Integration at two levels: West Coast healthcare delivery system tackles automating lab facilities and merging separate vendor systems - Laboratory Information Systems - Providence Health System

Health Management Technology, Oct, 2002 by Rick Skinner

At the end of 2000, we at Providence Health System (PHS) made a big decision: to implement a new, standard laboratory information system in our Oregon region, which includes seven facilities across five cities.

Providence Health System is a large, not-for-profit healthcare organization with a variety of services and facilities across four states--Washington, Oregon, California and Alaska. The seven hospitals in Oregon support more than 1,200 beds--and the seven laboratories support general laboratory, microbiology, anatomic pathology and outreach services.

The decision to bring the lab systems together under a single solution wasn't made without substantial thought. We wanted an application that would not only improve performance and lower costs, but also would complement the organization's goal of operating more efficiently.

Every organization is different, but the principles used to govern the project at Providence Health System could apply to almost any project:

* Clearly understand your goals;

* Be prepared to do what it takes to get the job done;

* Gain the full support of key people within the organization.

A Winnowing Process

Once we decided that implementing a standard laboratory system had business value for the organization and was supported by all the stakeholders, the process we used was fairly straightforward. We employed a traditional request for proposal (RFP), and sent out six RFPs to different vendors.

The RFP stressed two key elements of functionality that we felt were required to produce a return on our investment. These requirements were:

Multi-entity capability. At the time we issued the RFP, the Oregon region of PHS had seven lab facilities with three different outdated information systems. Not only were the labs in different geographic areas, but each lab was unique in function and capability. A new system must support all the labs with standard functionality.

Strength of the ambulatory outreach function. We wanted to dramatically increase our laboratory outreach business, and to do so we needed to increase our service levels and the flexibility we offered physicians. We knew we had to have Web-based order entry and results retrieval to be competitive in our market.

We knew that to achieve our goal of a single, standard system supporting standard processes, we would have to assure that all stakeholders had a say in, and ownership of, the selection process. We assembled a team of representatives from every facility and across every job category. Physicians, lab technicians and nurses Were all included on this group.

Finding the Answer

After six months of reviewing proposals, conducting on-site visits, and a healthy smattering of internal discussion and debate, PHS selected PathNet from Cerner Corp., in Kansas City, MO. While there had been a great many different opinions and positions during the debate, the entire team supported the final decision, which would ease our subsequent implementation.

We implemented PathNet at our facilities over a period of nine months, with the last facility coming online in February of this year. We installed the system in a specific order at our facilities, based on the complexity of the various institutions and to balance our lab needs at that time.

Because of the sheer size and volume of results at our largest lab facilities, we started with one of the smaller facilities so we could validate that the system was built and installed correctly. We could then move to our larger facilities to gain the most benefits from the process.

While the implementation process was ultimately a success, it wasn't without challenges. The most important one was interfacing PathNet with the existing IT system resident in each of the hospitals, which is from a different vendor. The physical linking of the two systems wasn't that difficult, but getting them to function fast enough, in real time, to deliver integrated clinical results to physicians and other staff members, required serious elbow grease.

Measuring Benefits

We are already seeing concrete results from our new, standard lab system, and we are envisioning what might be achieved in the future. PathNet has allowed us to integrate our lab system into a statewide physician result retrieval system. Our doctors can get results wherever and whenever they want, with just a computer with Internet access.

Our lab facilities now process just under 3 million orders per year, which churn out 19.5 million results. This includes the general laboratory, microbiology, ambulatory services and anatomic pathology.

We also are able to provide safer care through the expert rule system, Discern Expert, embedded into PathNet. The rules system averages 1,000 events per day, which helps avoid errors and expedites care for the 1,750 new patients we serve every day.

With a standardized lab information system in place, we are now pursuing a laboratory consolidation across our three Portland hospitals. This would not have been possible with our previous, disparate systems.