Editor’s Note: This article originally appeared in the Vantage Point, Vol. 8, Nos. 3/4, March 2004, published by the Clinical Laboratory Management Association (CLMA).

Do You Want Fries with that Lab Order?
Bringing Fast-Food Technology to the Laboratory

by Joanne Poeggel

If you walk into almost any fast-food restaurant across the United States, you are greeted by an employee who uses a computer touchscreen to place your order, compute your bill, and figure your change. Yet many laboratories, which perform medically important tests that guide a physician’s care of patients, use tons of paper and have valuable laboratory personnel entering data into the laboratory information system (LIS) before those tests can be run or billed. Spectrum Laboratory Network, based in Greensboro, North Carolina, decided to tackle that problem.

Spectrum Laboratory Network is a joint venture formed by three not-for-profit health-care systems: High Point Regional Health System, the Moses Cone Health System, and Novant Health Triad Region. Spectrum provides laboratory testing and consultation to clients in North Carolina, South Carolina, and Virginia.

Working with Atlas Products, based in Calabasas, California, Spectrum was able to incorporate the features they wanted into a system that used touchscreen technology. The product allows physicians’ offices to order lab tests by using a touchscreen system that is integrated with their office management system. The specimen arrives at the participating laboratories with a barcode that is scanned to bring the order up on the LIS. The system was first put into use in April 2003. Currently, about 120 physicians’ offices are using the system, and 25 to 30 new systems are installed each month. How is this product working for the physicians and laboratories that use it?

Benefits to Physicians
David Moore, Chief Information Officer, Spectrum Laboratory Network, says that physicians have a very positive reaction to the new touchscreen system. Physicians and their staff cite the following features as important:

• The touchscreen system can be interfaced with the physician’s office management system to forward billing data; office staff does not have to key in the information twice to update the office management system and lab ordering system.

• The system has a graph function that provides a comprehensive review of tests ordered through the laboratory for the past 2 years or for the time the results are available within the Atlas product.

• The physician’s office does not have to give up workspace for a keyboard.

• The physician’s staff does not have to key into a field or repeatedly hit “tab” to reach the field they want.

• If an office orders a limited selection of tests, such as for a specialty practice, the Quick List feature places the most frequently ordered tests and most frequently used International Classification of Diseases, Ninth Revision (ICD-9) codes at the top of the list.

• Lab results can be retrieved using the same interface system.

Benefits to Laboratories
According to Taylor McKeeman, Vice President of Clinical Operations at Spectrum Laboratory Network, 17 laboratories that belong to Spectrum or the organizations that formed the joint venture are capable of receiving touchscreen orders and reporting results through the same interface system. These labs include the core lab in Greensboro; 10 stat labs throughout North and South Carolina, which are scaled-down stand-alone laboratories that perform such tests as CBCs and protimes; and the labs that Spectrum manages in six hospitals.

These labs receive approximately 6,500 outreach orders a night; about 53% of those orders are through the Atlas ordering system, and about half of that 53% is through touchscreen clients. Spectrum expects this percentage to increase to 70% to 75% by the end of the summer. McKeeman says, “The main benefit to lab personnel is the efficiency of specimens arriving into the lab. The system saves about 30% of the time it takes to bring in a sample, put it into the computer, put it on a work list, and then put it on a machine. When lab personnel zap the barcode that arrives with the specimen, it is automatically entered into our LIS. Also, in a stat lab environment, one patient test is run at a time; they don’t batch specimens like they do for routine testing in the core lab. It saves about 3 to 4 minutes per patient.”

Moore cites the following benefits as important to labs:
• Data entry is not needed for orders placed using this system, increasing turnaround time and allowing for more efficient use of laboratory staff.

• Interpretation errors, which can occur when a requisition has no test checked off or 10 tests ordered, so that you have to guess what the physician really wants, or when a requisition got wet and is illegible, are eliminated.

• Data input errors, such as keying in the wrong number or test, are eliminated.

• Requisitions with questions or errors used to be held until the next morning, when the physician could be contacted for verification; now the error is caught by the system during office hours, before it leaves the physician’s office.

• Because the product is interfaced with office management systems, it brings the test orders, patient demographics, and all billing information, including ICD-9 codes, into the LIS. The lab does not have to re-enter any data.

Moore says, “We still have the paper. We get a piece of paper with a barcode on it. We read the barcode and that brings the information into the LIS. But what we don’t have is the thousands on thousands of keystrokes that have to be made every night to get those orders in. The order gets transmitted electronically to the servers here and it’s just waiting in a queue to be received; that we have the printed barcode to scan indicates that we have received the order, and it prints the labels for the tubes to go through the instruments.”

