• November 2008 FEATURE ARTICLES •
Laboratory Information Systems: Case History
Breaking the Mold
Adapting a one-size-fits-all approach to LIS for a growing NYC medical lab requires a few adjustments.
By Kristoffer Stewart, Associate Editor
Off-the-shelf software suites may fulfill the
expectations of many but every application of the technology is
different, with no two organizations utilizing it in exactly the
same manner. For those that require more than what’s included in
the box, the key to satisfaction often lies with a willingness
to compromise and, sometimes, a leap of faith.
Most entry-level laboratory information
systems (LIS) support basic functionality such as patient check
in, order entry and results entry, physician and patient
demographics, specimen processing and some reporting capability.
In addition, they commonly support rule engines, HL7 interfaces
with reference labs and electronic medical records (EMR),
Web-based order entry/result inquiry and workload balancing, and
should include a fully functional billing module. Arguably, the
most vital function of any LIS is its ability to collect money
for any billable service and to identify where the payment came
from, with custom reports that track every detail.
When Shiel Medical Laboratory outgrew its
legacy LIS the organization analyzed its previous system and
generated a list of must-haves.
Making a Shift
Shiel Medical Laboratory has been in business
since 1919, and is one of the country’s oldest, continuously
operating clinical laboratories and the largest privately-held
lab in New York. It services private physicians, group
practices, union and industrial accounts, long-term care
facilities and home care agencies throughout the five boroughs
of the city, as well as Nassau, Suffolk, Westchester, and
Rockland counties, and northern and central New Jersey. Shiel
maintains a fully operational client services department 24/7,
and offers flexible report distribution options such as courier
service, remote printing and the AutoReach Laboratory Interface.
Shiel’s management realized their legacy LIS
was causing serious connectivity issues within their large
physician client base, hampering the lab’s performance. The
advances of its competition and Shiel’s own rapid growth were
key drivers in the decision to replace the aging LIS. The lab
sought a solution that would put them back on the leading edge
of LIS processing and provide the unlimited connectivity they
required for their physicians. After a year of due diligence,
Shiel decided on a broad suite of scalable and flexible software
modules that it felt covered all aspects of clinical laboratory
work.
When Shiel CIO Aron Junger joined the company
a decade ago, the lab was processing approximately 600 specimens
a day — a virtual "mom and pop" medical laboratory. While
searching for a solution in early 2001 and evaluating competing
vendors and their products, a mutual acquaintance of the lab’s
CEO led them to a small developer of LIS software that was
itself an up-and-coming business — New Jersey-based NetLIMS.
"Our billing department was very unhappy with the capabilities
of our legacy system," Junger says. "They thought they were
losing a lot of additional billing opportunities because of the
old system’s limitations."
While some at Shiel examined the LIS during
the demo phase and saw challenges, others, such as Gitty Kohn,
Shiel’s vice president of billing and administration, saw an
opportunity and an ideal set of circumstances. Where no billing
module of any kind existed, one could be custom built from the
ground up without the usual workarounds. "When we selected this
company as our new LIS vendor, for me, one of the most
attractive features was the absent billing module," Kohn says.
"The vendor stated it would develop one according to my
specifications. Most of the LIS solutions that we evaluated were
missing features I felt were necessary to keep up with all the
changes happening in the billing field."
The Short List
During the year-long selection phase, a
committee that consisted of Shiel’s CFO, CEO, billing manager,
lab director and an IT manager, interviewed all of the major LIS
vendors. Tod Schild, senior vice president of sales and
marketing at Shiel says the vendor they ultimately chose
emphasized the flexibility of the system and their ability to
customize and build modules specific to the lab’s insurance mix.
"What attracted us was the customization
aspect and the relatively short time that could be done," says
Schild. When seeking reimbursement from large healthcare
organizations, he says, "You have to be able to go line by line
— test by test — and be able to correctly apply what you’re
getting reimbursed for and what you’re not. This system allows
us to get very specific and seek reimbursement for charges that
we were denied in the past because we just didn’t have the
capability to track those charges down."
Kohn’s list of "must-haves" addressed new
billing regulations and several insurance contracts requiring
sophisticated billing processes. "We had the top two LIS vendors
come in and demonstrate their systems. As far as I was
concerned, neither of them met the requirements I set for
billing," she says. "Neither vendor was willing to customize the
programs for us. That immediately ruled out both since it was
billing that was driving the need for a new system."
NetLIMS, however, impressed Kohn with their
programming savvy. "Even though they had no billing system in
place, I was impressed with the overall lab program," she says.
Several in-depth discussions with the vendor detailed exactly
what Shiel required of the LIS solution. "Since none of the
major systems out there totally met our needs, it seemed the
best approach for us would be to start from the ground up and
build a system to our specifications," she says.
A Fresh Start
During the week-long demo phase, the
selection committee commented on other functionality that was
missing, such as remote printing. A few days later, the vendor
added that feature. "They demonstrated an on-the-fly ability to
learn a new technology or concept and add it into the system," says Junger. An outreach
product for physicians accustomed to a shorter, more streamlined
process was another functionality the vendor quickly built. "The
order entry module was obviously very different because there’s no such thing as a
diagnosis code in Israel, where the product was made."
