NYC Lab Hand-Entered Reqs After Terrorist Acts

Electronic test ordering/reporting link severed by attack on World Trade Center

CEO SUMMARY: Crisis management was the watchword at Centralized Laboratory Services, Inc. of New York City following the terrorist attacks on September 11. Damage around the World Trade Center knocked out the communications link between the lab and a data server which transmitted electronic test orders and results. The lab found itself forced to hand-enter thousands of paper test reqs per day to maintain test services.

IMAGINE, ON AN EMERGENCY BASIS, hand-entering 7,000 paper requisitions into the LIS every day! That’s what happened on September 11 to Centralized Laboratory Services, Inc. (CLS) of New York.

Despite its location in Queens, a safe distance from the havoc wrought by terrorist attacks in Lower Manhattan, Centralized Laboratory Services, Inc. found itself facing a unique crisis on that fateful Tuesday.

“The data server which feeds us electronic test orders and transmits our test results is located in Lower Manhattan, not far from where the World Trade Center stood,” stated Eugene S. Pearlman, M.D., Medical Director at CLS.

Link To Data Server Lost

“The telephone lines which connect us to our data server ran through the telecommunications hub which was destroyed by the collapse of the twin towers,” he said. “The destruction of this facility meant our lab could neither electronically receive test orders nor electronically report test results. Because our entire testing work flow is organized around the computer server, losing this data link crippled our lab.”

That’s because CLS is organized in a unique way, different from just about every other clinical laboratory in the United States. CLS is a division of Health Insurance Plan of New York (known as HIP). HIP is an HMO which serves 1 million people, primarily government employees, police, and fire fighters.

“There are 47 HIP medical centers around greater New York,” he continued. “Test requests are electronically transmitted to HIP’s headquarters and data center, where eligibility is checked. The data center then forwards those test requests to CLS. When the test results are available, CLS transmits them through the data server to the referring physician.

“Our entire work flow is organized around the electronic transmission of test requests from the physicians to the lab and test results from the lab back to the physician,” explained Dr. Pearlman. “That is why the loss of telecommunications was so crippling to our lab.”

Hand Entry of Test Reqs

Daily, CLS handles about 7,000 patient test requisitions and performs about 10,000 tests. The unexpected loss of telecommunications with the data server at HIP headquarters meant that CLS would be receiving specimens at the lab and would need to enter the data on the paper requisition in order to run the test and generate a paper report.

But that was not the only challenge. The entire city of New York was in chaos. Transportation access to and from Manhattan was closed or severely limited. People coming in to work at the lab were stunned. Some had friends and relatives working in the towers or downtown.

“In the midst of all the confusion that morning, we convened a contingency planning meeting,” said Dr. Pearlman. “Although our lab is staffed 22 hours per day, the main work shift is noon until two a.m. That gave us some time to develop a contingency plan and have it ready as people reported to work throughout the day.”

Redirect Med Techs

“First, we decided to get as many people as possible working on data entry to accession specimens,” he noted. “To accomplish this, we used medical technologists and other trained positions. This did cause some delays in testing.

“In the following days, we had between six to eight temporary helpers. We used temps all the way through October 4, when telecommunications was finally reestablished with HIP’s data server.

“Second, we immediately did triage on the specimens,” he continued. “We identified STAT, pre-ops, and specimens with viability issues, such as CBCs and coags. These were accessioned and run on a priority basis. Tests considered ‘non-essential’ were held back and eventually referred to some labs in Brooklyn and Long Island. On an emergency basis, they did a great job and were most helpful.

“Third, we revised our courier arrangements. This was a challenge all its own, as bridges and tunnels to Manhattan were closed. It was impossible to use our regular courier routes. We also had the couriers hand-deliver paper reports of test results.”

Data Link Remained Down

At weeks’ end, transportation access around the New York area was restored, except in downtown Manhattan. But the data link remained down and telephone lines continued to be a problem. “By the following Monday, we had caught up with all the testing,” recalled Dr. Pearlman. “However, with no access to the data server, we were totally dependent on hand entry of data from the paper requisitions. We had to hand-enter data for three weeks, until the connection with the data server was restored.”

Because CLS outsources anatomic pathology (AP) work, accessioning and processing of these cases was unaffected by the loss of the data link to HIP’s computer server. “Our courier system was able to maintain timely delivery of AP specimens to our participating pathology groups,” observed Dr. Pearlman, “so this work flow continued without interruption.”

CLS continues to “mop up” lots of details left over from the crisis triggered on September 11. “Our normal telephone service is still unreliable,” he explained. “During the day, as the phone company works to restore telephones in lower Manhattan, our lines will unexpectedly cease to function. People calling in will only get a busy signal. An hour or two later, our phones will function perfectly again.”

Overall, Dr. Pearlman gives high marks to the management and staff of CLS for its successful response to the emergency. “Lots of our people made heroic efforts in the days following the disaster,” he said. “If it wasn’t for the sadness over this event, we’d be celebrating our response to a very challenging time. At the least, we are looking for an appropriate opportunity, in the near future, to formally recognize and thank everyone for their contributions.”

As CLS absorbs the management lessons learned from this disaster, certain changes are planned. “We are meeting next week to refine our contingency plans,” observed Dr. Pearlman. “Certainly these events raise questions about where the computer server is located and how our lab is connected to it.”

Because CLS is about to undergo an LIS conversion, there will be the opportunity to revise some of the data processing infrastructure. “We were scheduled to begin our conversion to the Soft Computer LIS system on September 13,” noted Dr. Pearl- man. “That will now start on October 18.Armed with our new experiences, we will definitely have some additional things to accomplish as part of this LIS conversion.”

Most Disrupted By Attacks

THE DARK REPORT believes that Centralized Laboratory Services probably suffered the most operational disruption of any American lab as a direct result of the terrorist acts on September 11. However, like labs around the country, CLS rose to the occasion and maintained a high level of testing services for its physicians and patients.

CLS’s Testing Fulfills A Different Mission

WHAT MAKES Centralized Laboratory Services (CLS) of New York City unique among the nation’s laboratories is that it is organized to serve a different mission.

“We are owned by Health Insurance Plan of New York (HIP),” said Eugene S. Pearlman, M.D., Medical Director of CLS. “Our job is to provide testing for the 1 million beneficiaries of HIP, who are primarily government employees, fire fighters, police, and their families.

“Our mission is to provide high quality lab testing at the lowest possible cost. We are also directly involved in managing test utilization to favorably influence outcomes and manage the cost of health services,” added Dr. Pearlman.

Because CLS serves a targeted population, its data system is organized to take a very high proportion of electronic test requisitions and report an equally high proportion of test results electronically. It was this reliance on electronic ordering and reporting which made the lab vulnerable to the loss of the telecommunications link to HIP’s data server.

Another interesting difference at CLS is extensive use of reflexive testing. “Our HMO pays for all testing services,” commented Dr. Pearlman. “Thus, Medicare regulations are not applicable for our beneficiaries. This allows us to design reflexive testing algorithms which maximize quality of care and reduce overall costs.

“We do lots of reflexive testing,” he added. “Since most of our specimens arrive in the lab by late afternoon and early evening, reflexive testing at the second and third levels is done in the early morning hours. This enables us to provide the physician with a complete test report when he starts the day in his office.”

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