Thriving under pressure: lab information systems can reduce errors and automate workflow. (2024)

ALL LABORATORIES IN THE UNITED STATES ARE UNDER PRESSURE. By 2020,there could be a 30 percent reduction in the clinical lab fee schedule,based on the current imposed laws. In the physician office lab setting,the decrease in lab reimbursem*nt is compounded with physician feeschedule cuts. Specialty laboratories, especially those focused ongenetic and molecular testing, will be acquisition targets for biggerreference laboratories. Independent reference labs also need to considernew ways to stay competitive as consumers are offered testing in retailsettings.

As a result, many fee-for-service models and outreach practiceswill be in jeopardy. In order to survive and thrive in this challengingecosystem, laboratories must evaluate ways to decrease their unit costper test. One approach is to develop strategies that will increasevolumes, to take advantage of excess capacity. In parallel, operationalimprovements can help gain efficiency and wring costs out of theiroperations.

When considering opportunities for operational improvement, eachstage of the testing process must be evaluated to maximize efficienciesand ensure improved patient care is being realized. Labs will need astrong laboratory information system (LIS) partner who is cost consciousand able to adapt as testing menus and workflows shift. With an LIS,many of the pre-analytic steps are automated, resulting in reducederrors. Tools and automation in the analytic phase assist the lab inproviding the best patient outcomes. Lab data access, analytics, andcustomer management will be required post-testing to service providersand laboratory customers.

There are considerations to take note of when evaluating an LIS,including:

* Electronic orders and lab labels: It is not uncommon for a laborder to be generated in the EMR. Patient demographic information isupdated from the order message, ensuring accuracy in the LIS. When theorder is received in the LIS, a label is printed that includes at leasttwo forms of patient ID. Handwritten names that are incomplete orillegible are eliminated.

* Specimen requirements: Phlebotomists can see tests, collectioncontainer, patient preparation, specimen storage, and stability in oneplace, with one click.

* Turnaround-time monitoring: Laboratories can lose preciousrevenue, or even clients, if they are not meeting their target servicelevels. An integrated dashboard of pending results can highlight thespecimens that are approaching their target turnaround time,facilitating interventions that get results out on time.

* Monitor result discrepancies: Critical result handling supportand automatic delta checking allow laboratorians to alert a provider tochanges in a patient's condition.

* Management review: The LIS can facilitate and store proof ofreview by the managerial staff for the analytical review of definedtests or selected personnel. Management review is useful for complextesting and training new staff.

* Quality control: The LIS assists with ensuring the qualitycontrol (QC) is acceptable and can disable release of results if certaincriteria are not met. The LIS stores values, graphs, corrective action,and proof of review, reducing printing and paperwork. Rules prompt thetech to enter a corrective action note into the LIS, improvingdocumentation and allowing QC to go paperless.

* Automated test reflex or testing cascade: Rules also allow usersto set up ordering rules and automatic reflex testing rules based onresults, ensuring all necessary testing is done and billed.

* Auto-verification: Auto-verification rules allow rapid flow ofresults (within the pre-defined ranges) into the patient chart,eliminating the need for interface review of test results within definedranges.

* Standing order and call documentation: Keep track of orders, anddocument attempts and outcomes of contact with a patient. This allowsbetter patient outcomes to be achieved with less lab staff intervention.

* Analytics: Provides data management that can be used to improveefficiency. Data can be analyzed to determine turnaround times, specimenrejections (QNS, hemolysis, incorrect tube, etc.), provider testutilization, and workload to ensure appropriate staffing.

Automating your lab is an investment, but there are LIS systemsthat can meet your needs and fit your budget requirements. Theimplementation of an LIS does not have to be a time-consuming processthat disrupts the lab. Laboratory medicine involves complex tasks thatrequire trained professionals, but learning and working in the LIS doesnot have to be a complex task. Look for an LIS that provides flexibleand scalable configurations, easy-to-use and intuitive navigation, andbusiness insight through operational monitoring and analytics reporting.

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By Sandra Laughlin, Product Manager, CompuGroup Medical USA