Effective Management of Laboratory Information System Personnel Kathy M. Davis, BS MT(ASCP) University of Michigan Health System Department of Pathology Division of Pathology Informatics 03/17/09 1
LIS personnel defined Overview Challenges facing LIS personnel and LIS managers Skill set requirements of an LIS support team Hiring and retaining a strong support team Relationships with lab personnel Relationships with other departments Relationships with vendors Project management and prioritization Crisis management 03/17/09 2
LIS Personnel Defined 03/17/09 3
Who are LIS Personnel? Understand the business needs and workflow needs of the clinical laboratory Responsible for support, maintenance, and configuration of the vendor product to promote and enhance laboratory workflow Responsible for implementation and support of all value added applications and processes that enhance laboratory workflow Understand the business of integration and interfaces Understand network infrastructure Understand systems management and security 03/17/09 4
Overview of Pathology Informatics at University of Michigan 20 FTEs divided into 5 teams Manage > 200 servers with numerous applications Engaged in >150 projects (30+ active at any given time) Support >20 laboratories and off site locations Maintain / support interface engines Manage > 80 interfaces Outreach program support Provide customer service / help desk for clinical, research, and educational divisions 24 x 7 support team 03/17/09 5
Pathology Informatics 03/17/09 6
Desktop Support 03/17/09 7
Operations and Customer Support 03/17/09 8
Systems Support 03/17/09 9
LIS and Interface Support 03/17/09 10
Web Support 03/17/09 11
Time Allocation 15% 5% 25% 10% 10% 15% 20% Help Desk / Customer Service Routine Operational Support Development and Projects Departmental Outreach Program Support Departmental Lean Initiatives Departmental Lab Support Support for External Institutional Initiatives 03/17/09 12
Common Configuration of the LIS Support Team Pathology LIS team supports the applications while the systems and hardware are supported by central IT Potential for conflict exists between LIS team and central IT because of differing priorities, business objectives, skill sets, and educational background MSIS Central IT Laboratories Outreach Program 03/17/09 13
Recommended Configuration of the LIS Support Team Dedicated LIS support team manages all lab applications, systems, and hardware Pathologist MD director provides clout and connections within the organization Manager and LIS support team have laboratory science backgrounds and can speak the language of the lab Central IT Team MSIS Laboratories LIS Support Team Outreach Program 03/17/09 14
Why Structured LIS Support Teams are Important LIS support teams are often more focused on clinical care issues while central IT teams are often more focused on system management and control issues Central IT teams have their own set of priorities and they don t t always include the needs of the LIS or laboratory Central IT team are often quite large which often makes progress more difficult Extra coordination is required to deploy software changes when system processes are required for implementing the change 03/17/09 15
Maintaining the Proximity of LIS Support Team, the LIS Server Room, and the Laboratories Immediate response to problems able to observe the problem Direct communication with the end users core labs Instrument and robotics troubleshooting Desktop support troubleshooting Workflow observation in the Gemba 03/17/09 16
Organizational Politics Educate institutional leadership of the merits of having an Informatics Division or an LIS support team within the Department of Pathology that is separate from Central IT LIS support teams are unique from traditional IT support teams There are inherent risks when LIS support teams have off-site configurations of servers and support staff Periodic struggles with Central IT who believe consolidation of the data centers and IT staff represent the best technical and economic strategy and we manage these struggles to protect and preserve our dedicated LIS support team 03/17/09 17
Understanding the Management Challenges of an LIS support team 03/17/09 18
LIS Management Challenges Information management with regard to laboratory medicine is in constant demand Demand typically exceeds available resources Rapidly changing environment Demands are imposed from many sources Internal LIS unit demands Pathology departmental support / clinical lab demands Mandates from external sources at the institution 03/17/09 19
External Demands Departmental Demands LIS Internal Demands LIS Support Team 03/17/09 20
Internal LIS Unit Demands Politics HR Hire Train Troubleshooting Maintenance LIS Team CAP FDA Data Integrity Security 24 x 7 Support Help Desk 03/17/09 21
