Managing LIS in Complex, Multi-Site Laboratories. Organizational slides courtesy of Laurie Huard, MT (ASCP), FACHE

Transcription

1 Managing LIS in Complex, Multi-Site Laboratories Dennis Winsten, MS, FCLMA, FHIMMS Dennis Winsten & Associates, Inc. Tucson, Arizona Hal Weiner, BS,MBA Weiner Consulting Services. LLC Eugene, Oregon Organizational slides courtesy of Laurie Huard, MT (ASCP), FACHE

2 MANAGING MULTIPLE LABS

3 ISSUES AND CONSIDERATIONS Multiple, Pre-existing LIS in Operation Multiple Different HIS Interfaces Multiple LIS Management and Support Staff Different Operational Models for Each Lab Geographically Distributed Locations Test Routing Approaches Coordination of Processes and Procedures Compiling Enterprise-Wide Statistics Organization and Staffing Management Guidelines

4 LEARNING OBJECTIVES Learning Objective #1 : Recognize the differing multi-site laboratory operational models and their impact on management Learning Objective #2 : Identify and describe the alternatives for LIS in multi-site laboratories Learning Objective #3 : Define the various issues associated with multi-site labs that affect organization. staffing and management.

5 Topics LIS Issues: Multiple vendors, Interfaces, Staffing Operational Models: Types, Considerations, Alternatives Organization & Staffing: Authority, Ownership Management Guidelines: Departments, Change Control, Compliance

6 Multiple, Pre-Existing LIS in Operation Potential for replacement with a single, common LIS? ROI reduced support fees, modern system Re-training and disruption considerations Budgetary constraints LIS-to-LIS Interfaces Simulate send-outs to reference laboratory Cost of interfaces vs. sneaker net

7 Multiple Different HIS/EMR Interfaces Potential for replacement with an Enterprise-Wide system with an integrated LIS? ROI reduced support fees, modern system Significant re-training and disruption considerations Integration across the enterprise Implications for laboratory operations? Significant budgetary impact of EWS

8 Multiple LIS Management and Support Staff Little change if same LIS are retained May require a Coordinating LIS Manager position Staff reductions possible if a common LIS is acquired

9 Different Operational Models for Each Lab How the multi-site laboratories will operate among each other and with their host hospitals can be a major factor in determining the best approach for LIS operations. If you ve seen one multi-site operation. You ve seen one multi-site operation. Generalizations are dangerous, e.g. MULHOS

10 LABORATORY OPERATIONAL MODELS OFF-SITE CENTRAL LABORATORY ON-SITE CENTRAL LABORATORY DISTRIBUTED LABORATORIES

11 OFF-SITE CENTRAL LAB ( Economies of Scale Model) Hospital A Hospital B RRL Central Lab RRL RRL Hospital C

12 ON-SITE CENTRAL LABORATORY ( Economies of Space Model) Hospital A Hospital B LAB RRL RRL Hospital C

13 DISTRIBUTED LABORATORIES ( Centers of Excellence Model) Hospital A Hospital B LABa LABb LABc Hospital C

14 OPERATIONAL MODEL IMPACTS ON L I S CONSIDERATIONS ISSUES GOVERNANCE UNIFIED OR AUTONOMOUS DATA BASE SINGLE OR MULTIPLE DATA ACCESS OPEN OR LIMITED PATIENT IDENTIFICATION SINGLE OR MULTIPLE TESTING SITES CENTRAL OR DISTRIBUTED TESTING PROTOCOL UNIQUE OR REDUNDANT

15 Alternatives for LIS in a Multi-Site Environment Multiple, Independent LIS (HIS/EMR as liaison) Multiple, Inter-Operating LIS Single, Best-of-Breed LIS Enterprise-Wide LIS

16 Multiple, Independent LIS Ability to compile, compare and combine statistics, e.g. common statistics reports Excel format or other Ability to compare, compile and summarize financial data May need interface to enterprise-wide system No accrual of benefits or savings for the multi-site entity

