Labs were among the first hospital departments to benefit from computerization, and many lab leaders consider it obvious that they are fully committed to information technology. However, today's lab must look far beyond sample tracking and results reporting and push hard for IT budgets that allow the lab to explore new capabilities. Cutting-edge analytics, clinician alerts, and other IT innovations can help labs play a key role in achieving the best possible clinical and financial outcomes for their institutions. Every lab needs an IT investment strategy that reflects and serves the mission of improved care at lower cost.
The cornerstone is a state-of-the-art laboratory information system (LIS), says Eyas Hattab, Chair of the department of Pathology and Laboratory Medicine at the University of Louisville. "[The LIS is] that network of roads and highways that not only traffics information back and forth but also creates an infrastructure through which you are able to derive data mining, and data analytics," Hattab says.
Without the right LIS infrastructure, institutions may struggle to extract the lab data they need to measure their performance, achieve their quality targets, and capture performance-based reimbursement. Lab leaders may have to push their C-suite to understand the value of proper LIS support, Hattab says, and they should be prepared to illustrate how the investment will allow the lab to contribute to the larger mission.
Even the best LIS must be able to feed information to, and draw from, the electronic health record (EHR) system. "Without good continuity there, everything breaks down in terms of the clinical practice," says James Nichols, Medical Director, Clinical Chemistry and Point-of-Care Testing at Vanderbilt University School of Medicine. Integration isn't always seamless even when the same vendor provides both the lab system and the EHR, but it's especially important to budget time and money to get disparate systems talking.
Analytics are as vital in the lab as in any other part of a medical center, says Steven Zibrat, Laboratories Manager of Quality at University of Chicago of Medicine. "The laboratory is producing vast quantities of data that go into a typical EHR and with all that data, there's the need to be able to extract relevant parts of it in order to make datadriven decisions about care, about processes, about what you're going to do within your organization to manage the care of your patient population," Zibrat says.
Lab leaders must be prepared to participate in integrating multiple data sources to answer key questions about the value of their services, says Diane Kremitske, Vice President of Laboratory Operations at Geisinger Health System. "What was the effect of having that test performed?" Kremitske asks. "Did it keep the patient out of the specialty office? Did it reduce length of stay?" Those types of questions can only be answered by combining multiple sources of data, from the lab itself, from the EHR, from administrative systems, and insurance claims.
Lab leaders must play a role in designing EHR functions to help clinicians order the correct tests and interpret the results from them, Kremitske says. Geisinger has significantly decreased unnecessary blood tests by eliminating standing orders for inpatients, which allows clinicians discretion in deciding when the tests are actually needed. Vanderbilt has gone even farther, building a "lab formulary" into its EHR that uses the patient's information to determine which tests are appropriate; it also blocks orders for tests that aren't in the formulary. Each new test must be approved by a committee that defines its appropriate use.
"Simultaneously, we are working backwards to look at bad patterns, like 'top of the list' items that are over-utilized" simply because they come first on the list, Nichols says. "We have to decide how to attack those, both with education and with hard or soft stops in the IT system. We need good IT support to think around these systems and support these laboratory initiatives."
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