Data Innovations - Instrument ManagerA Path to World Class Patient Care

Introduction

• Adventist Healthcare contracts with Quest Diagnostics to provide Managed Laboratory Services.

• Quest Diagnostics manages the Clinical Laboratories at Shady Grove Adventist Medical Center, Germantown Emergency Center, and Washington Adventist Hospital.

3 Sites

Washington Adventist Hospital Shady Grove Adventist Medical Center

Shady Grove Emergency Center at Germantown

About Us

• Three testing sites• Core Lab:

Hematology, Coagulation, Urinalysis Chemistry Limited Microbiology

• Blood Bank WAH (Open Heart) full service blood bank SGMC (L&D, NICU, PEDS) full service blood bank GEC (Emergency Center) ABO Rh and emergency release

Data Innovations – Instrument Manager

• Instrument Manager - Today– Auto Verification (Siemens Vista X5, Siemens Centaur X2,

Siemens Expand)– QC Analysis built into rules where required (What does your

instrument do for you?)

• Instrument Manager – Pending Projects– Coagulation Auto-verification middle of April 2015– Specimen Storage and Retrieval scheduled for May 2015– Iris Auto-verification tentatively scheduled for June 2015– Moving Averages TBA 2015– Downtime Report Formatting (LIS Down)– ODBC connection (ADHOC Reporting and Data Mining)

Data Innovations – Instrument Manager

• Instrument Manager – Future Projects– Manual Testing (Pursuing Quote)– New Hematology Equipment Auto-Verification

• Instrument Manager – Future Considerations– CAP Interface

About Us

• Technical FTEs assigned to chemistry– SGMC (1 Day Shift, 1 Evening Shift, 1 Night Shift)

3- Vista’s, 1- Centaur CP, Plus miscellaneous testing – WAH (1 Day Shift, ~.75 Evening Shift, ~.5 Night Shift)

2- Vista’s, 1- Centaur CP, Plus miscellaneous testing– GEC (~.4 Day Shift, ~.4 Evening Shift, ~.4 Night Shift)

2- Expand’s

• Core Lab Scheduled Technical FTEs– SGMC 18.2– WAH 12.8– GEC 4.2 (Must have one tech on site 24/7)

Limitation – We all have them!

• Adventist Healthcare owns the Healthcare Record and in our case the IT system used to run the lab as well as the hospital.

• IT Systems Utilized Lab – Sunquest (SQ Version we are on has limitations and we

cannot control upgrades) Hospital – Cerner (Lab system not purchased at this time)

It’s a Journey to World Class Patient Care

• Lofty Goals: System wide integration, standardization, and optimized resource utilization. How do we get to World Class? (Remember it’s a Journey)

1. Are all labs working from the same play book (SOP)?2. Are all employees implementing standard practice as designed?3. How do we get to where we need to be?4. What do we need?5. How do we decide on a path?

Journey to World Class

• System wide standardized electronic document control – Complete

• Electronic APP driven system wide scheduling (Staff have schedules on their smart phones)- Complete

• Standardized system wide training and staff rotation – 70% of technical staff rotate to alternate sites

• Data Innovation totally implemented and integrated by 2016

Our Team

• In the Beginning Rob SanLuis (Technical Lab Director) Marie Sabonis (Lab IT Manager)

• Now Rob SanLuis and Marie Sabonis Dennis (Lab IT) Ash (Lab Technical Specialist)

Current IT Configuration

Current IT/INSTR Configuration

Brief Overview of Validation Testing

• How do we test our rules:– Dry Testing

Edge test our rulesImport specific patient examples for troubleshootingEasily test 100% of rules if you wish

– Wet testingFull and Partial Path

Dry Testing Example 1 - Unexpected

Dry Testing Example 2 - Expected

Wet Testing Plan

• Full Path Testing– Testing for all routes that the data can take to make to the final

destination– Path (LIS, DI, Instrument, DI, LIS, HIS)

• Partial Path Testing– Testing for functionality– Path(Instrument, DI, LIS)

Full Path Testing Plan

LIS(Test) IM(Test) INSTRUMENT

IN (Orders)

SENT (Orders)

SENT (Results)

IN (Results)

HIS(Test)

START

END

Partial Path Testing Part 1

-Select an accession from production instrument-Move instrument from PROD to TEST in LIS AND DI-Place an order in LIS-TEST that matches the selected accession

LIS(Test) IM(Test) INSTRUMENT

IN (Orders)SENT

(Orders)

START

Partial Path Testing Part 2

-Retransmit selected accession from PROD instrument to IM TEST

LIS(Test) IM(Test) INSTRUMENT

SENT (Results)

IN (Results)

START

The QC and Auto-verification Connection

• What is acceptable QC frequency for Auto-verification?– Just enough to ensure accurate results!

• Some points to consider– QC timing, Automated QC, QC Lockout– Batch size (Stability of Analyte)

If you run QC every 2, 4, 8, 12, or 24 hours then that is your batch size!Disperse QC within the batch

– Close out your batch before maintenance– Lookback process (This is why batch size is important)

Instrument Manager and BioRad

• Rules– QC is out = stop autoverification– QC timed out = stop autoverification

• Easy of Use– Tech enter actions and comments– Tech access to LJ’s, Ranges, and CV – Tech review performance against the peer group– Tech bench level review

Instrument Manager and BioRad

• Management– Captures all QC data (Regards if tech accepts, rejects, or

ignores)– Easy setup– Easy Review & Signoff– Easy to add new lots and make range adjustments– View multiple instruments/analytes across sites together– Quick system wide level review– View Graphs against your mean/sd or peer or method– Supervisor Signoff

Instrument Manager QC Setup

• Enter Connect Name• Instrument ID• Lab NumberThis data comes from your setup. It is really quite easy and support from DI and BioRad is very good.

Instrument Manager QC Setup

Instrument Manager QC Setup cont.

Vista - QC Display in Instrument Manager

BioRad QC Views

Staff generally utilize the Lab Tab to access data for a specific instrument.

BioRad QC by Instrument

• QC organization– Instrument

QC Lot– Analyte

Tech View in BioRad with Action

BioRad – Multi LJ Review

• QC Trouble Shooting– Multiple Instrument View

New QC Lot– Problem with just a

single instrument– Problem corrected with

recalibration.

GEC QC display in Instrument Manager

Tech View in BioRad Action Pending

• Tech is still trouble shooting issue at this time.

Bench & Supervisor Level QC Reviews

Summary

• We have had a very positive experience utilizing Data Innovations

• The implementation of DI has significantly impacted our productivity and staffing

• We plan to continue our journey with DI and to expand our utilization of DI

Wish List• We would like to see temperature monitoring as well

as RF ID (specimen and inventory) management as part of DI

Questions

All questions are welcome.

Thank you!

For More Information

Robert SanLuisEmail: rsanluis@adventisthealthcare

Phone: 240-620-3413