Use This Five-Step Process to Implement a New LIS

Experts working daily to help laboratories install Epic’s Beaker share lessons learned, what to avoid

CEO SUMMARY: Rolling out a new laboratory information system (LIS) is a costly, time-consuming project. One expert outlines five steps that clinical labs can take to alleviate pressures while ensuring the right people are onboard to help the endeavor move forward. Among the steps is the need to establish an analyst team to act as a liaison between IT and clinicians. 

EACH YEAR, HOSPITALS THROUGHOUT THE NATION using Epic electronic health record (EHR) systems transition away from their current laboratory information system (LIS) and implement Epic’s Beaker LIS. 

Hospital laboratories switching from one LIS to another know that this process can be turbulent and can cost hundreds of thousands of dollars in licensing, training, and maintenance costs over the long term. Moreover, it is critical to laboratory operations that the new LIS be installed correctly. 

One LIS company at ground zero in this trend is Honeydew Consulting, based in Sacramento, Calif. Many team members know Beaker well because they formerly worked on that product while employed by Epic. 

“Any new LIS is going to be the most disruptive project that a lab will experience,” said Robb Quiller, Honeydew’s Founder and CEO. During an exclusive interview with The Dark Report, he described best practices for a successful LIS conversion and started with three actions lab administrators should take before installing a new LIS: 

  • Determine decision-makers for the rollout of the new LIS. 
  • Establish an analyst team to bridge technology and clinical needs within the laboratory and throughout the parent organization. 
  • Map current and future diagnostic test workflows to understand how the new LIS fits in with lab processes. 

STEP ONE: Assign Advisors to Guide the Project

“One of the first steps is to establish a governance structure for the transition that outlines the business goals of the project and connects those objectives with IT strategies,” Quiller stated. 

Robb Quiller at Honeydew Consulting
Robb Quiller

“This structure should include an advisory board that will provide expertise about lab operations for the software build team,” he noted. “Typically, these advisory boards are semi-autonomous. They know the workflows. They know the system. They know the clinical content.” 

Quiller recommended keeping the workgroups small. “Labs don’t always need to have large meetings that pull in the whole Beaker team, for example. 

Instead, smaller meetings can help build rapport between the advisory boards and build team members,” he added.

It’s also important to clearly identify which individuals to approach when problems arise. “Labs should spell this out and write it down,” he said, especially in larger organizations.

In addition, Quiller noted, laboratory leaders should clearly identify decision-makers for different areas within the organization and be sure those individuals are held accountable.

Contracted work should be spelled out in this step as well. For example, every Beaker installation requires a third-party contract for middleware that allows instrumentation to interface with the LIS. 

“Those middleware contracts should be signed early on,” Quiller advised. He cautioned that if contracting becomes a drawn-out process, it is likely to delay other critical tasks and could derail the LIS implementation project in its earliest stages.

STEP TWO: Link the IT, Vendor, and Clinical Teams

Months of planning, perhaps even years, go into an LIS rollout, involving staff members and managers who devote large amounts of time to the project. Given the national shortage of pathologists and medical technologists, setting aside resources for an LIS project is mandatory, though challenging. 

“Resource allocation for a Beaker implementation is a big aspect early on,” Quiller said. “Everyone has their bandwidth compromised. Part of the problem is that resource allocation isn’t just the IT team. Operational and subject matter experts [SMEs] need to be involved to a high extent. Their buy-in and involvement is pivotal to success.”

Much of the work of implementing the new LIS will fall to an analyst team that serves as an intermediary between the SMEs and the LIS vendor. The team should be well-rounded and include members who are familiar with clinical issues, the legacy LIS, the lab’s hardware devices, and reports generated by the laboratory. 

“Too often, labs will have an IT team without a ton of clinical background or, conversely, people with a lot of clinical background, but no IT experience,” Quiller observed.

Beaker, he said, is part of the integrated Epic EHR system, so the build may be part of a large workflow that includes placing lab orders, collecting specimens, and reporting results.

This means that the LIS will have impacts beyond the lab itself. Therefore, the analyst team should include members who can address where an LIS installation overlaps with other areas in the hospital or health system, such as ordering, billing, and ambulatory care.

STEP THREE: Map Lab Workflows and Data Exchanges

Laboratories should build flowcharts that illustrate current work processes. This will help the analyst team understand the current state of operations and identify pain points that can be improved with the new LIS, Quiller recommended. 

By comparing legacy LIS processes with flowcharts for the new system, labs can identify areas where staff might require new training, he noted.

One tipping point for many labs involves receiving data exports from the legacy LIS—such as reference ranges—and rebuilding them in the new LIS. 

“Many times, these exports are heavily coded,” Quiller explained. “The information needs to be in a usable format and well understood.” The analyst team, he added, should be prepared to work with the SMEs to bridge the communication gap between the legacy LIS and the new Beaker LIS infrastructure.

Labs also must account for instruments and devices that will interface with the new LIS. The rollout benefits if labs use the same software drivers. But Quiller advises labs to have a cut-off phase for bringing on new equipment, if possible. 

“Adding an instrument to the legacy system just to take it down and bring it back up in Epic can derail a lot of resources,” he said. 

STEP FOUR: Determine What LIS Features Work Best 

Pre-built functionality in an LIS may not address all the needs of customer labs. Instead, the system’s foundation serves as a jumping-off point. 

