Toxicology Lab Operations

One of the keys to staying competitive in today’s clinical laboratory and toxicology market is finely tuned customer service and operational efficiency. A physician or client’s concerns about turnaround times, requests for reflex testing, or questions about results can be challenging to respond to quickly and to the satisfaction of the client. Fortunately, with new business intelligence (BI) tools, laboratory managers are able to drive process improvement and respond to client question with hard facts and an information-based manner.

Pathology Associates Medical Laboratory (PAML) is a full-service medical reference laboratory headquartered in Spokane, Washington and owned by Providence Health & Services (PH&S) and Catholic Health Initiatives (CHI). PAML Toxicology recently implemented a business intelligence tool in order to acquire and analyze laboratory and business-related data in a more timely and practical fashion. David Michaelsen, MS, RP, general manager of PAML’s Toxicology Department, indicates that they have utilized the BI application in a variety of ways, including managing and growing client accounts. “Almost every day we talk in a meeting about a concern or a question and we turn to the BI application to pull the data to determine how it really affects us.”

Customer and Physician Satisfaction
BI tools help make laboratories more responsive to customers, which in today’s competitive marketplace can be a game changer. Michaelsen says they are utilizing their BI application to audit clients, acquire a real-time snapshot of what their test volumes and test mixes are, and determine whether results are being delivered as quickly as they believe. The analysis allows everyone involved, from the administrative, technical, and sales/marketing departments, to actually see what is occurring and how it compares to what is anticipated. “Using our BI application, we also look at the positive rate on different tests that need confirmations, allowing us to more effectively price our testing for clients,” Michaelsen said.

Customer requests can also be dealt with using reliable facts and figures with a BI application.

An example at PAML Toxicology was that clients were requesting automatic reflex testing for methamphetamines to the D- and L-isomer test whenever the original test was positive. PAML’s policy was to only perform the D- and L-isomer test when the methamphetamine test results fell below a specific value. The concern on the part of PAML was that this increase in reflex tests would affect their personnel’s workload. By using the BI application and crunching the numbers, Michaelsen found that it was actually only one or two extra samples per day and changed their internal process. “We determined it wasn’t going to have an enormous effect, it wasn’t going to change our workload or FTEs.”

Another prominent example is a client calling in with concerns over turnaround times (TAT), believing that they were not getting their results as soon as they were accustomed to. Utilizing their BI tool, Michaelsen ran the numbers to determine the actual times for resulting. The team evaluated whether there were actual issues with the lab processes that were causing delayed results, IT problems such as connectivity issues between the electronic medical record (EMR) systems, or if the delayed TATs were more about perception rather than actuality. Michaelsen said, “By crunching the data, we found there were a few positive tests that took longer because they were sendouts that we didn’t handle in-house. So it seemed as if the TAT had increased, but it was really only one or two tests with increased TATs. This was a perceived problem rather than a real problem.”

Process Change and Employee Buy-In
Anyone working in a laboratory understands how difficult it can be to change processes — “But we’ve always done it this way” is pretty much a mantra in any lab or office. By using a BI application, it makes it easy to quickly analyze operational and clinical data. The data is then easily presented to employees to identify new processes or modify existing ones. At PAML Toxicology, Michaelsen says, “I’m thrilled to be able to have the data to explain a problem, even if it means we need to correct or do things differently. If you can’t measure it, you can’t monitor it. So it’s nice being able to see what the numbers say both before and after a change.”

Potential areas for process changes in the laboratory are the time it takes getting samples to the technologists at the bench (processing), how long each type of test takes to perform, and individual technologist productivity, for example. Michaelsen pointed out that having the data at hand improves employee buy-in. “A lot of time you will suggest a change and the employee will say, ‘That won’t work, that will increase costs, increase TAT, increase this or that.’ However, when you’re able to pull the data and show that it actually improves things, it helps support the change of direction.”

PAML Toxicology also uses their BI tool to analyze staffing and the time needed for samples to be processed and resulted. It allows them, on both their forensic and clinical toxicology sides, to detect patterns. Michaelsen said, “Do we have the right number of processing people? Do we have the right number of technical people? Are there significant fluctuations on any given day or time of day?”

This further allows PAML to evaluate those patterns over time — by day, by week, by month, and eventually, by year. Are the fluctuations in certain types of specimens seasonal? Michaelsen asked, “Even with our annual growth, are those fluctuations scalable? Can we use those fluctuations to actually map out a calendar to predict what days, weeks, or months we will see a higher percentage of those tests?”

BI tools enable users to find and analyze outliers. Michaelsen said that they were able to analyze the individual tests that made up their pain management test panel in order to determine which test was delaying the majority of the results. “We started by breaking out the outliers of each of the individual components or groups. Was everything getting out quickly? What area did we need to focus on to make sure that results were going out smoothly?”

Michaelsen indicated that one of the advantages of BI in the laboratory is how quickly it puts usable information in the manager’s hands. Prior to using BI tools, laboratories would pull the data from IT, which was time consuming and used up valuable IT resources. The data would then be presented to whoever needed it in a spreadsheet, which would require more analysis. Business intelligence is typically offered with a “dashboard,” which allows the user direct access to the data that can be mined according to customized parameters and presented in a variety of graphical and table formats.

“Normally it would take a day or two to grab all the numbers,” Michaelsen said, “throw them in a spreadsheet and toss in some formulas and try to calculate out the information we were trying to obtain. However, with our new BI solution, many of our templates can quickly be modified to use for gathering specific data on clients, on tests being performed, on employees or whatever else we want without reinventing the wheel each time.”

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Marketing and Sales
Although having a business intelligence tool has definite uses in responding to customer queries and problems, and analyzing processes, it is also an effective tool for sales and marketing. The particular BI application used by PAML is Viewics Health Insighter (VHI). This solution provides PAML quick access to templates that allow them to instantly review each client. Michaelsen said, “It allows us to effectively market; it allows us to effectively review by client exactly what’s going on, whereas before it took a lot more work to get the data.”

In addition, BI tools allow laboratories to smash individual silos and provide all the data to anyone who needs it, whether it’s the operations staff, sales, marketing, or administration. Sales people can be more responsive to individual clients’ needs and concerns while shedding light on upselling opportunities, marketing people will have access to sales and customer trends, and operational and administrative users will be able to identify areas for change, implement the change and have actual data to support the effectiveness of that change. Furthermore, because of the real-time dashboard component, there is no more error-prone uploads to spreadsheets, third-party requests for information to the IT department, and wait times for data collation — the information is literally at the fingertips of whoever needs it and when they need it.

Justin M. Clark is senior marketing manager, Viewics Inc., Sunnyvale, CA.

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