From a business perspective, McKeeman reports, “It saves about $35,000 per month just for the people who work in the specimen data entry department. I used to have 24 data entry personnel, and now I have 11. As laboratory reimbursement decreases, we have to monitor expenses closely. Fixed assets can be amortized over a period of years, so we are focusing on the electronic transfer of orders and results because it saves time and money. Labor is expensive. I can get a lot more work done in a shorter time with these new advances.”

Moore reports that although Spectrum’s business has grown about 35% since they started implementing the ordering system, they have redeployed personnel from the data entry and specimen processing areas and have not had to add staff to the billing area.

Installation and Training
Installation of the systems has been gradual. McKeeman says, “This has been an ongoing project for the last year and a half. We started with just one or two clients to work the bugs out of the system, and all touchscreen orders came to the core lab in the beginning. We started in our client base and grew it to where 30% of our accessions were interfaced. Eight or 9 months ago, we deployed the system not only to our stat labs, but to all patient service centers that draw more than 20 patients a day; that raised the percentage to 55%. We calculated the return on investment to be about 18 months, and we’re right about there.”

The system is relatively easy to install in physicians’ offices. Moore reports, “We typically spend 2 to 3 days in a physician’s office installing the system, getting the interface running, and training the office staff after the telephone line and Internet system are installed. If the staff doing the order entry is familiar with an Internet-based ordering system, such as L.L. Bean or amazon.com, training is easier. The pacing factor is interfacing with the physician’s existing office management or electronic medical records system. We have a team of 9 or 10 people who have undergone extensive training who are devoted to installing and maintaining these products. That’s a substantial expense we didn’t have 2 years ago, but we also have the benefit of the ordering system and interfacing with the office management systems, which reduces our errors and our personnel requirement in the order processing and specimen handling areas of the company.”

As far as training lab staff to use the system, McKeeman says, “It’s very user friendly. The lab per se really doesn’t use the interface or the Internet product. All they do is zap the barcode to bring the order into our mainframe LIS. The main training goes to our clients, our patient service centers (phlebotomy stations), and our stat labs.”

Since the project started, Moore says, “We have learned a lot. We are very fortunate that we have a senior staff, administration, and ownership at Spectrum that realized the value of the technology, so we were able to make the appropriate investments in the technology before we ramped up, rather than after. We had about 70% of the solution defined a year ago, and we now have about 90%.”

McKeeman adds, “This is a first-generation type software program that was basically dedicated to the client, not the lab, so we had to mirror what our needs were as a lab providing service to the client without affecting the bells and whistles for the client.”

Internet-Based Ordering and Results Retrieval System
Spectrum Laboratory Network also has an Internet-based system in place through which physicians can order lab tests and retrieve results through the Spectrum web site by using their security password. Currently, Moore reports that less than 20% of physicians use the Internet for this purpose. He says, “I think a number of physicians haven’t made it to the web yet at home, or they get home and log into their own office management system and the results are there, so they have no reason to log onto the web site. We are now working on a system based on a personal digital assistant (PDA), such as a hand-held Blackberry or a Palm Pilot, for our clients.”

McKeeman adds, “Ordering through wireless PDAs will take about 3 months. We are working first on retrieval of results for our owner hospitals because most of the physicians in these hospitals use PDAs and the wireless network is already in place in the hospitals. They will be able to retrieve results for both their inpatients and outpatients at the same time. Eventually they will be able to order tests over the PDAs.”

Where Do Laboratories Go from Here?
For the lab of the future, the next step would be to install a working lab track system. McKeeman says, “There are a number of these systems available now, but they’re very expensive. Using a system like this, you would wand the specimens to put them in the LIS, put them on the track, which would deliver specimens to the machine, and the machine would test the specimen and automatically verify the result. Lab techs would manage the flow and troubleshoot the track and instruments. One lab tech would be able to manage three or four instruments. This is important because the current shortage of lab techs makes it difficult to hire lab staff.”

Joanne Poeggel is a freelance writer and editor living in Moon Township, Pennsylvania. She can be reached at countrymorn@aol.com.
Vantage Point, March 2004, Vol. 8, Nos. 3/4

Atlas Medical contact:
Paul Park
Atlas Medical Software
Tel: +1.818.340.7080
ppark@atlasmedical.com