“Epic Beaker recommendations certainly are helpful, and they can be accurate maybe 80% of the time,” Quiller observed. “But this still means one out of every five recommendations is not going to be right for a particular lab.”

Lab managers and pathologists should investigate which features offer the right fit for them, he advised, and determine how the system can be configured to accommodate their lab’s processes.

Tied to this notion, labs will likely have to rethink some aspects of how they currently operate. “For example, lab managers won’t just take a report from the previous system and build the exact same report in Epic,” Quiller said. “Instead, they’ll want to think about what need that report satisfies, and how do they address that with the Epic LIS tools?”

This is one area where advisory workgroups and SMEs can be helpful. “The build team should have a strong relationship with workgroups and SMEs so they can ask questions and escalate concerns,” he added. This type of interdisciplinary cooperation is also useful for post-live monitoring and discussions about future software adjustments or upgrades.

STEP FIVE: Test Software Functions and Train Staff How to Use the LIS

Testing the features of an LIS, and then preparing to educate employees about its functions, will go smoother if the steps noted above are carried out carefully.

“An emphasis on a good build is going to create more streamlined testing and training,” Quiller said. 

For example, one of the most time-consuming aspects of a Beaker implementation is clinical content validation, in which the lab ensures that clinical data in the system meets Epic’s standards. 

“It’s incredibly important to do this early and often during the build phase,” he advised.

Part of this involves testing the clinical lab’s workflow “from the beginning on an instrument to when the results come back,” Quiller added. This work can be especially time consuming for SMEs, he cautioned.

Labs also must test the LIS’ charging and billing functions, interface connectivity, integration with other applications, and label printing. Quiller warned that labs have struggled with printing because some instruments are better than others at scanning printed barcodes.

Aside from formal training from vendor representatives, some staff will emerge as “super users” who can assist others in learning the system. Lab managers should identify these internal champions early, he said. 

Quiller also advised labs to create tip sheets on how to navigate difficult areas of the system, or aspects that deviate from the legacy software.

Additionally, staff should become well-versed in the ticketing system through which they will alert IT personnel to any problems with LIS functions and receive technical support. 

“Many times, the information that comes across in these tickets is insufficient and requires follow-ups to figure out the issue,” he noted. 

Two essential elements of any LIS support ticket are the specimen ID and a direct call-back number for the person who filed the request. The specimen ID, he said, is “linked to all information pertaining to the progression of the specimen, including the order and results.”

Quiller advised labs to be mindful of the date they choose for switching between the legacy system and new LIS. Do not, he cautioned, schedule the transition if a large amount of staff turnover is imminent or a visit from The Joint Commission or College of American Pathologists is expected.

“With a newly installed LIS, staff might not be clear on how to pull up quality control reports or other required documentation,” Quiller noted. “These are lapses which may grab the attention of an accreditation surveyor.”

People Key to LIS Success

Taking the five broad steps above will not guarantee success during a laboratory information system implementation. However, these critical steps will help clinical laboratory managers and staff think more clearly about their lab’s process and data needs so as to better prepare LIS users for problems.

Quiller further observed that one common element to successful Beaker implementation is when laboratory-based champions can be identified who are capable of bringing the LIS project forward while maintaining their regular duties.

Time-Tested Steps to a Winning Beaker Install: Anticipating Common Problems, Positioning Experts

MUCH CAN GO WRONG when a new laboratory information system (LIS) goes live. The ability to rebound from these temporary problems rests with the earlier preparation work of lab staff, vendors, and consultants.

“Going live with Epic’s Beaker or any new LIS is not the end, it’s the beginning,” said Robb Quiller, Founder and CEO at Honeydew Consulting. Labs can expect periodic software updates, system upgrades, and new functionality. And they may have to perform optimizations they delayed until after launch.

Immediately after going live, labs should focus on key performance indicators. “Look at the overarching themes. How are the billing charges doing? Are the test turnaround times sufficient?” Quiller noted.

Once a system goes live, it is important to have personnel on hand to provide needed assistance, including people responsible for data migration and middleware support. Generally, support personnel should be available for night shifts as well as day shifts. “Vendor contracts should also specify some level of support as a safety net,” he suggested.

Lab leaders should clearly define how to escalate a problem so that staff members know the appropriate people to approach when roadblocks or other issues arise. Labs must also establish an approval process for going live with specific parts of the system. “It’s good to outline what needs advisory board approval and what needs to just go through a manager,” he said.

Provide Adequate Resources

The final stage is what Quiller described as “post-live stabilization,” and, as with other aspects of the LIS buildout, labs must assign adequate resources to make it work. 

Lab leaders should avoid “silos of knowledge”—for example, making only a small group aware of reporting problems—and be sure that documentation can be easily shared and accessed across the organization.

“As much as possible, staff should be cross-trained so everyone has a working knowledge of how to troubleshoot issues, avoid certain bottlenecks, and maintain the system better in general,” he advised. 

Contact Robb Quiller at robb@honeydewconsulting.com.

Comments

;

You are reading premium content from The Dark Report, your primary resource for running an efficient and profitable laboratory.

Get Unlimited Access to The Dark Report absolutely FREE!

You have read 0 of 1 of your complimentary articles this month

Privacy Policy: We will never share your personal information.