Reporting functions were also adapted to the
lab’s liking, says Junger. "The vendor duplicated copies of our
reports into the system exactly as those we had been using. They
also set it up to generate not only the text but also the image
of the page." Junger says the pricing of the product was
substantially less than the competitors’, further helping the
decision. "We structured a contract that specified what we still
needed from the system," says Junger. "There were a lot of
safety nets built into the contract when we signed it, but it
was still a leap of faith."
Shiel finalized the contract for the AutoLims
LIS and implementation and support services on Sept. 11, 2001.
Kohn says the development of the new billing module didn’t hold
up the implementation. "The work began in earnest in early 2002
and the lab system went live prior to the billing module going
live, which was completed in early 2003." According to Junger,
some of the system interfaces were ready for go-live, while
others such as the reference lab interface required
post-implementation work. "Instrument interfaces, for example,
went quickly and smoothly," says Junger. "But the reference lab
interface was an incredible challenge and, in fact, with our
previous vendor, our first reference lab interface failed."
Successive interface development proceeded with fewer issues and
once the infrastructure was in place, "the system did everything
we needed."
Results
According to Kohn, Shiel is now interfaced
through the new LIS to all of the major insurance carriers for
sending claims and receiving payments electronically. "The
vendor delivered every interface I sent them in a relatively
short time," says Kohn. "The system now enables us to complete
more work with fewer staff. Additionally, much of the work that
was done manually is now handled by the billing system and this
translates into shorter days in A/R."
Schild says the new LIS helps him to quickly
redirect his sales reps’ efforts wherever he sees a need. "I can
quickly get a breakdown of insurance summaries and identify
which may not be a good account for us. It allows me to
immediately identify the strengths and weaknesses of a
particular account. We’re capturing at least 10 percent more in
reimbursements from our insurance providers."
Schild says the legacy system hampered them
with limited lab processing capabilities and lacked client
connectivity technology. It also had an inefficient billing
module and provided limited flexibility for customization. "Our
new LIS significantly improved all of these activities, helping
us better serve our clients and making us a better, more profitable lab," says
Schild.
The most notable feature of the new LIS in
Schild’s opinion is the Web-based AutoWeb module. It provides
clients with an interface that allows them to obtain lab results
on their patients via the Internet. "It’s an extremely
user-friendly access tool and we have doctors who rely on it
heavily."
In addition, a variety of sales
representative monitoring tools are available via AutoWeb. These
tools assist Schild and his representatives to track new and
existing clients, including specimen count and test statistics
as well as pending results. "The system allows sales reps to
review the accounts they manage, plug in specific dates and get
a summary report of all specimens that have yet to be reported
for any date range. They can then notify the lab to prioritize
processing of these specimens."
AutoLims’ XML/XSL technology enables the
lab’s sales team to customize requisitions and results reports
to gain new accounts, as well as the ability to incorporate
graphs, pictures, instrument printouts and cumulative reports.
Additionally, several tools allow them to monitor and grow
existing accounts. "It’s one thing to get a physician to agree
to set up an account," says Schild. "It’s another to get them to
actually send you specimens, or the right specimens."
AutoWeb allows Shiel’s reps to regularly view
the specific number of requisitions and number of tests per
requisition that a client sends in. In addition, the
AutoCommissions function enables them to view the type of
insurance an account uses or any bad debt that may exist. With
this information, they can point the clients in a better
direction, thereby increasing their profitability. "AutoCommissions
also enables us to deselect any less-profitable accounts,
helping to increase our bottom line," says Schild. "These tools
help us grow our existing business and keep our laboratory financially viable."
Schild says their new LIS is increasing the
lab’s competitiveness in the New York market and helping Shiel
to outperform its competition. "The vendor designed from the
ground up what we consider to be a superior and flexible
system," says Schild. "For us, it has brought all phases of
laboratory operations under a single umbrella." The new LIS
provides technical lab operations, client and lab connectivity,
ancillary lab operations — including logistics and supply
inventory — instrument interfaces, referral labs, physician
practice management and EMR systems, and client and sales
monitoring functions. Additionally, it provides support for the
complicated and constantly changing medical and insurance
billing requirements of today’s healthcare environment.
Moving Forward
Schild, Junger and Kohn expect to continue
improving the functionality of the new LIS. "We’re upgrading to
the latest version and we’re very excited because it’s going to
add to the capability we now have," says Schild. The pathology
capabilities are what Schild is most looking forward to.
"Currently, our pathology reports really aren’t that competitive
because a lot of the specialty pathology labs offer the
photomicrographs and have better report formats," says Schild.
"We expect the upgrade to give us the edge that we need to be
even more competitive and to surpass some of our pathology
competitors." The upgrade is expected to take approximately
three months to complete.
"We have great pathologists and we’re hoping
to improve our market share in the pathology market," says
Schild. "Currently, our medical laboratory provides a range of
services but we want to focus more on pathology, gastro and
urologists. That’s what the upgrade to the new system will allow
us to do."
