Tim Bickley on the importance of developing a clear vision of your lab data

At my first job out of MLT School, I worked the midnight shift, mostly by myself. You learn a lot working by yourself on the midnight shift in a busy community hospital lab. After one year, I entered the MCV/VCU Medical Technology program and obtained my BS in Medical Technology in 1988. I worked for many years as a bench tech and supervisor, and later held management roles in the laboratory. When LIS’s were first introduced, I immediately took an interest in LIS and its features and benefits for the lab. I had an opportunity to join a leading “Best of Breed” LIS vendor in 1996, and I learned about how the LIS works with instruments and connectivity to the EMR and other systems. I’ve seen a lot of technology changes over the years, from instrument automation to sophisticated IT/LIS information systems. With the advancements in automation and IT, including lab analytics software, lab managers are being asked to produce data constantly, and getting to that data is usually a challenge. Once you have the data, which is typically a large spreadsheet with a lot of numbers, what do you do with all that data? How do you aggregate and analyze the data?  A lot of lab managers rely on monthly reporting, which is a poor way to manage your lab. Daily management and looking at your lab metrics every day is ideal. Laboratorians need access to their data immediately; you shouldn’t have to rely on IT to run your reports. How you analyze and present the data to the end user(s) is what makes lab analytics meaningful. Lab analytics can help identify trends and show areas in the lab that need attention. Having worked for a LIS vendor for over 9 years, I learned there are things the LIS is simply not designed to do. Ultimately, I was asked to head up sales at a leading laboratory analytics company, Visiun, and joined in 2014. We are a medical technology-led company, our CEO is a Med Tech, I’m a Med Tech, all our support and implementation team members are Medical Technologists. I believe our combined years of laboratory experience combined with our laboratory analytics software provides lab leadership with the answers they need for today and the future. 

At the MLO Laboratory Leadership Summit in December 2019, you spoke about the importance of improving quality, efficiency and test utilization. What have been some of the biggest changes you’ve seen in being able to gather and use that information?

We’ve seen laboratory reimbursements decline, and there is a shift away from fee-for-service. This has led to increased emphasis on the quality and value of the services provided by clinical labs. With fixed reimbursement models no longer compensating for additional hospital clinical lab testing, and increased patient length of stays due to additional lab testing, we’ve seen test utilization become one of the greatest opportunities for health systems to cut costs while improving patient outcomes. The laboratory is sitting on a goldmine of data that can save the health system thousands or millions on unnecessary lab testing. In the past, this data was somewhat locked away by busy IT teams or buried within the LIS. Now, with data analytics, laboratory managers are able to independently generate instant reports identifying sources of unnecessary testing with the click of a button. And when the laboratory works with physicians to eliminate these unnecessary tests or duplicate test orders, the cost savings are immediate. We have seen hospital labs save an average of $230k/year (based on a hospital performing one million billable laboratory tests) after installing our laboratory analytics software. The data is there. It’s just a matter of implementing the right tool to unlock data that was previously inaccessible and present it in a meaningful, actionable way to help quality initiatives, improve processes, and show you where to reduce costs.

What are the advantages of linking LIS with EMR, and are there any IT-related advances on the horizon in the lab that are forecast to become the next important trend or asset to the healthcare industry?

There are certainly advantages to linking EMR data and LIS. We pull in EMR data with our analytics. This can be very useful when looking at AKI-Acute Kidney Injury analytics or evaluating reference intervals by looking at well patient visits to get a normal population, and you need EMR data for that. Because hospitals and labs are starting to look at population health, DRG and diagnosis codes from the EMR can be useful information.

In terms of forecast trends and assets, I think Artificial Intelligence (AI) and Machine Learning(ML) will have greater roles to play in the lab. Predictive analytics for workload is a huge opportunity to make sure you have the right staffing, at the right hour, for the right department. When this is accomplished, we'll see improvements in turnaround times (TAT)s, patient satisfaction, time savings, etc. We are already performing AI on test utilization with notification alerts to physicians and are developing some significant safety and quality AI reporting, so stay tuned for that!

At the Summit, you addressed the value of being able to compare your lab results to other lab peer groups that give visibility into turnaround times for various tests. Why is that important to laboratory operations?

We have seen significant improvements in performance and reduction in outliers, both in-lab and pre-lab, when labs are able to compare their performance that of peer groups. When key performance indicators reveal areas that are underperforming in comparison to a peer group of similar institution type, lab type, or test volume, lab managers can make the changes needed to lead their teams towards those levels of best practice. I tell my clients to hold a mirror up first and see how you’re doing internally before jumping to external peer comparisons. Visiun has internal peer comparisons that show which labs are your best and worst performers. We see this being used as a teaching tool to motivate staff to improve. External peer comparison is also extremely important as long as the peer group is significant, large in number, and matches your scope of operations. With external peer comparisons, you can quickly identify areas in the lab where you should focus on improving and whether you are underperforming or overperforming in comparison to your peers. Visiun has the industry’s largest peer comparison turnaround time database with hundreds of labs providing an excellent lab data set for this.

What are the biggest challenges currently faced by labs, and what tools are available to help?

There are several issues lab management must tackle daily from requests for data, to staffing, or maintaining a competitive edge as a lab service. Lab managers are being pressured to reduce costs, trim budgets and document any savings they can find, and analytics can help lab managers see areas where they can improve service and productivity. Poor quality is a big waste in the lab. Lab analytics can help improve quality and reduce costs on repeat patient collections, unnecessary wasted reagents, and unnecessary quality control (QC) runs. It also can minimize time spent troubleshooting. Another area that I hear frequently is staffing issues. By automating lab analytic report generation and analysis, you free up time for managers who previously spent time compiling reports manually. When the lab has access to detailed staffing reports, they can see visualizations of staffing levels and efficiency. They also can use queuing models with lab analytics to show how adding or removing staff will change patient wait times at outpatient or remote-collection sites. Predictive models of workflow can indicate expected staffing level requirements. Lab analytics should touch on every area important to the lab manager.

Currently, Visiun connects real-time test results with LIS. One of the greatest challenges across all healthcare IT is achieving interoperable systems that actually store and provide patient data in a way that is beneficial to patient care.There is of data, but how do laboratorians turn that into meaningful information that they can analyze and act on?

With lab analytics you can add so much value and do things like manage your laboratory quality, help physicians with lab stewardship and guide them to order the correct tests, and focus on risk management and population health with care gap analyses. The result we’re seeing is that analytics are empowering the lab to become a hospital-wide partner and asset, while improving patient safety and satisfaction.