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Web-based reconciliation system for HL7

Meadow Mind, Inc., USA

Pathology Inc. (Path Inc.), a medical corporation, is a regional, physician pathologist owned independent laboratory specializing in medical anatomic pathology and molecular diagnostics services. Managed care is a prominent feature of medical care in California. Meadow Mind, Inc. provides custom programming for Path Inc. and depends on Lispworks to enable top-to-bottom Common Lisp custom programming solutions.

Path Inc. sub-contracted with Laboratory Corporation of America (LabCorp) to provide pathology services for a segment of LabCorp's exclusive managed care contracts. While accounting for only a minority of Path Inc.'s business, this segment was strategically vital to Path Inc.'s business interests because of its geographic distribution and historical relationships between Path Inc. and the physician clientele treating the patients covered by this form of insurance payment.

A two way electronic interface was developed between LabCorp and Path Inc.'s laboratory information systems. However, managing the complexity of the data exchange in this was problematic. Staff in both companies found it difficult to understand the reasons for the failure of data transmission, and problem resolution management was poorly organized. A solution was needed to these and other problems in the system.

This situation provided an ideal opportunity for exploratory custom programming. Not only were the root causes of the problems unknown at the outset, but the nature of the problems themselves was uncertain. The solution was to design and implement an intermediate system to reconcile the electronic traffic between the two laboratories. A web-based system tracked orders and results, assigning logical categories based on declarative rules. This system not only eliminated extraneous traffic, but it allowed both parties to accurately visualize, track and repair the numerous points of failure in their communication. Over time, this monitoring system has evolved and been streamlined as knowledge of the underlying problems filters into ability to prevent and repair them optimally.

Common Lisp -- and LispWorks in particular -- played a vital role in developing and maintaining this reconciliation system. The system, written entirely in Common Lisp, processes HL7 (Health Level 7: the standard medical data interchange format) and categorizes orders and results using KnowledgeWorks. By performing logical inference on persistent Lisp objects, the system expresses the fundamental business logic in a way which is both manageable and tightly integrated with the web and messaging portions of the application.

Based on the success of the reconciliation system, Path Inc. has gone on to make Lisp-based systems a growing part of their information infrastructure.

Links:
Pathology Inc.: www.pathologyinc.com
Meadow Mind, Inc.: www.blui.com/meadow-mind

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