Thriving under pressure

All laboratories in the United States are under pressure. By 2020, there could be a 30 percent reduction in the clinical lab fee schedule, based on the current imposed laws. In the physician office lab setting, the decrease in lab reimbursement is compounded with physician fee schedule cuts. Specialty laboratories, especially those focused on genetic and molecular testing, will be acquisition targets for bigger reference laboratories. Independent reference labs also need to consider new ways to stay competitive as consumers are offered testing in retail settings.

As a result, many fee-for-service models and outreach practices will be in jeopardy. In order to survive and thrive in this challenging ecosystem, laboratories must evaluate ways to decrease their unit cost per test. One approach is to develop strategies that will increase volumes, to take advantage of excess capacity. In parallel, operational improvements can help gain efficiency and wring costs out of their operations.

When considering opportunities for operational improvement, each stage of the testing process must be evaluated to maximize efficiencies and ensure improved patient care is being realized. Labs will need a strong laboratory information system (LIS) partner who is cost conscious and able to adapt as testing menus and workflows shift. With an LIS, many of the pre-analytic steps are automated, resulting in reduced errors. Tools and automation in the analytic phase assist the lab in providing the best patient outcomes. Lab data access, analytics, and customer management will be required post-testing to service providers and laboratory customers.

There are considerations to take note of when evaluating an LIS, including:

• Electronic orders and lab labels: It is not uncommon for a lab order to be generated in the EMR. Patient demographic information is updated from the order message, ensuring accuracy in the LIS. When the order is received in the LIS, a label is printed that includes at least two forms of patient ID. Handwritten names that are incomplete or illegible are eliminated.
• Specimen requirements: Phlebotomists can see tests, collection container, patient preparation, specimen storage, and stability in one place, with one click.
• Turnaround-time monitoring: Laboratories can lose precious revenue, or even clients, if they are not meeting their target service levels. An integrated dashboard of pending results can highlight the specimens that are approaching their target turnaround time, facilitating interventions that get results out on time.
• Monitor result discrepancies: Critical result handling support and automatic delta checking allow laboratorians to alert a provider to changes in a patient’s condition.
• Management review: The LIS can facilitate and store proof of review by the managerial staff for the analytical review of defined tests or selected personnel. Management review is useful for complex testing and training new staff.
• Quality control: The LIS assists with ensuring the quality control (QC) is acceptable and can disable release of results if certain criteria are not met. The LIS stores values, graphs, corrective action, and proof of review, reducing printing and paperwork. Rules prompt the tech to enter a corrective action note into the LIS, improving documentation and allowing QC to go paperless.
• Automated test reflex or testing cascade: Rules also allow users to set up ordering rules and automatic reflex testing rules based on results, ensuring all necessary testing is done and billed.
• Auto-verification: Auto-verification rules allow rapid flow of results (within the pre-defined ranges) into the patient chart, eliminating the need for interface review of test results within defined ranges.
• Standing order and call documentation: Keep track of orders, and document attempts and outcomes of contact with a patient. This allows better patient outcomes to be achieved with less lab staff intervention.
• Analytics: Provides data management that can be used to improve efficiency. Data can be analyzed to determine turnaround times, specimen rejections (QNS, hemolysis, incorrect tube, etc.), provider test utilization, and workload to ensure appropriate staffing.

Automating your lab is an investment, but there are LIS systems that can meet your needs and fit your budget requirements. The implementation of an LIS does not have to be a time-consuming process that disrupts the lab. Laboratory medicine involves complex tasks that require trained professionals, but learning and working in the LIS does not have to be a complex task. Look for an LIS that provides flexible and scalable configurations, easy-to-use and intuitive navigation, and business insight through operational monitoring and analytics reporting.