Pathology Departmental Demands Rarely a departmental project that doesn t t require IT resources Support for LEAN initiatives and other process improvement activities Support for laboratory outreach programs Support for creation of and implementation solution to complex laboratory workflow processes Manage LIS replacement projects Support for construction and remodeling projects 03/17/09 22
External Demands from Other Institutional Departments Testing and validation of existing interfaces when interfaced systems are upgraded Implementation of new interfaces to support institutional initiatives such as CPOE and ambulatory care information systems Participation in institutional initiatives such as external lab result reporting and blood product usage Interface engine management Majority of demands are unfunded 03/17/09 23
How do we manage all these demands? Identify the necessary skill sets Hire and retain great people Anticipate future staffing needs Build strong work teams Project management tools Customer support tools Communicate, communicate, communicate Constantly prioritize 03/17/09 24
Practically Speaking Don t t attempt to micromanage team members Encourage and enable staff to attend training classes Enable staff to work on projects that excite them in addition to the daily operational support tasks - Happy workers are productive workers All projects will take longer than expected due to competing project priorities and mandates or issues for which you have no control 03/17/09 25
Prioritization Must prioritize patient safety issues first Constant struggle as patient safety issues always compete with project time Important for the LIS team to manage expectations Transparency is best solution to help others understand reasons for project delays Everyone has their own agenda and typically don t care about your concerns Develop executive steering committee to assist with prioritization 03/17/09 26
Skill Set Requirements of an LIS Team 03/17/09 27
Desirable Character Traits Solid interpersonal and communication skills Chemistry that fits with other members of the team Connects well with peers Respected by others Transparent open, truthful, and honest Service-oriented oriented Team player Demonstrates integrity 03/17/09 28
Skills Required Medical Technology or clinical lab science background Application and system programming Database management and query skills HL7 interface programming Desktop support skills Systems, networking, and security knowledge Web programming skills 03/17/09 29
Hiring and Retaining Staff 03/17/09 30
Finding the Resources Medical technologists with aptitude for information management often interested in new career path Central IT staff with desire to change job roles Internal vs. external candidates Experienced vs. inexperienced Consultants Horizontal integration into the laboratories - Laboratory Med Tech IT specialists 03/17/09 31
Medical Technologists Understand the business of the clinical labs and speak the language Tend to have excellent troubleshooting skills and analytical skills Are respected and trusted by fellow laboratory staff Are readily available in the laboratories 03/17/09 32
Consultants Consultants are excellent team members for urgent closed-ended ended projects Consultant salaries often exceed the salaries of existing IT staff which can cause rancor among regular employees Knowledge about how to support the application or service often leaves with the consultant 03/17/09 33
Job Competition with Central IT Staff Important to work with HR departments to ensure LIS personnel and Central IT staff have similar pay scales Use similar job classes and job titles to prevent loosing valuable trained team members to the Central IT division Job satisfaction is often greater in smaller divisions where individual team members tend to learn more skill sets and are less likely to be limited to one or two skill sets 03/17/09 34
Retaining the Resources Exciting and challenging work Diverse work assignments Choice of projects and responsibilities Ability to learn on the job Opportunities for career growth Being part of a good team Supportive management Recognition, value, respect, and trust Flexibility Being fairly treated with fair pay Goodies on Friday 03/17/09 35
Friday Treats 03/17/09 36
Work Groups or Teams Small teams or work groups ensure redundancy of required skills to support the system or application Always avoid single threaded models of support Progress is threatened when bottlenecks occur Team leader roles for each team provide stratification and upward mobility for team members 03/17/09 37
Teamwork Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the tool that allows common people to attain uncommon results. - unknown 03/17/09 38
A Winning Team! 03/17/09 39
More team work! 03/17/09 40
