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Max001

An overall thought on Blood Bank computer systems

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One thing a surgeon will tell you is that the hallmark of a procedure which is not really ready for 'prime time' is the sheer number of ways to do the procedure.

IOW, if there are 10 ways to do heart surgery, it means that some of them are still searching for the right method and once the procedures mature, there are only one or two methods which are 'right'.

If you extend this analogy to BB Computer systems, it appears as though there are -too many- and that no one has 'hit' upon the right method or type.

The problem with 'Windows' based system is the way they do their menus. If you want to make a choice or two and each time you have to re-navigate the menu each time, you're spending a lot of time going back to the same place. One vendor even tried to get MS to use 'tear off' dropdown menus but they never received wide acceptance.

It appears to me that every system available must have some rather substantial flaws or we'd have one or two emerge as 'the' systems to use and all others would drop off.

I wonder what the problem is? Am I correct, do all systems leave you wanting?

I only have experience with three of them, only two of which I can recall, that being Hemocare and Sunquest.

It's unfortunate, since the Bench tech is the one who suffers.

Maybe it's just that BB-ing and Transfusion Service lab work is too complex to be a good fit? (though this seems unlikely).

Is there a 'big list' of all the systems available?

Thanks!

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See CAP Today http://www.cap.org/apps/docs/cap_today/surveys/1007BBSvy.pdf

There will never be a "perfect" system. Seems every BB does things a little differently. See the list of enhancements requested for the system you are using. The more controls we want, the more complicated the programming, especially when added on to an older system. They fix something and break something else. Windows creates its own set of problems.

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See CAP Today http://www.cap.org/apps/docs/cap_today/surveys/1007BBSvy.pdf

There will never be a "perfect" system. Seems every BB does things a little differently. See the list of enhancements requested for the system you are using.

Thanks. Cool.

I think a near perfect system can exist, it would just have to be highly customizable. Too often we have to get in line to get enhancements made and they may take months, years or never get added. A system which has a customizable interface would be very nice, including one with a macro capability. (i.e able to record your actions and play them back as clicks or keystrokes. So much of what we do is repetitive).

You are prob. right, there's no one-size-fits-all right now, even if we just consider BB systems of different sizes. A small hospital may reject a robust system because it is too complex and has too many features.

Still I think there is hope, although (dare I say it) it might not be programmed before Blood Banking is superseded by a blood substitute which perfectly mimics real human blood, or we go to all bloodless surgery (but we'd still have traumas right? :) )

Having said that, I was fearful back in the 90s when it looked like plasma expanders and perfluoros began development and again when automation started taking over, but it appears that BB-ing, may be too complex for artificials and automation.

Thanks for the input!

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Part of the problem is getting any major changes through the FDA 510k process. Also, the more customizable it is, the more complicated the programming. A validation nightmare.

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There seem to me to be several reasons why there are so many BB systems and none is technical reason. Speaking as a technical person, I don't see a technical reason why a single customizable app might not emerge.

I can't speak to how similar BB operations are but extreme similarity is not a necessary for a single customizable app to emerge. For example, SAP is deployed by vastly different companies -- organizations which are as much more different then BBs are from each other. Now of course, the deployment of SAP to an enterprise is serious, time consuming and expensive project but its doable.

If we look at the growth of SAP, the necessary component is not so much the similarity of operations but the need by customers to have both a custom app that suits there needs and one that cuts costs too. Since these two requirements are in conflict with each other, a compromise must be made with both.

Perhaps one reason is that a single app has not arisen is that BB's are sacrificing cost cutting for customizability, or the perceived need for customization? Even though BB's are non-profits, this does not necessarily mean that they put as much emphasis on IT cost cutting as, say, a for profit business.

The question is not, what is the right system for a BB but what is the best system at the price the BB wants to pay. To do this analysis the BB must understand the "total cost of ownership", not just the cost of the software and hardware, but the support costs, training costs, management costs, costs of bugs, costs of customization, costs of changing customization, etc. For ex, if a BB's extremely customized app needs 2 years to get a required change, say to move to ISBT, then that represents a huge cost, implementation, maintenance, validation, etc. Only when the total costs is taken into account can the management of a BB answer, is customization X worth Y dollars? And it might be or it might not.

Making this problem worse is that BB's are a niche market and that there aren't many providers of software. There is nowhere near the level of competition that exists or existed in other, larger markets. When there are fewer providers in a small market, there tends to be less competition for price. Providers may depend on propietary technology and customization to compete and seperate themselves from other players in the market.

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I agree with angonzalez the costs of a system are not the software only. Part of the BB'er's responsibility is to ask these tough questions befoe they buy. Vendor Qualification is an important Quality Assurance step in the selection process. If the system tha is the "winner' in your analysis, lacks features that are absolutely necessary, make sure you get that in the contract.

