Indiana Clinical Lab Taps Data to Improve Service to Doctors

Real-time business intelligence (BI) guides decisions

CEO SUMMARY: Business intelligence is on the verge of becoming the next “big thing” in clinical laboratory management. Lab teams are using real-time data dashboards to quickly identify problems and take proactive steps to raise service levels to clients. South Bend Medical Foundation says these software systems and related tools are helping it raise the bar on service and quality.

EVERY CLINICAL LABORATORY is a gold mine of data. There is information in abundance, ranging from patients’ lab test results to the performance of individual analyzers and time stamps on every aspect of pre-analytical, analytical, and post-analytical work processes.

“To be successful moving forward, it will be necessary for labs to unlock the knowledge contained within all this data and use it to inform real-time management decisions,” predicted Bob King, Senior Vice President of South Bend Medical Foundation (SBMF), in South Bend, Indiana. “Tapping this data to extract the knowledge requires the use of new software tools and represents the next big area of opportunity in the management of clinical labs and pathology groups.”

South Bend Medical Foundation is one of the nation’s first labs to acquire and deploy some of the latest tools in business intelligence (BI). Its lab teams are finding ways to use data that help them deliver levels of lab testing services that were impossible to achieve just a few years ago.

The informatics foundation required to produce business intelligence is what King describes as a “laboratory customer relationship management (LCRM) system. “Within our laboratory, we use software and other tools to present relevant data in real time to pathologists and lab directors,” he stated in his presentation at the Executive War College in New Orleans last month. “We believe that every lab can better utilize real-time data inputs to improve client services in three specific ways.

“First, tools now exist that allow labs to gather several related sets of data and process that data to gain immediate access to client intelligence,” he explained. “For example, at SBMF, we know how many tests clients are submitting at any one time. We can also quickly see whether a client is having problems getting specimens picked up.

“Second, these data give labs what I describe as a ‘360-degree view’ of each client relationship,” said King. “It is the full picture of all service elements and it allows our lab team to boost sales and service by identifying and solving problems in real time.

“Third, these are the data sets that allow nimble lab organizations to be proactive in sustaining top service to their client physicians,” he noted. “By having this data available through the day, every day, our lab team is able to immediately identify trends. They can then react to those trends before anything develops into a problem for either our clients or our lab.”

South Bend Medical Foundation is a sizable clinical lab organization. “We serve hospital laboratory clients located in the four states of Indiana, Illinois, Ohio, and Michigan,” stated King. “The foundation has 800 employees, including 21 pathologists. It operates 24 hours a day, 365 days per year.

Building on Informatics

“In some of our client hospitals, SBMF is fullly responsible for all inpatient and out-patient testing activities,” noted King. “In these settings, SBMF employs the laboratory people, owns the equipment, staffs the pathology departments, and provides all laboratory testing and quality assurance. At other client hospitals that operate their own laboratories, SBMF provides medical directorship of the pathology services.

“In addition to these management arrangements for various hospital clients, SBMF provides reference laboratory services, blood products, and traditional outpatient laboratory services,” he continued. “We are a SAMHSA-Certified Laboratory for forensic toxicology.”

SBMF is also a major participant in the area’s health information exchange (HIE). “We own 50% of the Michiana Health Information Network,” said King. “MHIN was established in 1998. It is a health information exchange in South Bend that also has an electronic medical record (EMR) system and houses a data repository.

In 1985, 75% of SBMF’s specimen volume came from four hospital-based laboratories and the remaining 25% came from office-based physicians,” he explained. “Obviously, much has changed in those 27 years.

Building Lab Outreach

“Increasing test volume is still a primary driver at our laboratory,” noted King. “At the same time, our strategy is to leverage informatics in ways that directly help us expand our business and develop new outreach clients.

“To achieve these goals, we wanted to gain immediate access to the client intelligence that we know exists within all that information found in a variety of systems,” King said. “After beefing up our lab’s informatics capabilities, we now provide that information to our sales, service, and operations staff so that they have a consistent view of each client relationship.

“Further, we wanted to transition our lab away from being reactive—responding after a problem is identified—to proactive,” he continued. “We are getting better at identifying and addressing issues before they turn into problems.

“We call this ‘proactive trend identification’ and we think we are one of the first lab management companies in the nation to do this,” King noted. “A cornerstone of this capability is to acknowledge mistakes and learn from them.

