View PDF - Pathology Informatics 2014, May 13-16

Lab IT Strategy:Evolution or RevolutionWhere do we go from here

How did we get here:Peaceful CoexistenceHIS Takes on the LabPoor results due to:• Transaction Volumes bogged downsystems during peak use• Detail level of applications to supporteach discipline and sub-disciplinerequired resources beyond the vendorscapacity• Very few attempts achieved moderatesuccess (UAB), most were disasters• ROI for vendors was poorExceptions: MediTech and Cerner• Both Started in LabEWS Integration AboundsHL7 helps, but doesn’t solve theproblemPID issuesData Synchronization IssuesDifferent types of lab data notgracefully handled by HISIt’s hard to doLack of “Interoperability”HIS vendors learn to Peacefully Coexist with the LIS BoBLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

TodayReferenceLaboratoriesCORE LABLISNetwork ConnectionsLocal, WAN, VPN…Clinics,NursingHomesRemoteLaboratoriesHospitalsPhysician’sOfficesLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

BoB Single DatabaseOutreach/Client ServiceHLAGL/ MicroSingle DatabaseAP/ GeneticsBBTrans/Donor• Applications utilize asingle database• Complex Rules andAlerts can be utilized• All lab results onpatient reports• Single vendorcontract andcontact.• BoB cost $300 to$4.0M & up,depending onmodules andhardwareLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Integrated Platform• Outreach• Genetics• ClientServiceCoreGL/APLISMicro/BB• HLA• All applicationsinterface results toCore LIS• Multiple vendorsrequire multiplecontract, contacts,license, andmaintenance fees• Some loss offunctionality withRules and alerts.Larry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Vendor Application ComparisonDepartment Epic Cerner McKesson Meditech SCC Soft SunquestSpecimen ProcessingGeneral Lab / CoreBlood Bank TransfusionBlood Bank DonorStem Cell LabApheresis LabMicrobiology LabAnatomical PathologyCytogenomicsImmunogeneticsImmunologyMolecular GeneticsPoint of CareVirology LabOutReach ModuleClient Services moduleCommentsAll Vendors listed in alphabetical orderAll responses sent by each vendorCompiled by S&P Consultants, IncSeparate applicationLimited functionalityStandard FunctionalitySeparate database

Version and Performance Upgrades• OS/Database Versions, interconnectivity issues, aging hardware platform• Need enhanced performance to handle larger volumes, new business opportunities• $’s can be significantFractionated Acquisition/Upgrade• Digital Pathology• Molecular/Genetics/….• OutreachDepartmental Issues• New Automation• New Services• New Business OpportunitiesDriving Forces in LISRequires C-Suite ApprovalLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

EWS Encroaches on the LabExecutives make huge investment in EWS.Vision is a single EWS serving all departments.If your lab has a need to upgrade to a new version or acquire newmodules, the cost will be significant enough that it requires C-suiteapprovalLabs being asked to or directed to switch to the EWS lab module for thegood of the whole (similar to Meditech situation 10-15 years ago)Are you ready to install a completely new LIS? Is this the right move foryour lab? How do you know?Are you prepared to build a case to counter the C-suite’s generous offer?Larry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

