All healthcare IT must be highly reliable, but laboratory information systems need to be rock-solid; only the toughest of applications can cope with the 24×7 demands for information, which can often prove to be life-critical.


Nowhere is this fact put to the test as thoroughly as at two major Danish medical institutions. Both the Copenhagen County Hospitals group and the Statens Serum Institute needed new laboratory information systems. They are two very different organisations, but their key requirements are the same – extremely high volume capability matched by absolute dependability.

At the heart of these two applications is InterSystems’ Caché, a post-relational database system and the world’s leading database in healthcare. The term “post relational” is used to distinguish Caché from relational databases that force data into the simplistic 2D model of rows and columns.

Instead, Caché stores data in a multidimensional structure, which is designed to manage complex laboratory data, resulting in inherently faster data access. This also means that the system performs exceptionally well in 24-hour operation. Acceptable performance could prove a significant challenge for older, relational technology.

The Copenhagen County Hospitals group consists of three sites – Glostrup, Herlev and Gentofte – delivering general care for those who live in the surrounding Danish capital area. Each hospital has approximately one thousand beds – and their laboratories collectively perform nearly three million tests (or requests) a year.

“We looked for the most solid and stable system we could find,” says Professor Steen Gammeltoft, professor of clinical biology, explaining why the group decided on the Sunquest Laboratory™ solution from InterSystems partner, Sunquest Information Systems.

Nearby, is the Statens Serum Institute (SSI), Denmark’s national centre for the prevention and control of infectious disease and congenital disorders. If you really wanted to put a Laboratory Information System (LIS) through its paces, this would be the place. Some 6,000 – 10,000 requests a day pass through SSI’s 14 diagnostics laboratories.

Some 6,000 – 10,000 requests a day pass through SSI’s 14 diagnostics laboratories.

Dr. Vibeke Rosdahl, Director of Diagnostics
Statens Serum Institute

Like the Copenhagen County Hospitals group, the SSI also needed a new laboratory information system (LIS), “with a good reputation” as Dr. Vibeke Rosdahl, director of diagnostics puts it. It also decided on Sunquest Laboratory.

Sunquest Laboratory is a comprehensive, high-speed LIS that manages specimen data from requisition entry to production of a final, cumulative report. As a modular system, it offers the flexibility of a customised solution: all critical parameters and formats may be user-defined.

The Copenhagen County Hospitals was the first Sunquest Information Systems implementation in Europe to use Caché.

Integrating Three Systems

The whole “Year 2000” compliancy issue seems like a distant memory now. It may not have caused the mayhem predicted, but it did help turn things around, in more positive way at the Copenhagen County Hospitals.

The hospital laboratories had been running on a home-grown system for 25 years and they were quite happy with it. However, it was not Year-2000 compliant and so needed to be changed. Professor Gammeltoft explains that once this had been decided they then began to realise that the functionality in more up-to-date systems had increased significantly – for example, documentation could be improved considerably.

A change would also give them the chance to integrate the data from the three laboratories. “Although all three of the sites are general hospitals, they obviously have their specialist areas. By bringing together the three separate databases in a multi-hospital configuration we can access test results right across the board,” says systems manager Kristina Rasmussen.

We wanted to go to companies with proven, highly regarded reputation
in the healthcare market…

Professor Steen Gammeltoft
Professor of Clinical Biology

So why did they choose Sunquest and InterSystems in particular? “We wanted to go to companies with proven, highly regarded reputation in the healthcare market – those with many customers, on the premise that if it has many users, it must be good. If we couldn’t have a company with a Danish office, we at least wanted a company with a UK base,” says Professor Gammeltoft.

Professor Gammeltoft first met Sunquest in 1998, and was impressed by Sunquest Laboratory’s functionality and also that it seemed to be, “the robust system that we needed to fulfil the demands of running 24 hours a day, 365 days a year”.

There was also the question of scalability, as InterSystems Managing Director, Northern Europe Graham Frost explains: “Having gone to Copenhagen to assist Sunquest in procurement, I was aware of the hospitals’ concern about the scalability required to run such a large LIS. However, knowing that InterSystems has sites running 4,000 users on a single Compaq Alpha server and that we have even demonstrated up to an 8,000-user level of scalability in benchmarks, I was confident that Caché could support this implementation.

