. Harvey]

Does anybody currently using Echo have a Cerner interface?

[nat martin]

We are set to install Echo in January, 2008. The last conversation we had with our Immucor Rep was that the Cener interface would not be ready at the time of install. We were told that "they" are working on it. Sorry...

[Mabel Adams]

A ballpark price I got for the Echo was ~$95,000.

[jcoburn]

I'm happy to see this thread evolve. We will be installing an Echo in February. I looked at the ProVue and manual gel as alternatives to our current tube testing, but manual gel still requires a great deal of hands-on time and the Provue is more expensive and slower than the Echo. Also Ortho wants twice as much for a service contract! According to my last e-mail from Immucor, the instrument will be installed on Monday, Training on Tuesday through Friday and then we're ready to start our validation. Hopefully, it won't take too much time since we are a commercial lab and do not do any transfusion medicine, only T/S, DAT, ABID. The reason I even looked at automation? there is such a paucity of scientists that our only alternative is to automate! I look forward to watching the progress of the other new ECHOites here and I will try to keep you apprised of our progress as well.

John, have you finished your validation? How'd it go?

[John C. Staley]

We finished our validation and started testing and reporting patients on December 14th. So far no significant issues. The techs are using it extensively and so far are pleased with the operation.

We have found a few issues that were more a reflection of our expectations than anything else. It is not a true random access analyzer like the chemistry analyzers are but it is certainly a big step up from the ABS2000.

Automation is an evolutionary process and this is just the second step. That's what I keep telling my self and it seems to make sense.

[huntilla]

We have found a few issues that were more a reflection of our expectations than anything else. It is not a true random access analyzer like the chemistry analyzers are but it is certainly a big step up from the ABS2000.

.

John, could you elaborate on how the sample throughput is affected by waiting to load any new patients,is it longer than you anticipated? And my other question is are you interfaced with your LIS for result transmission (which vendor are you using)?

Thanks,

Barr Antilla, Coordinator, MT(ASCP)

Texoma-UHS