Thorough analysis leads to improved workflow when choosing and implementing laboratory information system (LIS) solutions.
Once a client decides to purchase diagnostic information technology solutions, how do they ensure that the solution will result in the optimal workflow desired so they can realize the full benefit and return on investment (ROI) of the solutions they've bought?
The answer is that they have to use a set of validated, repeatable and proven best practices to ensure the successful implementation and adoption of the solutions are on budget and on time. These best practices should use proven methodologies, developed and deployed by experienced professionals. This will ensure that the end user adopts and implements the most effective use of the new technology. This will, in turn, optimize the use of staff resources.
Among the steps necessary is a full review and assessment of the client's current state workflow, including floor layout or physical plant; a review of potential workflow improvements that take advantage of both the existing physical spaces and also leverage and optimize efficiencies delivered by the diagnostic IT solutions, a complete review and assessment of the wireless technical infrastructure throughout the entire facility and a review of any anticipated future business and regulatory requirements.
Successful implementation is dependent upon using a project management system that ensures project success by maintaining communication and accountability, proactively identifying project issues and bringing the right resources to the project at the right time.
Finally, the move from manual processes to fully automated processes is often not an easy transition for the end users, and it is critical that the IT professionals have experience in organizational change management to ensure that this transition is a straightforward one. Organizational change management must consider technology, workflow and behavior change. It is such an important part of a successful project that Sunquest routinely presents high level workshops on organizational change management at its annual user group conference.
Workflow assessment specifics
Many users are updating their practices to move from longstanding manual processes to fully automated practices with the implementation of new diagnostic IT technology. The processes that are affected are integral to the specimen's entire lifecycle, including the reporting and communicating of accurate results, upon which patient diagnoses and treatment plans are based.
Processes that are optimized and automated include process steps within the specimen management lifecycle, beginning with point-of-care sample collection and labeling, sample receipt, verification of normal results, auto filing, automated interfaces to instruments as well as other applications and the timely communication of results to the patient care provider. Fully automating these processes results in the achievement of the highest possible outcomes associated with staff productivity, patient safety and accuracy.
The assessment of the existing workflow for all these steps must identify and review the desired outcomes and work to optimize the new workflows for the specific environment. This process includes a comprehensive review of the environment, following the specimen from order, to receipt, through testing and result reporting, to storage and finally disposal. It includes such items as:
- Types of tests;
- Volumes of tests;
- Number of workstations;
- Types and number of instrumentation; and
- Types and number of robotic lines.
A critical part of the review must be an analysis of the facility's wireless technical infrastructure. The review should identify areas of poor wireless coverage and make suggestions to the IT and facilities departments to ensure that the relationship between performance expectations and infrastructure capability is articulated and understood. Opportunities to improve the performance of solutions dependent upon wireless technology should be identified throughout all patient care areas and clearly communicated to stakeholders.
The proposed future workflow should include ways to effectively and efficiently address existing and future regulatory and business requirements.
Project management best practices keep implementation on track
After completing a comprehensive workflow assessment, addressing all site-specific needs and concerns, and designing a workflow that will meet client requirements, project success can only be ensured by using a project management process that maintains communication and accountability, proactively identifies project issues and brings the right resources to the project at the right time. These steps are reviewed in detail below.
Project launch — The initial launch process should include a kickoff call or on-site kickoff meeting to pass on critical information and expectations for resources required for the successful completion of the project. The size and complexity of the project determines the need for an on-site kickoff. During the call or meeting, all parties should be at the table, including the C-level stakeholders and cross-departmental representation. At that time, questions and concerns are clarified and a “cross-functional team” named, with a single contact for areas of the project such as servers, interfaces and laboratory department representatives.
Negotiation of project plan and project resourcing — A reasonable project timeline and implementation schedule is developed and used as the basis of a project plan that will be employed throughout the project to track progress. Key to the development and approval of a project plan is an assessment of resources available to the project. A clear expectation of resources is critical. It may help to develop a very detailed project task list, which helps organize the resources that will be needed for successful project completion.
Site profile — Developed during the project launch phase, the site profile is a living document shared with the teams and serving as the “single source of truth” for project information. It includes high-level, site-specific project information and tracks such things as products and services included, versioning, team contacts to facilitate ease of information sharing, milestone schedule, issue identification and issue tracking, risk identification, assessment and mitigation strategies, success criteria identification and project change management.