“The application also makes use of the fast communication that Caché provides. Its multidimensional nature means that the network traffic required to process the large number of daily transactions across the three hospitals is considerably reduced. This enables applications to run faster and to handle more concurrent users. “

…We [had] the help of the Sunquest team through[out] and worked together on any problems

Professor Steen Gammeltoft
Professor of Clinical Biology

The implementation itself was not without its challenges, Professor Gammeltoft admits: “Each of the three labs had different ways of doing things. Although this underlined why standardisation was needed – it didn’t make the whole process any easier, but we did have the help of the Sunquest team all through and worked together on any problems.”

Now the three laboratories share their processes, including medical coding. This means that when patients move from hospital to hospital, details of previous tests are easily available to clinical staff. It also means that the laboratories can prepare similar and comparable reports which makes reporting and forward planning across the whole region far more accurate and useful.

Kristina Rasmussen says that staff have found the system intuitive and relatively simple to learn and there is also the advantage that the person actually doing the testing inputs the results into the system, giving far less room for error. “Because other major changes have also been taking place throughout the hospital we haven’t worked with fewer staff – but the system would have allowed us to do so if we wanted.”

Staff have found the system intuitive and relatively simple to learn.

Kristina Rasmussen
Systems Manager

But like her colleague Professor Gammeltoft, Kristina Rasmussen sees the system’s reliability as its most important advantage. “Availability has been on average above 99 per cent. It’s a very smooth-running system,” she confirms.

Says Graham Frost: “Caché customers report that their applications run up to 20 times faster once they are ported from a relational database to Caché. And because Caché is designed for applications that run 24 hours, everyday of the year, on all sizes of systems, it dramatically reduces the amount of maintenance commonly associated with database systems.”

Kristina Rasmussen has also been pleased by the support from Sunquest. “If there is a problem, their round-the-clock support means they are able to help straight away,” she says. “This is very important to us.”

Used by the World Health Organisation

If the Copenhagen County Hospitals application has really demanded that Sunquest Laboratory running on Caché prove its worth, then this has been backed up by the requirements at the SSI. With over 14 labs and over 600 different types of tests, it needed a system not only with high functionality and strength, but also one capable of providing complicated data and reports. Once again Caché’s ability to store complex data and enable users to access it quickly is being put to the test.

Their round-the-clock support means they are able to help straight away.

Kristina Rasmussen
Systems Manager

Dr. Vibeke Rosdahl, director of diagnostics at the Institute explains: “We are a national institution, which means that not only do we perform tests, but also we do surveillance and monitoring of, for example, staphylococcus or syphilis. Because of this, we need a system which will both handle data and also give us the reports needed for surveillance.”

She says that the old system had been custom-built, but had been changed so many times that they knew the local supplier did not want to develop it any further. They also wanted a system – with the potential for electronic requisitioning from GPs and other users – which they plan to implement in the future.

“The first thing we asked ourselves was ‘are there any systems on the market which can live up to our ideas?’ We narrowed it down to two, including Sunquest. We had many questions and it’s a very complex organisation and many of the questions we had were probably not the same as they would be from a normal hospital,” Rosdahl says.

The first thing we asked ourselves was ‘are there any systems on the market which can live up to our ideas?

Dr. Vibeke Rosdahl, Director of Diagnostics
Statens Serum Institute

Part of the challenge at the SSI was not only changing the system, but also changing a considerable number of daily procedures to create a paper-free environment. For example, all specimens now come into a central processing department, whereas before they went straight to the relevant laboratory.

Systems manager Charlotte Nobel is clear about what it used to be like: “There was anarchy in the numbering systems – each department did it their own way and it was very hard to organise. Now, when a sample arrives at the SSI, it is unpacked and put straight into the system in a central area and then distributed to the different laboratories.”

To help this work, the SSI has implemented the Sunquest SMART – specimen management routing and tracking – module. “In the old days, we couldn’t track specimens as they made their way through the labs. We don’t just do tests, we advise: we have a lot of places calling here and wanting us to advise on the results or asking ‘when can I expect my results back?’ Before this, it was very difficult to be able to say when they could expect an answer.”

All the surveillance work we do is in collaboration with international bodies such as the World Health Organisation.

Dr. Vibeke Rosdahl, Director of Diagnostics
Statens Serum Institute

“All the surveillance work we do is in collaboration with international bodies such as the World Health Organisation. so it’s highly important to have easy access to the data we have from our diagnostic procedures,” says Dr. Rosdahl. The SSI has also implemented Sunquest Laboratory’s Microbiology module, which has enabled it to report far more complex examinations and testing.

“It hasn’t just been a big change in the technology,” says Charlotte Nobel, “it’s been a radical re-think of processes and the way people work.” She is expecting that soon they will begin to see the cost benefits of the system: “I foresee faster turnaround of specimens and lower costs per test by next year,” she says.