Clinical labs, like many organizations, struggle with how to innovate while accomplishing daily tasks. But by dividing functions and assigning to specific employees, labs can smooth their path to the future.
“Why is the rear view mirror so small and the windshield so big?" asks Terry Carroll, rhetorically. He's a long-time health system CIO who's now a principal with the SPRING Network, an organization that helps healthcare organizations manage and embrace change. “It's because it's less important to see what's behind you than to see what's ahead. A lot of resource mismanagement comes from making your rear view mirror too big."
Carroll says daily operations should be separated from future planning to a large degree. “People dealing with keeping the trains running don't have the time to look through the windshield and see what's ahead," he says. “You need to build time into the schedule to plan for the future."
Looking too long in the rear view mirror can lead to squandering capital trying to correct past decisions, when minor tweaks might be enough to make the original decision a viable one, at least for the time being. Carroll says legacy electronic health record (EHR) systems are a frequent target of buyers' remorse.
“People wonder if they've outgrown the capabilities" of their EHR, Carroll says, when it turns out they've never taken the trouble to explore and fully use all its features and functions. Switching systems is tremendously expensive—tens of millions of dollars even for a relatively small organization, and into the billions for a new system-wide EHR for a large health system—and all EHRs currently on the market are built on older technologies that don't warrant extensive additional investment at this point.
“The industry needs a whole new way of looking at EHRs, and we'll see the next generation from new ventures," explains Carroll, like the healthcare organization recently formed by Amazon, JP Morgan Chase, and Berkshire Hathaway. Meanwhile, health systems shouldn't squander major capital outlays that could be better spent on exploring technologies like digital pathology, genome testing, or artificial intelligence, and they should delve into more effective ways to use the EHR technology they have.
Finding those missed opportunities can create major wins for a lab, says Peter Gershkovich, MD, Director of Pathology Informatics at Yale University Medical School. For example, a lab might expand the capabilities of its laboratory information system (LIS) with a program to integrate lab results into the EHRs at medical practices.
“Group practices expect more electronic integration and exchange of information with their EMR systems, and they may switch labs if your services are inadequate," he says. “Some labs are losing clients because they can't provide ordering interfaces and can't deliver patient reports electronically."
Carroll says organizations that think in terms of change management are already behind because they are thinking reactively rather than proactively. “You don't want to manage change—you want to design and execute it," he says. “Being deliberate about where you're headed with your capital is important."
The organization's senior leadership has to align those who run the day-to-day operations—and need systems and procedures to be tried and true—and those who incubate innovations and want to make fundamental transformations in those systems and procedures. Every investment needs to be thought through, to avoid poor execution and reap the full advantage, Carroll says. “Once you've mismanaged a resource, whether it's people or capital, it's gone."
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