Happy Holidays everyone!

Edited by rnozick

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Guest jatin.chaudhari

Thanks man This is what I was looking for since past 2-3 days. Thanks a lot. Do you have a latest version of this feature comparison? If you have please send me the link.

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Guest jatin.chaudhari

Are these Blood Bank Softwares as mentioned in the link posted by tricore really worth thousands of dollars including their training and monthly maintenance costs. Adding all these fields the softwares are worth more than around 50,000$. Is it really worth to put in so much amount of money for the automation??? Please guide me...

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It is, for the following reasons, not necessarily in order of importance. I am sure others can think of more.

Patient safety.

Record keeping, no more paper files in drawers, on clip boards, or in notebooks.

Legible records.

Helps ensure that a patient receives his autologous units before allogeneic.

Keeps track of units with special antigen typings.

Can be set so a patient with an antibody cannot be crossmatched with a unit with the corresponding antibody or no antigen typing, even of the antibody screen is currently negative.

The computer can give QA warnings such as reaction pattern does not match interpretation, although if there are too many QA warnings they get ignored.

Will give a warning that a patient has special transfusion requirements, such as, needs irradiated products, needs CMV negative, needs washed products.

The computer can control the blood type of products given to a patient, i.e., won't let you give an O Pos whole blood to an AB or non type specific platelets.

Billing is automatic. No paper billing.

Electronic Crossmatch - when we went to EC we gave up an FTE - moved the position to the donor side.

The computer can print transfusion tags much neater and faster than hand writing them.

Much better than log books - you can see the entire patient history, find information. The tech doesn't have to look in a manual antibody file when a patient needs a transfusion.

If you are currently using individual cards for patient records, the computer can file alphabetically much better then a person.

The computer can give QA warnings, although if there are too many they get ignored.

The computer can control the blood type of products given to a patient, i.e., won't let you give an O Pos whole blood to an AB.

Much better inventory management. Much easier to do a lookback.

Easier to handle the long numbers of ISBT.

Reduce transcription errors by using bar code scanners for specimen entry, entry and processing of products.

If you have instruments they can be interfaced with the computer reducing transcription errors.

Reports - workload, transfusion committee, management.

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A BB utopia will be a BBer writing the BB software. S/he will know exactly what we want, and what could be sacrificed to improve the more important feature.

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You should also remember that the system has to be supported from a software and hardware perspective. This is typically done by vendor staff, which need to be paid, as well. There are always bugs and other support issues that add to the cost of supporting the system, which, in a hospital environment, usually requires 24x7 support access. Most BB systems also need to be interfaced to the HIS or LIS in use, even if from the same provider. HL7 interfaces, while relatively standard, still add a layer of complexity, which again, adds to the cost of the system (HL7 interfaces are big business because they are ingrained in every system in some way) Finally, in the US, you need to stay compliant with the FDA (510k), which is expensive. All these things considered, if the systems are too "cheap", the vendors lose money on them. That's why there are so few HIS vendors offering BB systems, and even fewer companies focused on just the BB component.

I will close by saying that if you can get any BB system for less that $50K, you're doing pretty good.

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A BB utopia will be a BBer writing the BB software. S/he will know exactly what we want, and what could be sacrificed to improve the more important feature.

I disagree. Speaking from both sides of the user/programmer equation, the programmer does not need to be a user of the software in order to program it the right way. Keys to producing a good product are clear communications between user and programmer, well defined program specifications and a rigorous testing program.

If designed properly, there should be no need for sacrifices beteen features. The only "sacrifices" that are needed are those of quality versus speed and cost. But if managed correctly, one can deliver a product of quality in a timely manner and for a reasonable cost.

The fact that BB software is often of such low quality is because BB software companies are often managed poorly and have poor proceses for software development and software support.

However that state can only exist in my opinion because BBer's do not require more of their software vendors. They are often willing to pay highly just to settle for an inferior product.

Partly this is because BBer's often have pressing business goals in mind. That is, if good enough works to insure safety and getting product out the foor then good enough is settled for.

Partly, I think this is due to non-profit mentality. That is, in my opinion, non-profits pardoxically do not processes in place or put an emphasis in cutting costs. Before you can even say that $50k is a good price, first you have to be able to say that you are actually paying $50k for what you are getting from the vendor alone. Often I find BBer's will only consider the initial software cost when they state they paid $50k for a product. They do not take into account the total cost of ownership which would include such things as the cost of validation, user training and maintanence. One also has to count time lost to outages or to finding workarounds for the limitations of the system.

And finally, I do not think BBer's do enough to communicate publicly to each other problems encountered with particular vendors or products.