Diversity Cultivate an atmosphere that recognizes, values, respects, and appreciates the strengths and differences that exist among people Average age of population and workforce is rising Two thirds of new entrants into the workforce are women Minorities comprise 29% of new entrants into the workforce Research shows that building diverse work teams take longer, but that innovation and productivity improve over time 03/17/09 41
Managing Across the Generations Traditionalists 1900-1945 1945 Baby Boomers 1946-1964 Generation Xs 1965 1980 Millennials 1981-2000 Loyal, self-sacrifice, sacrifice, likes respect for authority, dislikes waste Optimistic, workaholics, likes responsibility, dislikes laziness Independent, suspicious of authority, likes freedom, dislikes micromanagers Hopeful, determined, likes latest technology, dislikes anything slow 03/17/09 42
HR Issues Anger and hostilities in the workplace Deceitfulness Insubordination Instigators and troublemakers Fault-finders finders and complainers Slothfulness 03/17/09 43
Relationships with Lab Personnel 03/17/09 44
Importance of LIS Liaison in Each Laboratory Section The LIS team must stay connected with the laboratories Horizontal integration into the labs achieved by tagging a bench technologist in the laboratory as an IT specialist that works directly with the LIS support team Ensure that front line workers have ownership of LIS workflow processes Must stay in touch with laboratory initiatives; each lab has their own agenda and priorities 03/17/09 45
Relationships with Other Departments 03/17/09 46
Relationships with Central IT Build strong relationships with Central IT and utilize the infrastructure; it enables LIS teams to address the business needs of Pathology Desktop clinical images, email management, paging systems, security policies are well managed by Central IT teams Utilize server room space for redundancy of hardware and disaster recovery solutions 03/17/09 47
Relationships with Other Ancillaries Important to establish working relationships with other ancillary departments May be able to share expertise when troubleshooting problems May be able to provide mutual space for hardware that provides server redundancies between the two ancillaries partnerships Maintenance contract consolidation Shared hardware resources to reduce cost of ownership and duplication of effort 03/17/09 48
Relationships with Vendors 03/17/09 49
Relationships with Vendors Must work towards a partnership relationship with your LIS vendor to create value for both parties Kindle a culture of co-development and trust LIS personnel are responsible for helping LIS vendors understand the workflow needs of the laboratory Stay involved and participate in user groups Pursue participation on vendor steering committees No undelivered communications 03/17/09 50
Project Management and Prioritization 03/17/09 51
Project Management Keep it simple Formal project management can consume available time and resources to complete the project Web based forms for user requests and status updates Manage expectations - COMMUNICATE 03/17/09 52
Project Management Documents Project Scope Document Project Technical Document Project End User Document Project Validation and Testing Documentation Project Sign Off Project Status Report 03/17/09 53
Project Prioritization IT staff must be able to multi-task task Very difficult to prioritize projects as everyone has their own agendas and priorities The organization is a pyramid with LIS support team the base of the pyramid Steering committee is beneficial to remove IT staff from front line decision making regarding a project 03/17/09 54
Project Dashboard Departmental Projects Team Name Notes APP LIS APP LIS LIS/Balis LIS/Balis LIS LIS LIS LIS LIS LIS LIS HLA Project Mlabs Integrated Report Transcription replacement project AP Inbound Orders Cytology Printers AP Custom Labels Mlabs Connect LEAN data collection for Micro and Cytology Antibiogram revisions ESR Analyzer Interface Chemistry Interface Cytogenetics State Reporting Hematology Paperless Workflow 03/17/09 55
Crisis Management 03/17/09 56
Support Documentation Must have adequate support and troubleshooting procedures for all supported applications Make these procedures available on line Ensure complete information is on file regarding vendor contact information and escalation procedures Conduct drills and post mortem analyses 03/17/09 57
On Call Support Staff Ensure a team member is on call for all technical or end user issues 24 x 7 Cross train individuals for on call rotations Cultivate an expectation that team members may be called upon during off shifts and weekends even if they are not on call if they are the expert for the issue 03/17/09 58
Summary Communicate, communicate, communicate Hire and retain good people Provide ample training opportunities Build strong teams Build strong relationships with labs staff, other departments, and vendors Stay organized Be NICE! 03/17/09 59