Status calls and status reporting — Regularly scheduled (weekly or bi-weekly) project status calls help keep the project on track and have been identified as a common factor in successful, efficient projects. In addition, specific technical calls may be conducted with the client team to address issues and answer questions with a goal of moving the project smoothly toward go-live. Preparation of project status reports, detailing project activity, schedule status and risks, helps keep all stakeholders well informed.
Phase reviews — For very large projects, periodic on-site phase reviews can be useful. This is a formal written document that is intended for the C-level stakeholder audience and is typically delivered in a formal meeting. A phase review should focus on status of the project in relation to the schedule, specific areas in the project that worked well, lessons learned and areas for improvement, and identification of project risks and mitigation strategies. The outcome helps to ensure that a large project is indeed on track and that all participants are dedicated to a successful outcome. This formal review can be an effective tool in keeping project focus and commitment.
Examples of workflow analyses using best practices
To illustrate the importance of the best practices outlined, including a thorough workflow analysis and project management process, two examples of successful processes in which Sunquest has been involved are provided.
The Public Hospitals Authority of The Islands of the Bahamas (PHA) selected Sunquest to modernize their entire healthcare support system. The challenge was to install Sunquest Laboratory, CoPathPlus, Collection Manager and ICE (Physician Portal) at the two primary hospitals and more than 50 Department of Public Health clinics throughout the island chain. Although the hospitals had up-to-date laboratory instrumentation, only one of the hospitals was using a laboratory information system (LIS).
Sunquest performed a workflow assessment, which included addressing infrastructure recommendations, examining specimen flow throughout the enterprise and looking at obtaining order-entry and results reporting in an efficient and timely manner. In many cases, mail delivery of results was dependent upon inter-island ferries, and delays were common.
On the basis of the review, Sunquest recommended use of Sunquest ICE Physician Portal throughout PHA, providing immediate electronic order entry and the ability to view results in real time via the ICE Web-based application. This reduced turnaround of patient results from days/weeks to hours.
In addition, with the wide geographical nature of this client, the ability to track specimens using the SMART application has significantly improved specimen processing, tracking and accountability.
Another example is Medfusion, in Lewisville, Texas. This brand new, state-of-the-art laboratory facility set out to design a customer workflow that would support the adherence to a system standard. The company selected Sunquest CoPathPlus, Laboratory, and Clinical Financial solutions for its implementation.
Sunquest conducted a detailed investigation, including proactive research and discussion about the facility's wireless environment, instrument and interface needs so there would be no surprises as the project was implemented.
The original specimen receipt and tracking system workflow focused on the receipt and verification area to enhance efficiency and minimize user intervention. The receipt and verification staff used rapid receipt/modify (RRM) to receive specimens with a single scan made possible with use of the Sunquest Advanced Accessioning module. The scan associates the foreign container ID received using a Sunquest container ID, eliminating the need for re-labeling of specimens and downloading orders to instruments. This Advanced Accessioning capability is unique to the industry and delivers significant cost savings because it eliminates the need for staff members to enter orders manually and manually re-label the specimens. Sunquest's ROI model demonstrates that this delivers a quantitative cost savings of more than $1 million per year.
Post project implementation go-live, Sunquest developed a solution that replaces the RRM process by using an interface to connect with a robotic sorter to direct specimens to the correct testing location. Instrumentation communications are handled using the Sunquest Instrument Manager and the Siemens Centralink data manager interfaced to eight Sunquest instruments. These results are currently filed into the Sunquest software. In the future, auto-filing of instrument results will be implemented to further increase efficiency, eliminating required review of results within normal ranges.
Currently, all patient reporting is done via the enterprise software. Sunquest designed a system that will create a comprehensive patient report system pulling Sunquest results, CoPath images and other data from a variety of sources, including clinical trial data and related medical publications.
ROI for diagnostic IT solutions using best practices implementation methodology
Sunquest has conducted ROI modeling, performed with the cooperation of existing clients, that reveals a robust and repeatable ROI for the best practices implementation methodology used to ensure the successful implementation and adoption of the solutions. Figure 1 shows that the net present value of the savings, productivity and revenue increases following an investment in a diagnostic IT solution over a five-year period would be more than $39 million for the organization studied.
Further, delaying implementation can have significant effects. For example, Figure 2 shows that the organization would sacrifice more than $6 million in cash flow by delaying implementation by just nine months.
Best practices begin with the end in mind and make sure the organization is positioned to be successful. Understand your goals and use the best practices so you can meet or exceed them.
About the authors:
Judy Hallada, MBA, PMP, and Pat Reed, MT(ASCP), PMP, are both managers, professional services consulting, at Sunquest Information Systems. For more information on Sunquest solutions: www.sunquestinfo.com