CEO SUMMARY: Last month, a group of Canadian early-adopter pathologists and laboratory directors came together for the first-ever Executive Edge forum to share best practices and other cutting-edge developments in laboratory management. Among the noteworthy developments is Canada Health Infoway, a national effort to create a universal electronic health record as early as 2009.
LABORATORY PROFESSIONALS from across Canada and the United States convened in Toronto last month at the first-ever Executive Edge forum on laboratory management with a focus on issues of special interest to Canadian laboratories.
“Like their peers south of the border, Canadian laboratories are battling inadequate funding against a steady increase in demand for lab services and an ever-growing shortage of trained technical staff,” observed Sheila Woodcock, President of QSE Consulting of Toronto, Ontario and a co-producer of Executive Edge. “At the same time, several provinces are initiating laboratory accreditation guidelines based on ISO standards and encouraging laboratories to adopt quality management tools like Lean and Six Sigma.”
Early-adopter laboratories in British Columbia in the West and Nova Scotia in the East shared their successes and setbacks at Executive Edge. In fact, Providence Health Care (PHC) of Vancouver, British Columbia was one of the first laboratories in Canada to use Lean methods to redesign its high-volume core chemistry and hematology laboratory.
“Facing the pressures to improve patient outcomes, to do more with less money and resources, and streamline work processes in our laboratory, we decided to use Lean techniques,” stated Enid Edwards, M.D., Medical Director at PHC. “We recognized the need to engage operations experts that could help us rethink our traditional paradigm of laboratory operations.
Used Outside Expertise
“For that outside support, we turned to Ortho-Clinical Diagnostics,” she said. “Using Lean, Six Sigma and Design Excellence principles, we slashed our test turnaround time by 40% and reduced operating costs by as much as 50%. Benefits extended beyond those improvement measures. What resulted was the unexpected opportunity for our laboratory—and its pathologists—to regain a higher profile within our health system.”
Edwards is referring to efforts in British Columbia to improve patient outcomes. “Providers, including laboratories, will increasingly be ranked and reimbursed according to performance measures,” stated Jane Crosby, R.T., Laboratory Leader at PHC. “Our Lean project is a deliberate strategy to put our laboratory ahead of that curve.”
Nova Scotia Lab Goes Lean
On Canada’s East Coast, the laboratory at IWK Health Centre in Halifax, Nova Scotia is using Lean and Six Sigma methods to revamp lab operations in different departments, using an incremental approach. One major benefit has been streamlined specimen flow through the laboratory, along with more consistency in the output of individual work processes.
“In the laboratory, our Lean environment allows med techs to become like a chef who focuses on preparing the meal without the distraction of having to chase down the lettuce and tomato and meat slicer before each step,” stated Kent Dooley, Ph.D., Director of Pathology and Laboratory Medicine, IWK Health Centre. “Staff spends more time on the value-added steps and less time searching for items or prepping for the next batch.”
Canada seems to be moving faster than the United States on creating an integrated informatics platform to support the healthcare system. Even as the United States is moving forward to develop the proposed National Healthcare Informatics Infrastructure, a parallel effort is under way in Canada. Canada Health Infoway was launched as an independent, not-for-profit corporation. It is chartered to develop an electronic information sys- tem for patients that reaches across all the Canadian provinces and territories.
Infoway’s role is to be a strategic investor and catalyst with these governments, helping them develop enhanced healthcare informatics solutions. It is an ambitious plan, and requires establishing information systems in therapeutic drugs, laboratory, diagnostic imaging, public health, and telemedicine. A major portion of Infoway’s investments will be to create an electronic health record solution and a “Client, Provider, Location” registry.
Infoway’s timelines are tight. By 2009, Infoway wants to have its third-generation laboratory information solution deployed. Five provinces are already in Generation 1 implementation of the laboratory information solution. These provinces represent about 60% of Canada’s total population of 30 million.
If Infoway is successful at meeting these timetables, Canada is likely to be among the first developed countries in the world to deploy an integrated healthcare information system that functions at a national level. The closest informatics initiative to be found in the United States currently is at the Veterans Administration. It has created a regional, paperless, EHR (electronic health record) system. However, it is encountering significant obstacles in its efforts to link the regional EHRs into a uniform national system.
Another interesting insight was delivered by Bruce Friedman, M.D., Professor of Pathology at the University of Michigan Medical School of Ann Arbor, Michigan. Friedman spoke on the subject of laboratory information systems and the emerging dominance of “middleware” as an important component of the informatics solution for many laboratories.
Because of the importance of informatics in today’s healthcare system, along with the explosion of testing done outside the core laboratory, Friedman now defines a laboratory as “one person plus an instrument.”
“My point for defining a lab in this way is this. What is of ultimate value to the healthcare system is the information produced by the laboratory test,” he explained. “Anywhere that laboratory test data is produced can be considered a laboratory—and the key management objective is to get that lab test data into a clinical repository and report those results, in real time, to the clinicians. This definition eliminates the size of the laboratory as a critical factor and emphasizes the value of all lab data for an individual’s longitudinal health record.
“We also need to break down the ‘glass wall’ standing between laboratory professionals and clinicians. To do this, we have to transport ourselves to the ‘sweet spot’—which is the moment in time and space when the clinician needs to decide which lab test to order to develop a diagnosis, and, upon receiving lab test results, what type of therapy is appropriate for the patient,” said Friedman. “Laboratories need to be at that ‘sweet spot’ helping the clinician at those moments of decision. By using the right information technology, laboratories can be the clinical knowledge resource for clinicians, regardless of their location, because information technology destroys time and distance.”