Elements of a Successful LIS Change

September 2015 - Vol.4 No. 5 - Page #2

Q&A with Anntoinette Burger, MBA, MT(ASCP)
Cayuga Medical Center
Ithaca, New York


Medical Lab Management: What are the overarching keys to a successful LIS upgrade or replacement?
Anntoinette Burger: Cayuga Medical Center (CMC)—a not-for-profit, acute-care medical center in Ithaca, New York—has undergone significant structural and operational improvements in the last 5 years, not the least of which was the building of an entirely new laboratory in the summer of 2012. Although the upgrade to our laboratory information systems (LIS; as part of a hospital-wide adoption of EHR systems) came shortly thereafter, it is important to note that the lab was able to revamp its entire management structure prior to the upgrade in order to better manage process improvement projects, and this has been integral to the success of subsequent initiatives, including the LIS upgrade. 

Many laboratorians have gone through similar transitions with a major upgrade, and it is vitally important to include input from lab staff in the planning. Changing or instituting major upgrades to an information system (such as an LIS) broadly effects any department that has its own workflow, requirements, and responsibilities, the nuances of which may be unfamiliar to information systems (IS) staff making decisions for the entire hospital. Thus, laboratory directors should take it upon themselves to demand a seat at the table when facility changes will affect something as significant as a medical center laboratory’s LIS. Although there are myriad important keys to success, making sure lab experts are highly involved in the project from day one is arguably the single most important factor in the successful transition to new LIS functionality.

MLM: How should laboratory administration approach an LIS change?
Burger: First, identify the functional specifications necessary for the lab to run smoothly—a process that requires input from frontline staff. In order to create a comprehensive workflow map, ask staff members to elucidate a best-case scenario from their workflow perspective. Detail how specimens currently are delivered to the lab and how they are identified, handled, analyzed, resulted, and stored. Then look for areas of improvement. Challenging staff to identify the best way to manage lab workflow is a great way to gain their buy-in and support.

Clearly, collaboration with IS services is vital to any LIS change, but this is an area where careful management is necessary. The lab must lead the change process with support from IS, not the other way around. 

In my experience with multiple, large-scale computer hardware and software installations, the most successful projects start with broad education for all parties involved in the build about the new functionalities. An implementation team should be formed comprising operational, managerial, and LIS/IS technical representatives, and those people need to be provided with a detailed overview of what the new system can do. Ideally, the system vendor will put you in touch with other users to gain insight into the scope of the system’s capabilities. This process can take time, but is absolutely essential to avoid greater problems downstream, once the new system is in place.

Once all relevant staff have a firm understanding of the new system capabilities, the operational aspect of the team must take over and align those capabilities with the best-case scenarios elucidated during workflow vetting. Without a doubt, each member of a given lab’s staff can name at least one operational improvement that would benefit themselves, as well as the lab; extricating detail is the key. For example, ask each staff member to indicate the type, time, layout, and content of LIS reports that would be most advantageous. Having already gained an understanding of the system’s capabilities via the aforementioned education, this should be a relatively straightforward task. Ideally, IT then will take these suggestions and find ways to make them reality.

The desire to maintain control should not be underestimated, as it can be easy for the IS team—given their innate experience with information systems—to make independent, substantive decisions regarding system functionality that may be at odds with what the lab wants. Therefore, the essential, broad-stroke concepts that tend to be the most useful when it comes to LIS changes are as follows:

  • Educate all affected staff on the new system’s functionality
  • Describe the current workflow and create an ideal-state workflow via operational lab staff
  • Consult with IT representatives and have them support with technology the designs created by lab operations 

MLM: What is the management structure for the LIS from a personnel standpoint?
Burger: We currently employ an LIS manager and two dedicated analysts, one of whom primarily works with our middleware systems. Our LIS and IS teams were in transition with new leadership after the upgrade go-live. The importance of a culture of detail, inclusion, and imagination cannot be underestimated in maximizing the value of information technology. This is as important as the department structure.

MLM: What is the role of middleware in enabling the lab to realize fully the capabilities of the new LIS?
Burger: As most lab directors know, working with a legacy LIS can be challenging when the upgraded or replaced system is less than robust in meeting the lab’s demands. In today’s clinical lab, which encompasses so many platforms and software systems, it can be unrealistic to expect a single LIS provider to accommodate all of the lab’s needs. This is why middleware has become such an important aspect of lab operations. In our core lab, we have an automated line that went live in early 2014. The line’s middleware has capabilities that our legacy LIS could not match. In order to plumb the capabilities of our new automated line and analyzers, we implemented data management middleware that provides several benefits. It allows our team to configure for auto-verifications, auto-reruns, auto-dilutions, automated add-on testing, automated specimen retrieval, and EQC rules.

As opposed to placing an expectation on the legacy LIS vendor to enable this compatibility, we found that middleware is ideal for bridging the gap. The focus of an LIS vendor (or that of a vendor of an EHR with LIS functionality) likely is on the fundamentals of order entry, result reporting, specimen management, and interfaces with equipment, but the lab requires progressive functions, such as auto-verification rules—that many legacy LIS systems do not perform well. As middleware developers have become more sophisticated, our lab has acquired additional middleware for point-of-care data management and for connectivity to CMC-affiliated doctors’ offices (ie, outreach). We are in the process of implementing a courier tracking system for specimen accountability both within CMC and throughout our outreach network.

MLM: Now that you have settled into its use, what are the primary benefits of the LIS system?
Burger: Formerly, nurses had test descriptions that were separate from ours; now all testing descriptions and terminology are universal in the system. If we update our side, the nursing side is automatically updated using the same terminology. The upgrade also gave us the opportunity to rebuild test dictionaries and improve process designs.

MLM: How does CMC integrate LIS capabilities for outreach efforts?
Burger: As part of CMC’s ongoing outreach efforts, we partnered with another hospital in 2014 to provide lab services (among others). Despite having the same IS vendor, the versions of the systems were different and had a hard time interfacing. In the course of jump-starting our outreach program over the last few years, we worked with Mayo Medical Laboratories to reassess our program. Given my past outreach experience, both as a consultant and in previous lab management roles, I realized we needed to revamp our lab outreach program to make it more competitive. Although we had launched an outreach program and been successful in gaining business, we were losing some of that business due to a lack of necessary features, such as timely EMR integration and a dedicated courier service.

Mayo Medical Laboratories was able to assess our operational and IT resources. Out of that came recommendations to acquire middleware for EMR integrations. That component completely changed our direction for the positive. The ability to interface with practically any outside EMR or LIS gives significant control to the laboratory when it comes to enabling client lab services for outreach business. By developing this open integration system, we will be acting as a reference lab for the other hospital. They can send us batch orders through the interface, and we can send results back the same way. This is the same system we use for our doctors’ offices outreach.

Anntoinette (Toni) Burger, MBA, MT(ASCP), is the administrative director of laboratory services at Cayuga Medical Center at Ithaca in New York. She received an associate of arts degree in medical laboratory technology from the College of Mount St. Joseph in Cincinnati, a bachelor of science in medical technology from Bowling Green State University, and an MBA from the University of Toledo. Toni also received a Lean Healthcare certificate from the University of Michigan and is a member of the Clinical Laboratory Management Association (CLMA) of Central New York.


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