Learning from Experience

“Such mistakes were embarrassing when we look back on them,” King admitted. “But they were highly instructive because they gave us the road map to improve how we manage information.

“SBMF generates a wide variety of information from multiple systems,” observed King. “We have a laboratory information system (LIS), of course, along with middleware solutions.

“We also have a customer service system—our CRM—where every call is logged as it comes in to our client service department,” commented King. “We average about 1,200 calls a day and each call is categorized. It might be a client looking for a result. It could be a client requesting a specimen pick-up, a stat, or an add-on test. These are the basic categories of calls.

“Because we log every call, we can go back and look up that information by call, category, date, or other factors,” King continued. “This information informs our studies of service levels, as well as identifies opportunities for us to proactively ‘up the ante’ and improve a client’s service.

“For instance, we can review which accounts call our client service department multiple times a day,” he said. “Those clients might benefit from electronic connectivity. Now we have objective, detailed data upon which to base those decisions and guide our actions.

Identifying Clients’ Needs

“Our laboratory also has systems for resource scheduling and inventory management,” added King. “This will make it possible, for example, to identify which office-based clients might be using our sterile urine cups for their own urinalysis testing.

“Of course, these examples are just the starting point for the information systems found in our laboratory,” observed King. “The list is substantial.

“There are systems for billing, patient registration, courier management, and payroll,” he noted. “Like any other lab, we have Outlook, email, and a customer relationship management (CRM) system.

“Each of these systems is useful, but, because they did not talk to each other, it was impossible for us to move out of the reactive mode I described earlier,” emphasized King. “That was a challenge for us, but there was a bigger problem.

“For a few years, we had a generic CRM that was not specific to laboratory operations and workflow,” he recalled. “We tried to get our people in the field to use this CRM for documentation of their visits.

South Bend Lab Organization Uses Informatics To Convert Abundant Data into Intelligence

Challenge: Lack of 360° Degree View of Each Lab Client

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At left is a diagram that shows how the multiple and unconnected information systems at South Bend Medical Foundation (SBMF) made it nearly impossible for the laboratory staff, service reps, and sales reps to gain a consistent 360° view of each client.

Solution: Access to 360° Degree View of Each Lab Client

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Following installation of a laboratory customer relationship management system (LCRM) at South Bend Medical Foundation and integration of this LCRM with the other informatics solutions within the lab, it became possible to see a real-time, 360° view of each client. Now lab staff and service reps can act proactively to improve client service.

“The system was found to be cumbersome and so the sales staff didn’t use it in the field,” King continued. “When we started looking at a new CRM program designed for use in labs, the sales staff got very excited.

“Made specifically for use in a medical laboratory, this CRM is quick to set up because it already understands lab lingo and lab processes,” he said. “Also, this new CRM allows the reps to use iPads with 3G connectivity.

“This is a benefit for our sales team,” he explained. “Because their mobile devices are always connected via 3G, they can go to a client site and quickly document their calls and their follow-up actions on the spot.

“The 3G connection has another substantial benefit,” King declared. “Such connectivity allows us to feed all the information that we have in the lab—except the inventory or resource scheduling—to the sales reps in the field.

Access to Real Time Data

“This real-time data access gives our sales and service reps the specific information they need to resolve problems and proactively address important issues while standing in the client’s office.

“There is a staggering range of information that they can access,” he emphasized. “For example, they can view all our logged calls. They can see all clinical laboratory information, all fee schedules, all managed care contracts, as well as the billing and insurance activity associated with a particular client. That allows each sales rep in the field to see if there are any billing or courier problems. They can also view the level of activity from each client, including test volume.

“This is how our business intelligence solution gives us a full, 360-degree view of all client activity and why it can be accessed by people in operations, in sales, and in client services,” he commented. “To further support these activities, we have created management dashboards.

“The tool we use to assemble all of this data and convert it into dashboards is HC1.com,” offered King. “It is sold by Bostech Corp., a company in Zionsville, Indiana, that helps medical labs use technology to improve operational efficiency.

“Now, by client and by individual physician, we are able to track the volume of specimens for each type of test and whether the trend is up or down.”

“The dashboard presents turnaround time, test panel volume, provider order volume, and the sales pipeline, as well as many other kinds of data,” he noted. “Click on any one data component and the dashboard drills down to provide access to the source data.