C-Suite Understands:LIS Strategies• Costs, Head Count, Revenue, Liability• Financially focused not clinically or functionally focusedC-Suite believes they already paid for new LIS – It’s FreeC-Suite likes followers - Don’t directly challengePro-Active Now - Develop a business plan that justifies staying with BoBAssess Where you are, Where you need to be and When (Timelines)Info to collectMetricsOld Style RFP will not work in your favorLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Version Upgrade VS New LIS6 figure funding opens Pandora’s boxAll questions become open and long term LIS strategy is a new focus.Cost:Time:$150K to $750K & UP depending on vendor, system size and ifhardware upgrade is required2-12+ months for new code to be installed and validatedResources: All areas of the lab must be involved to validate code and anynew enhancements. IT is also included due to interfaces andhardware.Benefits: Many times little to no major enhancements are included.Required by vendor or due to new module being implemented.Larry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Version Upgrade VS New LISNew LIS is much more complex than any upgrade.C-Suites do not understand the complexity of the lab or the LIS.Implementation of a new LIS is 3X to 4X harder and more costly.Cost:Time:$2.5 Mil to $4.0M+ depending on vendor and modules12 to 36 months depending on size, vendor and modulesResources: 6 to 14 Lab resources, 1-4 LIS resources, and 2-3 IT resourcesBenefits: New modules may be added to the Core system.New technology platform which will allow for easier upgrades.Additional functionality in Core LIS due to age of currentsystemNew hardware which may reduce maintenance cost andsupportLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

TimelinesVersion UpgradesLIS and minor lab involvement2 – 12 monthsNew LIS Implementation12 – 36 monthsIT, LIS, and entire lab involvement. Re-training of ALL staffIt’s NOT FREELarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Reasons for new LIS• New functionality needed that is not included in current LIS• New modules required for emerging markets that are not available orfully functional by current LIS• Extremely old version of code which will require multiple upgrades toget you back to current release• Entire institution is moving to an EWS with a BoB LIS included• Institutional growth and current LIS can not meet the needs of newentity• Vendor sunsetting current system and upgrade to new system is acompletely new LIS install• Current system unable to interface with new instruments andautomationLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Questionable reasons for new LIS• EWS or EMR system being installed and contains a less than BoB LIS• Move to a single vendor due to IT strategy• C-Suite decision without any input from Lab Management• Moving to an incomplete system that does not have current modulesor full functionality• Move to new LIS simply because Version upgrade is requiredLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Business IssuesPatientContinuumDiagnosticReportDay-to-DayOperationsIntegrationStillHereSpecialtyAreasOutreachIssuesAccountabilityMgmtReportsThe FutureData vs InfoPreciseMedicineLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Source of Patients• Enterprise, (Hospitals, Clinics, Physician Office)• Non-Enterprise Source – Physician Office, Corporate Contracts, Nursing Homes, Outof AreaOverlapping Patient:• Separation of Records when patient is both Enterprise & Non-EnterpriseCollection & Routing Issues:• Couriers, Payor requirements, Multi-site routing (time, day, priority, preference)Billing• Technical & Professional components, add-ons, cancellations, direct bill, self pay,ACO( lab pertinent performance measures)Results Reporting – Timeliness• Delivery MethodsPatient ContinuumLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Integration/InterfacingIt doesn’t go awayLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Day to Day OperationsAutomationReference Ranges & StudiesCross department RulesSpecimen FlowsDashboardsTracking – Orders, Specimens, Results, Repeats….Lab Data as the Lab Knows ItLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Accountability/ManagementReports/ResearchManagement ReportingBusiness IntelligenceTurnaround Time AnalysisTracking – Orders, Collections, Receipts, Corrections, Queries, ….Lab Retained Data (stuff that isn’t reported)Research/Special StudiesMulti-facility issuesLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Larry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Data vs InformationPSASample Report referred byBrian Jackson, MD, CMIOARUP from guest blog onLabSoft and article in WiredMagazineLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Data vs InformationCardiologySample Report referred byBrian Jackson, MD, CMIOARUP from guest blog onLabSoft and article in WiredMagazineLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Sample Report referred byBrian Jackson, MD, CMIOARUP from guest blog onLabSoft and article in WiredMagazineLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

Larry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants

ConclusionsAssess your Business & LIS Strategy NOWBe Prepared to measure costs at a higher levelFAQs:• EWS Lab Module is NOT FREE• Integration/Interfacing will not go away• Will lab be a Data or Information provider• Who is Responsible when it doesn’t work outLarry Wimberly Pathology Informatics 2012 Andrew SplitzWimberly Consulting Services Chicago, IL S&P Consultants