To support and sustain growth through any outreach program, laboratories must have the right application and vendor partnership from the start. A sustainable outreach program will be supported by a solution that is low cost, fast to implement and able to quickly bring up new customers. The solution also needs to be able to be funded as the business grows and not require a heavy upfront investment or out-of-pocket expenses. Think more in terms of "pay as you grow" for profitability and risk mitigation.
Outreach programs have evolved significantly from when they were initially rolled out; now they serve many functions and to multiple recipients. For example:
• Outreach programs provide additional sources of income to laboratories and the facilities that own them.
• Outreach increases the market reach and presence of the lab in the community that can, in turn, provide additional sources of business and attract new patients to their facility for other services.
• Outreach testing gives physicians and physician offices the ability to offer testing services to their patients directly from their office, preventing patients from going elsewhere and ultimately increasing patient retention.
• Outreach helps keep competition out of a hospital lab's geography simply by providing testing services so that other labs don't or can't; by offering outreach testing services, any lab can essentially become a reference lab regardless of size and location.
• Laboratories that provide outreach testing services can offer participating physicians and labs access to specialty tests, preferred or competitive pricing, faster turnaround times and customized reports.
All in the Infrastructure
The main consideration in supporting an ongoing, successful outreach program is in the cost of the infrastructure to include the information technology (IT) investment. A central focus is on reliability, scalability and return on investment (ROI). The main costs to consider are broken down into three main categories:
1. The cost to increase the lab's outreach business-marketing, sales, any new tests or cost of adding tests to the test menu. These can include instruments, staff, training, physical space and materials.
2. The cost to maintain the lab's outreach business-customer service that includes staff, ease of access, final report customization and branding, competitive pricing, turnaround times and quality of results.
3. The ability to scale quickly, affordably, effectively and efficiently.
Of the three items above that are instrumental to the overall ROI success and metrics of an outreach program, the first two are easy for a laboratory or facility to manage from a business perspective (includes planning, evaluation and a solid business plan that is regularly updated and adjusted to provide optimum results). However, the third item involves making the right decision from an IT and infrastructure standpoint. Selecting the right applications and understanding how to fully leverage those applications is the true key to affordable, sustainable growth and profitability.
Understanding, Accounting for Needs
Again, there are three main areas to consider under the IT/application heading:
• Internal needs and benefits include scalability and time to bring a new customer on board affordably. The right application will provide the ability to bring new clients on board in a fraction of the time and at a fraction of the cost of traditional point to point interfaces because those interfaces are now considered ancient artifacts in this space. With the speed of the Internet and 24/7 access, having to wait to hard code or program traditional HL7 interfaces is truly an archaic concept.
• External needs and benefits include the ease of use for participating physician groups' IT departments and organizations. The customers the lab is targeting also don't want to incur deep costs, drains on their technical staff or having to hire technical resources to get the program integrated and launched. The right application will enable the physician office to have minimal disruption and realize the benefits of an outreach service quickly.
• Customer service includes the ease of use for ordering, tracking tests or orders in process, getting their final results, determining what the final product actually looks like and how it is delivered. Physicians are looking for mobile and hand-held access, email notifications, performing location-based requisition rules, courier functionality, the ability to view the patient's entire history, the ability for the lab to display case documents with the result report, a client-specific testing menu, Medicare compliance testing and more. The latest requirement in service now includes what we know as "intelligent rules-based report distribution."
"The EMR is a component of the outreach program that has to be connected in a way that is scalable," says Brian Keefe, director of Sales & Marketing, Psyche. "Your customers are using EMRs in their offices and the ability to integrate with the EMR in a robust way is essential. Using web technology-leveraging the cloud-provides a much lighter footprint and enables the lab to fully integrate the capabilities of the EMR for result viewing and order input much more effectively than a providing a portal or full-fledged integration."
The traditional interface never had the capability to provide a unique patient identifier linking and, most importantly, the ability to support complex electronic requisitions, particularly for molecular, pathology and cytogenetics, Keefe continues. "Your connectivity needs to be able to supplement missing, or leverage existing, capabilities of the EMR in the testing process.
"The ability to offer something that fills the gaps missing in the EMR or for clients that do not have an EMR is necessary for the outreach solution. This may be the application of provider insurance rules to testing location-labeling at the point of collection-intelligent, integrated unique tools that labs can use to streamline the heavy lifting of establishing traditional connectivity such as test menu codes, insurance provider libraries, physician/submitter codes, LOINC and ICD-10 codes. This increases the amount of flexibility and control at the lab/physician level and decreases the cost of the vendor side involvement in these connections," adds Keefe.
Mobile access must include the ability to have physician order entry (CPOE) functionality on any mobile device to create electronic orders, check for compliance, generate the ABN form for Medicare, handle standing orders, provide a test compendium/catalog for specimen handling and test information to include special orders-all during the patient's office visit. This competitive advantage enables the delivery of a higher level of customer service from the physician to their patient and from the lab to the physician.
Lisa-Jean Clifford is CEO, Psyche Systems Corp.