17 Multiple, Inter-Operating LIS Establish an operational model for testing and reporting Ability to compile, compare and combine statistics, e.g. common statistics reports Excel format or other Ability to compare, compile and summarize financial data May need interface to enterprise-wide system (EMR or HIS) Establish a common test code dictionary or translation table Establish and validate all LIS-to-LIS interfaces

18 Single, Consolidated LIS Obtain discounts from selected vendor for multi-site operations with a common LIS Assure adequate time and expenses for re-training and transition to new LIS Consider impact on LIS support staffing for reconfiguration and personnel reductions Establish and confirm a transition plan for switchover

19 Enterprise-Wide LIS LIS is an integrated component of a comprehensive enterprise-wide system (EWS) Utilizes a common electronic medical record (EMR) to accept and retain data from all system modules including the LIS Laboratory management needs to assess impact of EWS LIS on laboratory operations The EMR may be the source of laboratory information for external users-except for outreach clients

20 TRANSITION TIME Enough about systems and things Time to talk about organization, staffing and management thereof

21 Organization and Staffing Authority Matrix Lab vs IT ownership Lab Model Impact Transitional Staffing Impact Traditional Staffing

22 Authority Matrix Local vs. System-Wide decisions Internal changes approve change control New partner HIS, Billing, Enterprise Solution Remotely Hosted LIS considerations LIS leader direct report to Lab Executive Participate at Lab Executive Level meetings > Provide solutions > Strategic planning

23 Lab vs. IT Ownership Pros and Cons of Lab Ownership + Timeliness + Prioritization of needs + Lab operational knowledge - Available $$ and physical space - Network expertise Pros and Cons of IT Ownership + Robust process checking + Network Infrastructure + Security - Prioritization issues -Timely support

24 Lab Model Impact to Staffing Off-site Central, On-site Central or Distributed Network infrastructure support at RRLs? Super-User support at RRLs? Disparate HIS? Standard instrument lines? Independent, Inter-Operating or Single LIS Staffing decreases proportionately > Fewer number of disparate LIS environment(s) > Cross training depth

25 Transitional Staffing Implications Current State vs. Future State Establish Timeline Outsourcing Possibilities Who is in charge? Dual leadership Team dynamics Operational challenges Transparency to stakeholders Key communications

26 Traditional Staffing LIS Leader Title dependent on size,scope of operation Authority joint with Lab Admin - IT Staff Position types General lab integration IT Liaison Advocacy role

27 Management Guidelines Authority Matrix LIS Dept FTEs Floats Department Organization Workstations Cross training Super User Concept Change Control CAP Considerations

28 Authority Matrix Management within established guidelines Escalation Grid Communication Board Resource availability continual challenge Daily operations vs. projects planned Consider chargeback for department labor Decision $$$ Labor

29 Department Organization Job titles Analyst Computer Operations Workstations By Application(s) Maintaining Competency Cross Training Buddy System Super User Help Desk

30 MURPHY S LAW If something can go wrong.... It will If nothing can go wrong....it will

31 Change Control In Complex Arena SINGLE MOST IMPORTANT PROCESS Affected stakeholders must be informed Robust testing plans > Outputs > Billing Scheduled Activities Unscheduled Activities Communication Plans

32 CAP Considerations LIS Manuals Build to reflect CAP checklists LIS Dept vs. User Manual Training and Competency Job descriptions drive these elements Hardware On site vs Remote hosted platforms Environment Internal vs. Outsource

33 SUMMARY There is no single multi-site laboratory operational model. Different models impose different requirements for operations and management LIS models can vary Single, Best-of-Breed LIS Multiple, Inter-operating LIS Enterprise-Wide LIS Establish an Authority Matrix. Decisions can be made locally or systemwide Consider who owns the LIS Lab or I.T.? Various pros and cons. Important to have direct communications to C-Suite and stakeholders Change Control is a key consideration Lab operational model significantly impacts staffing

34 QUESTIONS - COMMENTS??