By Roger Jacobs, MT(ASCP)

 Roger Jacobs in his office at Huron Medical Center

Staffing shortages; decreased reimbursement rates; JCAHO, CAP, and confidentiality regulations; the need for quality assurance and fewer medical errors, these issues are more than familiar to all of us. This is the reality each of us faces every day. These concerns are not a new reality for laboratory managers; we have been grappling with them for years now. In fact, in 1999, Huron Medical Center (Bad Axe, Mich) was at a crossroads as it faced this reality head-on, while wallowing in a paper jungle.

Huron Medical Center is a 64-bed rural hospital about 120 miles north of Detroit. The hospital operates a CAP-certified, full-service, 24/7 laboratory that handles approximately a half-million tests per year. Until recently, the laboratory used a manual ticket system to fulfill orders and report results of the tests performed there for the 800 doctors it serves on staff and across northeast Michigan. Information technology resources hospital-wide were limited and consisted primarily of an older hospital information system that was serviced by two consultants working on contract with the hospital.

We knew that a laboratory information system would dramatically improve efficiencies and help reduce clerical and billing errors. However, it was difficult to substantiate the costs associated with a non–revenue-producing capital expenditure to a conservative hospital board tasked with closely watching the bottom line. Even the board could not ignore the challenges we faced: a future with fewer certified, experienced techs and more complex testing combined with a demand for faster turnaround on results and improved reimbursement rates. The time was now.

The Search
As a longtime CAP inspector, I knew that there was a great deal involved in implementing an LIS. It was not just software. The physical infrastructure had to be in place: a dedicated room with the proper physical security, temperature control, humidity control, cabling, etc. The hardware on which the software would run had to be purchased, and this typically includes servers, workstations, printers, storage and network equipment, security gear, and backup and recovery tools. Additionally, services associated with the implementation of the system and training, as well as ongoing service and support, had to be factored in. And, as a full-service lab, we also had to account for an anatomic pathology information system in our budget.

We embarked on an 18-month research project during which we conducted exhaustive research of LIS vendors, relying on various industry resources, including the CLP Buyers’ Guide. We narrowed our search to 10 vendors that seemed to best fit what we were looking for from the standpoint of functionality for a lab our size. Cost was obviously a factor—even early on—and helped us further narrow our pool of contenders, particularly as some vendors seemed resistant to providing us a quote in the initial stages of our search.

Ultimately, we boiled it down to three finalists that best fit Huron’s needs. We began a more in-depth examination of these systems through on-site demos and site visits. On one of the on-site vendor visits, Huron learned about the hosted system option. We were somewhat skeptical at first because we weren’t familiar with this concept and I am not what you would call a tech guru. The beauty of it, however, is that you don’t have to be. In fact, the more we learned about it, the more it seemed the most sensible choice, since we didn’t have the in-house technical expertise. Moreover, we learned from our research that the hosted system—when we took all the related investments into account over a 5-year period—would actually come in at about one third the price of the average turnkey system.

How Hosting Works
What is hosting? A modernized, computer-age definition reads: “a computer that provides client stations with access to files and printers as shared resources to a computer network.” At Huron the LIS and supporting software and hardware on which it runs reside at and are managed by our vendor.

Psyche Systems runs and maintains the server, the software, and the network connections, and the systems experts there are responsible for system management and maintenance, proactive security monitoring, and 24/7 technical support. I regard them as my own personal IT staff. They are intimately familiar with the laboratory system, since they also developed, implemented, and trained the system.

Huron uses a frame relay circuit as a dedicated, private line that connects nine PCs—within the lab, ambulatory area, and nursing stations, one terminal server, three high-speed printers, and a fax modem to the data center at our LIS vendor where the server running our LabWeb software resides. Two firewalls—one there and one at Huron—secure the connection between the two facilities and a third firewall sits between the LIS and the HIS for an added layer of protection. Technically, the laboratory system resides on the hospital network, but is not actually part of it so if the hospital network goes down, the lab system is still up. This set-up enables us to run our system optimally since the system’s experts are managing it, while we preserve control over the data and the workflow. Just as is the case with a turnkey LIS, the system seamlessly interfaces to instruments in the lab, as well as the HIS.

What I’ve really learned from the experience is that I’m not losing a system, but rather gaining a virtual IT staff. When my users come at me with questions about reports or instruments or printers or whatever, I can pick up the phone and tap into a team of experts in different competencies to address my questions or troubleshoot my issues. Huron has limited in-house IT resources, charged with managing all the hospital’s systems and technology infrastructure, so seemingly minor issues—like a printing problem that may delay lab reports—might not be addressed right away. The laboratory is always a top priority in the hosted system arrangement.

Return On Our Investment
Implementing a hosted LIS yielded a much lower total cost of ownership than the turnkey software evaluated, and the laboratory has benefited from a virtual team of experts to help us manage and maintain the system. The real, measurable value of the system is in the significant increase in productivity we experienced, even with a 20% reduction in staff due to departures. On average, we handle more than 200 patient cases per day, which represents a 25% increase in caseload with the automated system. The increase in efficiency gained will be even more critical as we—as an industry—face an increasing shortage in qualified techs.

The LIS has enabled us to streamline processes and create efficiencies in billing and record keeping, as well as in distributing reports. Pulling demographics directly from the HIS has enabled us to ensure the accuracy of patient records and thereby minimize potential billing errors. This automation allows us to process claims faster for improved reimbursement rates, which contributed to hospital-wide savings from over 90 days to under 50 days for reimbursement. Similarly, electronic record keeping has cut the amount of storage space required for what previously was a very large volume of paper records, since we’re required to keep records for up to 2 years. Similarly, the ability to quickly and easily retrieve cases has allowed us to have ready access to historical patient data. It’s also helped us create efficiencies across two departments since all the reports automatically print alphabetically every day for the Medical Records department.

Perhaps more importantly, the laboratory has experienced improved turnaround time and achieved a higher quality output with the laboratory system. Preferences set in the system ensure that the reports are created and distributed to the right place at the right time. The physician can decide whether she wants reports couriered, faxed, or printed remotely—one, two, or three times a day. The system manages distribution to every doctor involved in a particular case, both within the hospital and outside its walls. As a CAP-certified lab, we conducted a survey of all our inpatient and outpatient physicians in which we received positive responses on improved quality and turnaround time of the reports generated. In the absence of such a formal survey, the system enables us to monitor our turnaround time directly, as well as produce other types of quality assurance reports, so we can make adjustments to improve our processes and adapt to the physicians’ changing needs.

The bottom line in implementing any new technology is better patient care. The ability to assure fewer clerical errors, and produce faster and better quality reports empowers our clients—the physicians—to make more informed treatment decisions. In our rapidly evolving health care environment, it’s the freedom to each focus on our particular areas of expertise that will ultimately produce a higher quality of care. And, a hosted LIS allows laboratories to focus on running the lab, not the computer system. Technology must be an enabler, not a distraction. The freedom for me and my staff to focus on generating a high quality product will ultimately help us keep ahead of this rapidly evolving industry and the changing needs of our clients.

Roger Jacobs, MT(ASCP), is the director of laboratory services for Huron Medical Center (Bad Axe, Mich).