Pushpanjali Crosslay Hosptial, a tertiary care facility, is the flagship hospital of the Pushpanjali Healthcare Group which is a dynamic, fast growing Indian healthcare group. It offers an unparalleled spectrum of preventive, diagnostic and treatment facilities with follow-up care, in virtually all medical specialties. The hospital has a blood bank where quality checks ensure that the blood is of the desired standard. The blood bank is well equipped to provide services like blood collection, testing for blood transfusion, cross matching and issue of whole blood and its various components like packed cells, saline washed packed cells, fresh frozen plasma, platelet concentrate and cryoprecipitate.

Background

The HIS (hospital information system) chosen by the hospital to carry out its routine clinical and administrative functions was a standard product from a reputed international vendor that has successfully deployed their HIS across various locations in and outside India. The key leaders at Pushpanjali, who contributed to the IT vision chose to employ a ‘best of breed’ approach where auxiliary functions of the hospital may choose to install specialized software that better suit the degree of complexity of the working of their departments with an understanding that these software products would eventually interface with the core hospital software viz – the HIS. Therefore, specialized software products were chosen for back-office operations, laboratory management as well as radiology image management.

Problem Statement

After a detailed review, Pushpanjali chose not to go with the blood bank module that was offered within the HIS. The reason for doing so was that most specialty modules in the HIS focused on order entry management. While this concept works well for most departments whose functionality essentially meant servicing requests from the wards, blood banks were far more complex as they involved management of donors and manufacturing of components as well as a detailed traceability to ensure the concept of haemo-vigilance from the standpoint of a  donor and the recipient.

At this juncture, Pushpanjali began to review some of the best-of-breed blood bank software products available in the world and arrived at a solution from an Indian company by the name – acuis. The name of their blood bank software product was acuVena. The team behind acuVena had concentrated on the complexities of the workflows of independent and hospital based blood banks. Their solution had been successfully running at many of India’s leading blood banks and they had been working with veterans from the Indian blood bank industry for the past five years. acuVena had been showcased at industry conferences in India and the USA and had evolved best practices from the industry over the years. Being an enterprise class, multi site, web-based software; it seemed to fit in line with Pushpanjali’s IT vision of enabling stakeholders to login from beyond the IT firewall.

Software Overview

acuVena presents itself as a process-driven, feature-rich blood bank software that has been built on a Service Oriented Architecture. The key to its success has been the inputs given by the core R&D team consisting of domain experts who are stalwarts of the Indian blood bank industry. acuVena has mapped key stakeholders like donors, blood drive organizers and care-providers in its design from the ground-up. This insures that these stakeholders can actively interact with the system rather than the system being run essentially by technicians and data entry operators. The software can be broadly classified into 3 subsystems mentioned below:

acuVena- presents itself as a process-driven, feature-rich blood bank software that has been built on a Service Oriented Architecture.

Donor Centricity

One of the key stakeholders in the system is the donor. The system helps mark donors as eligible and defers those who are not eligible. The entire donor workflow has been traced onto acuVena process map. Donor questionnaires are completely customizable. Donors can have the option of self-registration either via the web or an interactive touch screen module. It records history of previous donations and restricts donors from donating before their eligible period. acuVena has the added advantage of not losing track of donors who are temporarily unfit for donation by reminding them to come back when eligible.

Bag Lifecycle

acuVena maintains the detailed history of a bag right from the time the stores officer receives it, till it is finally issued to the intended recipient. The system accepts donors of whole blood as well as aphaeresis. It allows component preparation depending on the type of bag chosen. acuVena enables typing of blood for Red Cell, Leucocyte and Platelet Antigen. One can view the transfusion centre’s stock according to stock location, blood group or component. Every stage of the blood bag from collection, component preparation, storage, stock movement, cross-match, issue, return and discard are traceable within the system. The system has an option of automatic as well as manual discard of blood components.

Transfusion Care

The system allows both internal and external blood requests. In case of tertiary care centers, the blood banks also serve external requests from neighboring hospitals and nursing homes. The system supports bulk issues to storage centers, emergency issues, cross-match, issue, return and billing of blood components in stock. acuVena enables adverse transfusion reaction reporting from the point of care.

In addition to the above 3 subsystems, acuVena has a comprehensive blood drive (blood camp) organization module that helps blood banks organize blood drives (camps). Since Pushpanjali was not planning on organizing external blood drives, this module was not focused on.

Benefits of acuVena

(a) Donor Loyalty:

acuVena stores information about donors who are eligible as well as those who may not be eligible to donate today. This eligibility is automatically calculated by an intelligent questionnaire system that calculates the number of days a donor may be deferred due to a pre-existing condition. Since such a system is rule based, it allows the blood center to change the eligibility days depending on the rules set forth by the governing regulatory authority. Storing data of ineligible donors not only helps the blood center call them back when they are next eligible, it also enables the blood center from pro-actively knowing the status of the donor if he/she re-visits before they are next eligible to donate. In addition, this helps the blood center convert (motivate) replacement blood donors into voluntary blood donors by calling them when they are next eligible to donate blood.

(b) Process Driven:

Having been built with inputs from domain experts of the blood transfusion industry, the software has covered the various stages of blood banking in a comprehensive manner. It covers red cell antigen, platelet antigen and HLA typing. It takes into account informed consent of donors depending on the type of collection (whole blood or aphaeresis), exhaustive information related to blood collection, donor reactions as well as various stages of the component manufacturing process depending on the kind of bag used. These process driven stages can be traced per blood unit and technicians can also generate worklists corresponding to these stages that they choose to do in batches.

(c)  Enhanced Trace-ability:

In a regular blood bank module of an HIS, most of the stages mentioned above are carried out offline (not in the system) since the HIS essentially focuses on order entry management and billing. However, since the above mentioned processes are an integral part of acuVena, the blood bank personnel using acuVena can trace back any blood unit to the donor medical history or to the date of purchase of the blood bag from the vendor.

The intelligent labeling system also displays the test results of the Transfusion Transmittable Infectious markers carried out on the blood unit for enhanced safety. Any adverse transfusion reaction can be documented in the system and is once again traceable to the donor and blood bag.

(d) Faster TATs (Turn -Around-Times) :

Since the stock levels are instantly accessible within and outside the system, the blood bank staff are able to attend to blood requests in an efficient manner. The system allows blood reservation in advance. The system has in-built email and sms alerts for adverse transfusion reaction, low stock levels and expiring units of blood.

(e) Greater Compliance :

The system generates most of the essential reports required to be submitted to the authorities. Many blood banks either dedicate personnel for this activity or spend a lot of time collating this data again as most of the processes and consumables of the blood bank are not fed into the blood bank module of the HIS. acuVena’s process driven approach not only captures the essential information, it generates most of the reports required by the authorities who seek this information. These reports can be generated in addition to the manual registers being maintained by the blood bank.

(f)Focus on Point of Care:

Deploying a best of breed blood bank software like acuVena ensures that senior officials concentrate on using the data effectively to achieve their quality initiatives rather than creating the reports. By freeing up their time from report generating activity, it also enables the care-providers in a blood bank focus more transfusion care and research related activities.

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