Edited by angonzalez

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To make concrete what I posted above. Say for example that a BB buys a software product for $50,000 and that they will validate and deploy it in the course of 1 year. Let's say the maintenance cost is $5,000. Further suppose that over the course of the year, 3 staff spend 1/3 of their time validating the software. Assuming the average salary is $75,000, the the total validation cost is, naturally, $75,000. Staff have to learn to use the software. Even if taught in house, that takes time. Say 1 full person month is spent on training, that is roughly $6,000. The software had to be installed on a new server. Let's say that is $5,000. There had to be some IT support cost. Even if the BB pays a flat fee for IT support, it should still be counted as a cost because time spent supporting the new software is not time spent doing something else. Again say IT spent 1 full person month on support, that is another $6,000. So the total cost of ownership, before the product is ever used, is not $50,000 but $147,000. And that is assuming no problems, no cost overruns, and not taking into account the cost for making the initial purchase decision, converting old data, disaster recovery, etc.

As for the public communication of problems with BB software...there is very little in comparison with the public communication that is made regarding other software. If you go to various technical forums, user groups and sites for products such as Microsoft SQL Server or Oracle, even on sites owned by vendors, you will see very frank discussions of exactly what is wrong with the software including bugs, performance issues, problems with vendor support and lack of features. Such discussions are very rare for BB software, including this forum. Very few people have given reviews of the products they use.

Of the BB software I have seen, I would rate about half fair or meeting expectations. But the other half is unbelievably bad. I am talking about some of the major BB software vendors. Some of the software is badly designed, unstable, full of bugs and completely lacking in support, extremely expensive and yet in wide use throughout BBs.

Edited by angonzalez

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The biggest reason these products cost as much as they do is the very small number of potential buyers. Compare the number of active contracts to the number of staff listed to support the product for any one of the products listed. They all have to get enough revenue up front to be able to cover a lot of overhead and continue in business.

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This is an old topic so pardon my bringing it back. I retired from BB in 2001 and BOY was I glad. Why? Well we were required to enter SO MANY lot numbers BY HAND that it became impossible. A human makes a certain tiny number of errors no matter what you do. Let's say you make 1 transcription error per week - you write the lot number of your blood bag as 12x345872 instead of '12x354872'. You get 10 error before you get written up, it doesn't matter if they're FDA reportable (such as the wrong weight on an issued bag of plasma). Three write ups and you get fired. I don't know of ANY person who is always 100% particularly when they're literally writing thousands of numbers on a clipboard each week. I BEGGED them to get bar code scanners but NO-o-o. Hopefully they did do that before driving some poor OCD-bloodbanker (bless their hearts) mad. Is it any better 10 years later?

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Oh, and let me tell you why I retired (I joined administration an was much happier). I put a bag of blood that was in process of being screened for Kell, which was XM negative on a patient with a 4+ Kell antibody (so it had to be negative) on the 'ready to go shelf' but the antigen screening was still in process. It did NOT get issued, it did not cause a problem and in 15 min the screen was verified as Kell-neg. BUT the boss called me in and said 'I've lost all confidence in you...'. This was the ONLY error I made in 28 years on the job - I kid you not. The boss tried to fire me but my adviser and the head of the labs convinced her not to. This kind of error (putting a unit on the wrong shelf) occurred many times a week but I was singled out and I do not know - to this day - why. I was a favorite around there and a supervisor who had been downsized. Maybe they thought they were paying me too much.

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This is an old topic so pardon my bringing it back. I retired from BB in 2001 and BOY was I glad. Why? Well we were required to enter SO MANY lot numbers BY HAND that it became impossible. A human makes a certain tiny number of errors no matter what you do. Let's say you make 1 transcription error per week - you write the lot number of your blood bag as 12x345872 instead of '12x354872'. You get 10 error before you get written up, it doesn't matter if they're FDA reportable (such as the wrong weight on an issued bag of plasma). Three write ups and you get fired. I don't know of ANY person who is always 100% particularly when they're literally writing thousands of numbers on a clipboard each week. I BEGGED them to get bar code scanners but NO-o-o. Hopefully they did do that before driving some poor OCD-bloodbanker (bless their hearts) mad. Is it any better 10 years later?

I am now working on implementing software and currently deployed to a small hospital in TX. Happy to report we have barcode scanners at every workstation in the lab. I think they are much less expensive now - only about $200 each. We are also implementing single-sign-on, which allows one login to get into the workstation and then automatically logs into every application. We even have ID badges that are configured to log in and out by simply waving them near a reader.

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We are a 3rd party validation vendor. The thing that amazes me is the amount of variability from hospital to hospital within one type of system. For example you'd think that all the SQ users out there would have pretty much the same setup, but they don't. Given all this variability, we are implementing an automated validation process to really get into to all the differences to make sure the depth of testing is greater.

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That's a great point. I agree that there could much more communication and cooperation between blood banks using the same software.

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