Lab IT Strategy: Evolution or Revolution Where do we go from here

Transcription

1 Lab IT Strategy: Evolution or Revolution Where do we go from here

2 How did we get here: Peaceful Coexistence HIS Takes on the Lab Poor results due to: Transaction Volumes bogged down systems during peak use Detail level of applications to support each discipline and sub-discipline required resources beyond the vendors capacity Very few attempts achieved moderate success (UAB), most were disasters ROI for vendors was poor Exceptions: MediTech and Cerner Both Started in Lab EWS Integration Abounds HL7 helps, but doesn t solve the problem PID issues Data Synchronization Issues Different types of lab data not gracefully handled by HIS It s hard to do Lack of Interoperability HIS vendors learn to Peacefully Coexist with the LIS BoB

3 Today Reference Laboratories CORE LAB LIS Network Connections Local, WAN, VPN Clinics, Nursing Homes Remote Laboratories Hospitals Physician s Offices

4 BoB Single Database Outreach/ Client Service HLA GL/ Micro Single Database AP/ Genetics BB Trans/Donor Applications utilize a single database Complex Rules and Alerts can be utilized All lab results on patient reports Single vendor contract and contact. BoB cost $300 to $4.0M & up, depending on modules and hardware

5 Integrated Platform Outreach Genetics Client Service Core GL/AP LIS Micro/BB HLA All applications interface results to Core LIS Multiple vendors require multiple contract, contacts, license, and maintenance fees Some loss of functionality with Rules and alerts.

6 Fractionated Platform HLA Genetics BB Donor Additional independent installations months Additional cost for license and installation. $250K to $500K Outreach/ Spec Tracking Client Service BB Trans Multiple installs months Not interfaced with Core Additional cost for license and installation. $400k to $750K CORE LIS (GL/Micro/AP) month implementation May be part of EMR system Initial cost for application license and installation $800K to $1.4 mil

7 Vendor Application Comparison Department Epic Cerner McKesson Meditech SCC Soft Sunquest Specimen Processing General Lab / Core Blood Bank Transfusion Blood Bank Donor Stem Cell Lab Apheresis Lab Microbiology Lab Anatomical Pathology Cytogenomics Immunogenetics Immunology Molecular Genetics Point of Care Virology Lab OutReach Module Client Services module Comments All Vendors listed in alphabetical order All responses sent by each vendor Compiled by S&P Consultants, Inc Separate application Limited functionality Standard Functionality Separate database

8 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 significant Fractionated Acquisition/Upgrade Digital Pathology Molecular/Genetics/. Outreach Departmental Issues New Automation New Services New Business Opportunities Driving Forces in LIS Requires C-Suite Approval

9 EWS Encroaches on the Lab Executives 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 new modules, the cost will be significant enough that it requires C-suite approval Labs being asked to or directed to switch to the EWS lab module for the good of the whole (similar to Meditech situation years ago) Are you ready to install a completely new LIS? Is this the right move for your lab? How do you know? Are you prepared to build a case to counter the C-suite s generous offer?

10 C-Suite Understands: LIS Strategies Costs, Head Count, Revenue, Liability Financially focused not clinically or functionally focused C-Suite believes they already paid for new LIS It s Free C-Suite likes followers - Don t directly challenge Pro-Active Now - Develop a business plan that justifies staying with BoB Assess Where you are, Where you need to be and When (Timelines) Info to collect Metrics Old Style RFP will not work in your favor

11 Version Upgrade VS New LIS 6 figure funding opens Pandora s box All questions become open and long term LIS strategy is a new focus. Cost: Time: $150K to $750K & UP depending on vendor, system size and if hardware upgrade is required months for new code to be installed and validated Resources: All areas of the lab must be involved to validate code and any new enhancements. IT is also included due to interfaces and hardware. Benefits: Many times little to no major enhancements are included. Required by vendor or due to new module being implemented.

12 Version Upgrade VS New LIS New 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 modules 12 to 36 months depending on size, vendor and modules Resources: 6 to 14 Lab resources, 1-4 LIS resources, and 2-3 IT resources Benefits: 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 current system New hardware which may reduce maintenance cost and support

13 Timelines Version Upgrades LIS and minor lab involvement 2 12 months New LIS Implementation months IT, LIS, and entire lab involvement. Re-training of ALL staff It s NOT FREE

14 Reasons for new LIS New functionality needed that is not included in current LIS New modules required for emerging markets that are not available or fully functional by current LIS Extremely old version of code which will require multiple upgrades to get 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 new entity Vendor sunsetting current system and upgrade to new system is a completely new LIS install Current system unable to interface with new instruments and automation

15 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 modules or full functionality Move to new LIS simply because Version upgrade is required

16 Business Issues Patient Continuum Diagnostic Report Day-to-Day Operations Integration Still Here Specialty Areas Outreach Issues Accountability Mgmt Reports The Future Data vs Info Precise Medicine

17 Source of Patients Enterprise, (Hospitals, Clinics, Physician Office) Non-Enterprise Source Physician Office, Corporate Contracts, Nursing Homes, Out of Area Overlapping Patient: Separation of Records when patient is both Enterprise & Non-Enterprise Collection & 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 Methods Patient Continuum

18 The Diagnostic Report This is your product Data vs Information Patient vs Physican Digital Pathology Images Lost-in-Translation Issues Liability Issues Reference Lab Reports In/Out

19 Integration/Interfacing It doesn t go away

20 Day to Day Operations Automation Reference Ranges & Studies Cross department Rules Specimen Flows Dashboards Tracking Orders, Specimens, Results, Repeats. Lab Data as the Lab Knows It

21 Accountability/Management Reports/Research Management Reporting Business Intelligence Turnaround Time Analysis Tracking Orders, Collections, Receipts, Corrections, Queries,. Lab Retained Data (stuff that isn t reported) Research/Special Studies Multi-facility issues

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23 Data vs Information PSA Sample Report referred by Brian Jackson, MD, CMIO ARUP from guest blog on LabSoft and article in Wired Magazine

24 Data vs Information Cardiology Sample Report referred by Brian Jackson, MD, CMIO ARUP from guest blog on LabSoft and article in Wired Magazine

25 Sample Report referred by Brian Jackson, MD, CMIO ARUP from guest blog on LabSoft and article in Wired Magazine

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27 Conclusions Assess your Business & LIS Strategy NOW Be Prepared to measure costs at a higher level FAQs: 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 out