“A client site visit illustrates why this real-time information is useful,” he related. “One day, I accompanied one of our sales reps on a call to a urologist.

“This urologist was a long-time foundation client and a former board member,” recalled King. “During the conversation, he said, ‘You probably are here because you want to know why I’m sending all my prostate biopsies to a laboratory in Georgia.’

“At that time, I didn’t know this urologist’s prostate biopsies were going out of state because this information wasn’t showing up on anyone’s radar,” he explained. “From a sales perspective, that urologist’s overall test volume was growing. But the lab system we used at that time did not easily allow us to view test-specific increases or declines.

“That meant there was not a good way for the sales rep or client service rep to recognize that this urologist had significantly reduced his biopsy referrals to our lab over the prior three or four months,” noted King.

Tracking Specimen Volume

“That is no longer the situation today!” he declared. “Now, by client and by individual physician, we are able to track the volume of specimens for each type of test and whether the trend is up or down.

“Best of all, for client retention and client satisfaction purposes, in real time, we can immediately respond to a change in test volume,” emphasized King. “Today, if volume for one test declines sharply, we can visit that physician and have that conversation. And, when we make that call, our team has a complete picture of any service issues or problems that should be discussed with this client.

“These dashboards are equally useful to our lab’s managers,” he continued. “When preparing to meet with finance or our board, I can prepare a detailed picture of our sales pipeline. This information improves the accuracy of predictions of what sales activity will occur during the upcoming two to three months.”

Another use of dashboards at SBMF is to provide clarity when studying lab test turnaround times (TAT) and guiding work flow improvements. “We are able to retire all those TAT reports and spreadsheets that are so difficult to use,” he said.
“We’ve designed dashboards to view, in real time, turnaround times by each test and by individual specimens.

“These dashboards also give us more accuracy and faster access to information in ways that support our client hospitals,” stated King. “The Medicare program is about to require additional reporting on hospital-acquired infections (HAIs). As well, public health departments in our communities regularly want more timely information on infectious disease testing.

“The power of real-time information can be seen in the effort to prevent hospital acquired infections,” he continued. “One of our hospital clients told us that they are using this real-time information to help identify infection patients quickly and prevent the spread of HAIs.

“That’s a great outcome for both the client hospital and our laboratory,” observed King. “It shows how our lab delivers the highest level of service by gaining immediate access to client intelligence, then providing sales, service, and operations with the 360-degree view of the clients’ needs and experiences.

Demand for Information

“In the coming years, clinical laboratories will be asked to provide more information to the physicians and the hospitals they serve,” he noted. “With business intelligence systems like the ones we now use in our own lab, it will be easier and faster for laboratories to turn raw data into useful, actionable information.

“That will directly contribute to lower costs, increased quality, and—most importantly—improved patient outcomes,” concluded King. “As the laboratory industry reaches that point, clinical labs will be delivering real and substantial value to the healthcare system.”

SBMF Lab Celebrates 100 Years of Service

ONE NOTABLE ATTRIBUTE of South Bend Medical Foundation (SBMF) is that it celebrates its 100th anniversary in 2012! It was founded in 1912 and has operated continuously since that date. Not many clinical lab organizations in the United States share that distinction.

South Bend Medical Foundation runs a sophisticated lab testing operation and is a major regional presence in its service region. “We operate six hospital laboratories and in these labs we also provide the medical director and offer anatomic pathology services,” said Bob King, Senior Vice President at SBMF. “In addition, we have nine hospitals where we provide medical directorship and anatomic pathology services.

“For approximately 50 hospitals in Indiana, southwest Michigan, Illinois, and northwest Ohio, we provide reference laboratory services and serve more than 2,000 physicians,” King said. “Of course, SBMF has a thriving laboratory outreach program that is served by 11 patient service centers and five rapid response laboratories.

“Blood products, which we provide to 18 hospitals, is a growth area for us,” he continued. “We collect and procure blood and have the infrastructure in place to deliver and to take orders from hospitals for blood products.

“In 2007, SBMF procured and moved about 14,000 units,” King said. “This year, we are projected to move 35,000 units, which shows a growth in blood product volume of 150% in five years.”

Long term care (LTC) represents another important testing segment for SBMF. “We provide services to 89 extended care facilities,” he stated. “As a community provider offering lab testing services, we believe it is necessary to serve these facilities. This is especially important since the public lab companies walked away from these clients during the 1990s.”

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