le01.jpg (12846 bytes)Minneapolis-based Allina Laboratories — a reference lab that is part of Allina Health System’s network of hospitals, clinics and healthcare services in Minnesota and Wisconsin — operates in a very competitive environment. We needed to upgrade to electronic connectivity for lab results and lab orders to offer better service to current and prospective customers and also to compete with commercial laboratories.

    At the same time, Allina Health System wanted to help clinicians provide better care through enhanced access to clinical data and improved workflow. Specifically, the organization wanted to improve how doctors, nurses and technicians ordered tests and retrieved the results. Not only would this process improve patient care at Allina’s 54 clinics, but because of decreased test duplication and fewer errors, it would impact the health system’s bottom line.

However, considering that thousands of tests are processed every day, we knew this would be no easy task. The resulting solution would have to be implemented quickly, economically and provide functionality for thousands of clinical users. Performance was a key factor, considering the nearly two million clinical transactions per month. Because Allina planned to roll out the solution to its 54 clinics, flexibility and vendor receptivity were key issues.

Web-Based Solution Produces Real Results
After reviewing several applications, we decided on ClinLabs.com, a Web-based lab order and results management information system created by iMcKesson, a subsidiary of McKessonHBOC in San Francisco. We interfaced the product to our central lab information system and provided physician and clinic access to the application using our existing intranet. iMcKesson hosted the application on its servers so that Allina did not have to make investments in hardware and technical staff to support system operations.

    What started as a three-clinic pilot project is now a successful implementation. The Web allowed us to roll out the solution quickly to clinics, hospitals and other trading partners. It has improved both the efficiency and cost effectiveness of our laboratory services. Using ClinLabs.com, Allina physicians can quickly order tests, verify benefit eligibility and receive lab results anywhere there is security, connectivity and a browser. That includes Allina clinics and several of our hospitals.

    The Web-based solution also has allowed us to capture market share within the system. Allina currently uses the application at more than 45 clinics where physicians have access to critical patient data at the point of care. ClinLabs.com helps them support clinical care delivery through online, rules-based order entry for the 86,000 lab tests the Allina Reference Lab performs every month.

Better Information Improves Lab Services
In June 1999 we completed a customer survey to identify the percentage of total requisitions received with inadequate information. Then we identified missing data in the requisitions, including patient demographics, insurance information and diagnosis. We tracked the requisitions for one year before installing ClinLabs.com and verified that we received a very high percentage of requisitions with misinformation. In fact, the misinformation rate at one clinic was as high as 34 percent.

Web-based System Benefits
Doctors and Clinical Staff

Recent survey results revealed greater satisfaction with our lab because ClinLabs.com makes it easier for physicians to keep on top of patient status. Accessing data quickly from both the clinic and the hospital is enormously helpful. Physicians and clinical staff have noted the following benefits:

• Eliminates the time lapse between ordering, performing and retrieving test results and decreases test duplication.

• Ensures HCFA compliance, which improves reimbursement and medical necessity documentation.

• Built-in alerts notify a physician when test results are outside a predetermined range or when they aren’t received by the expected date.

• Graphs test results for trend analysis. This results in better care, understanding and analysis of patient and populations over time.

• Improves clinical workflow and reduces debt risk by automatically checking patients’ benefits eligibility.

• Reduces redundant testing by aggregating test information in an accessible clinical data repository of patient information.

• Reduces administrative burden and reliance on
patients’ paper records (30% of chart pulls in physician offices are to compare prior lab results).

• Distributes patient clinical data and follow-up tasks to all staff clinicians, vastly improving inter-office communication.

    We installed ClinLabs.com in February 1999 and tracked our customers’ requisitions for the next nine months. We quickly learned that when our clients started using the solution we received better and more accurate information. We saw a rapid decline in demographic and billing misinformation. In fact, the percentage of misinformation at that same clinic dropped from 34 percent to less than 5 percent in four months. Using the Web-based solution we get the right information from our clients to facilitate accurate test ordering. Other benefits include:

• Decline in diagnostic misinformation
Diagnosis is the most critical element in client billing. At first we did not make this a mandatory field, because we did not want to force physicians to use the system. But after several months, we made diagnosis a required field and began to see the improvements that brought our inadequate information figures below 5 percent.

• Increased access to lab results
Physicians in clinics and hospitals electronically order tests, verify lab eligibility and receive test results. Most find it user friendly. Some have jumped right in to look up results, while others will always depend on the lab staff to look up results for them.

• Increased user satisfaction with lab services
There has been widespread acceptance of the Web-based lab reporting system. Physicians find it easy to use. Recent survey results reveal that our clients find lab results easier to access and more usable. Results also point to an improvement in overall service quality.

• Big improvement in audit rates
During our quarterly audits we pull 50 requisitions, related to Medicare billing, to verify that we have met the government’s criteria. If not, we have to refund the money. We have seen significant improvements in our audit rates because ClinLabs.com gives us the information we need to create a compliant bill.

• Reduced administrative burden
Automating lab testing communications saves re-keying time and delivers results faster, allowing a higher volume of lab testing. Because of the interface, lab order information no longer has to be re-keyed into the results system, reducing our administrative burden and freeing up staff.

Keys to Success
ClinLabs.com is a success because we are in constant communication with our clinic clients and laboratory staff and have included them in the program’s development. Other keys to success include:

    Provide adequate training. Everyone has a different comfort level with computers, so we make sure our clients are well trained and comfortable with the system. At first there was a large learning curve and a little resistance, but the more our staff worked with the product, the more clients jumped on the bandwagon.

    Actively seek feedback. We constantly ask questions to make sure we meet our clients’ needs as well as the needs of our lab staff. We also meet regularly with the vendor to ensure the system remains user friendly and accurate.

    Select a Web-based solution. The Web-based solution’s flexibility and scalability were keys in the low-cost rapid deployment effort. We added a second clinic two months after the first one went live, then four months later four additional clinics went live. The only installation was the browser — there was no hardware investment — and the solution runs on iMcKesson’s network, so it doesn’t have a major impact on Allina’s IT resources. As a result of using the Web-based solution we are very competitive now, and we hope to have the solution up and running at all 54 Allina clinics by the end of the year.

Ron Villella, MD, is medical director at Allina Laboratories in Minneapolis.