RFID: A Strategy for Outreach
By Valerie Neff Newitt
It's not easy for a hospital laboratory to get a leg up on competition that includes behemoth reference labs with their lower price points gauged to volume and ubiquitous presence.
But radio frequency identification (RFID) may help level the playing field for those labs opting to use it. RFID appears to meld seamlessly with barcoding, marrying identifying information with time-stamping, location pinpointing, almost hands-free scanning and real-time tracking. These are benefits that can trump price point.
David Spears, vice president of sales and marketing at IDM LabTrack of Scottsdale, AZ, maker of LabTrack™, stresses that using RFID for tracking laboratory specimens is in its infancy, yet the technology is so sophisticated that users can proactively assume a differentiated position in a competitive environment.
How It Works
When a specimen is collected at a hospital, clinic, nursing home, physician's office, etc., it receives an RFID tag that is immediately "associated," via a barcode reader, with the specimen's barcode. The RFID tag, either embedded into that barcode or applied separately, contains an embedded computer chip that picks up vital information along the specimen's journey. Next, the originating facility groups its specimens into three types: room temperature, refrigerated and frozen samples. Like-type specimens are bagged together, and the bag receives an RFID tag. Those bags are put into a grouping chamber. The grouping chamber associates those individual specimens with that bag tag.
The RFID tags act as simultaneous communicators, alerting the lab that the grouping has been completed and that the specimens, according to various types, are ready for pick up. Thus, the receiving lab already knows how many specimens they will be testing, what type of storage they will require, and what time they were grouped for pickup.
When a courier picks up the specimens from the facility, he walks past a "portal"-an RFID reader which, in one fell swoop, reads all of the tags-both individual specimens and bags. Again information is relayed to the receiving lab that specimens are in transit. Likewise, when the courier arrives at the lab and walks through their portal, all of the bags and specimens are accounted for and logged in automatically-no need for each barcode to be scanned and read.
Laboratories have a continuous timeline, allowing them to track the movement and requirements of incoming specimens. Furthermore, it allows labs the advantage of less labor involvement in individual barcode scanning and logging, and even can alert a lab manager to staffing needs dependent on the number of specimens in transit. "That can be of value to a lab that runs lean and efficient," notes Spears.
He also emphasizes, "Hospital outreach always looks for a competitive advantage that's not contingent on price. They can't do tests as cheaply as those national labs that do 100 times the volume. But this kind of value is outside the realm of pricing. Imagine being able to say to a physician, 'We can track your specimens and we can guarantee that they won't get lost.' What physician in the world wants to call a patient back and say he has to take another specimen? Yet it happens every day."
Lost specimens take their toll not only in loss of timeliness, business and faith, but ultimately in diminished patient care.
"In nursing homes, for example, it's difficult to get blood from elderly patients; their veins collapse so easily. But if a blood sample is lost, that patient has to be drawn again," says Spears. In anatomic pathology, a lost specimen could be more than aggravating; it could be tragic. "You may have a mass for biopsy. If you lose it, you may be unable to get another specimen."
And then there are those times when a doctor calls a lab asking for results on a test that was never received in-house. "How do you prove it? Without tracking you have no way to know if it went into a bag for delivery, or if the courier picked up, or if the bag got to the lab and the lab lost it. There is no accountability," says Spears. "RFID tracking removes guesswork 100%. A lab can absolutely prove it did not lose a specimen."
While RFID is more expensive than barcoding alone, Spears says it offers demonstrable return on investment. It streamlines processes that actually result in cost savings-resulting from better staffing management, fleet efficiency, eliminating unbillable redraws, improving efficiency within the lab workflow resulting in better TAT, and more. The biggest "draw" is the value of use, and that, says Spears, can compute into outreach success.
Valerie Neff Newitt is managing editor.
By Pat Wolfram
Expert tips can help ensure the competitiveness of your lab outreach solution to an EHR world.
• Look at your solution through the eyes of your customer-the physician. They've bought an electronic health record (EHR) and it's now their clinical cockpit for all patient care. Orders originate in the EHR, results return to the EHR. If physicians don't like the EHR workflow that your outreach integration delivers you're not competitive.
• Think ahead. Assist the practice in setting up their EHR lab orders environment, and establishing the orders interface. Once orders are set up your operations will be smoother, you'll have fewer write-offs, and the lab results you return to the practice will be more accurate. This becomes even more critical when physicians are required to place orders in their EHR; a proposed requirement for EHR Meaningful Use Stage Two.
• Plan to support integration to an assortment of EHRs that vary greatly in their ability to send electronic lab orders. EHRs fall roughly into four functional groups; ones that can send lab-ready orders (there are only a few available commercially today), those that can send only basic order information but no draw information (AOE questions, specimen handling/storage, draw date/time, etc.), those that send only demographic data, and those that have no ordering module at all.
• Remember the patients. If your outreach solution enables easy-to-use (for the practice) patient-friendly lab reporting, the practice will love the improved patient care they can deliver.
• Team up with radiology services. If your hospital offers diagnostic imaging, add it as part of your hospital outreach solution and strengthen your offering to the practice.
Pat Wolfram is vice president of marketing with Ignis Systems.