Managing POCT Across 200 Sites: Successes and Lessons Learned at University Hospitals Health System

May 3, 2017

Presented by Patricia A. Hines MT(ASCP)BA

Presentation Overview

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UH Hospital Systems Background

How We Differ From the Competition

Managing a Vast Geographical Area for POCT testing Problems Solutions

Current Integration Plan Successes Opportunities for Improvement Future Plans

Review of Learning Objectives and Outcomes

University Hospital Systems

• Founded in 1866 • University Hospitals serves the needs of over 1 million patients per year,

servicing 15 counties • 18 hospitals • 40 outpatient health centers • 200 free standing physician offices • 10 counties throughout northern Ohio. • UH is the second largest employer in northern Ohio with 26,000 employees. • University Hospitals Cleveland Medical Center, is affiliated with Case Western

Reserve University School of Medicine. • The main campus also includes UH Rainbow Babies & Children's Hospital,

ranked among the top children’s hospitals in the nation; • UH MacDonald Women's Hospital, Ohio's only hospital for women • UH Seidman Cancer Center

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How We Differ From The Competition • Our community physicians are part of our system but have an

independent financial model. – Each office is responsible:

• Financial stability • Staff • Sites-independent and stand alone sites • Services offered • Office Hours/Other Services

• Each office benefits from the power of being a large institution • Billing • Purchasing • Ancillary Services • Research and Support Groups (Legal, Meaningful Use, Coding etc.)

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Managing a Vast Geographical Area

• More than 200 sites-how to maintain quality in these labs with non laboratory staff.

• 25-30K of miles traveled per year.

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Challenges • 5 Moderate CLIA labs performing in addition to waived testing,

CBC’s Chemistries and Immunoassay panels.

• 200 Waived, PPMP and Moderate CLIA labs – Performing more than 500,000 tests per year. – Billing more than $38,000,000 dollars in Gross Revenue per

year. • One Administrator to oversee all aspects of the lab, quality,

inspections, CLIA’s, to name a few. Mounds of paper to review compounding monthly.

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Monthly Lab Checks for 5 Moderate CLIA Labs

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CLIA Labs Totals by Level and Specialty

Lab Specialty Waived

PPMP

Moderate

High

Pediatric Care 22 1 11 Primary Care 53 51 4 Specialty Care 20 33 2 3 Urgent Cares 3 6 Totals 98 91 17 3

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Challenges Continued

• How to touch as many Waived and PPMP offices efficiently as possible.

• Only 2 waived tests have current and up to date automation. – HGBA1c- >30,000 annually – Urinalysis- >87,000 annually

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Status Plus and Vantage

Challenges Continued

• Different Allscripts versions based on geographic locations. • Navigating the Hospital IT infrastructure. Different departments for

different portions of the interface picture. Barriers to integrating quickly I. e. – EMR group – Integration group – Lab group – Connectivity Group – Architecture Group – Project Management Group – Server Group – Applications/Software Group – Desk Top Group

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Introduction of POCT Solutions

Current UHMP Interface Project Goal-To interface UHMP physician office lab instruments to the current AEMR.

to meet Lab Meaningful use

to decrease lab data entry errors to remotely and efficiently increase oversight

to allow physicians maximize review of patients with chronic diseases

Status- UHMP Moderate lab interface project-Complete as of June 1, 2016

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POCT Successes

• Discrete data entry.

• Eliminated scanning of moderate lab results.

• Decreased manual entry time. – UH POCT performs over 80,000 UA’s annually, manual entry

approximately 2.5 minutes per test. – 3,333 hrs. spent annually – $40,000 staff salaries spent annually

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POCT Successes • Decreased data entry errors. Pre-Trellis random review- 5 out 5

samples had at least one error.

• Post Trellis-5 out of 5 random reviews had no errors.

• Data mining capabilities.

• More confidence in quality outcomes for patients due to the input of quality results.

• Remote and Real Time QC reviews now possible.

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POCT Successes

• Out of range is obvious.

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POCT Successes Continued

• Meeting meaningful use for discrete data entry.

• Physicians liked that results are now easier to find by date of service than before when results were scanned.

• Able to trace patient trends now at a glance.

• CLIA regulatory compliance increased due to time stamping and automatic staff identification.

• More control of training and competency for non lab trained staff.

• Able to lock out non compliant staff.

• Security levels.

• Staff engaged moved to next level of POCT LIS.

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Opportunities for Improvement

• Administration still learning all the opportunities and functionalities of the Trellis product. A lot of potential waiting to be tapped.

• Added additional FTE for administrative lab support.

• Increase amount of IT support.

• IT slow to make changes-many steps to complete.

• More rollout support staff available.

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Future Plans

• Phase 2- All UHMP Waived and PPMP physician labs with at least two interfaceable instruments and currently using the AEMR. About 22 offices

Time frame-2nd Quarter 2017 • Phase 3- All UHMP Waived and PPMP physician labs with either

no instrumentation or instrumentation that needs upgraded. About 40 offices

• Time frame-TBD

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Review of Learning Objectives and Outcomes • Increased remote oversight has many cost savings and efficiencies and

increases the end product of good quality patient care. – Less commuting to offices to review labs. – More reviews completed in the average week than before. – Touching more staff with the reviews. – Opening bi-directional communication lines.

• Computer related oversight opens dialogs that increases learning and better understanding of quality POCT lab testing. – More real time hands on to address opportunities for improvement quicker.

• The dialogs are dynamic, the administrator is able to share the lab regulations, competencies, quality measures and improvement opportunities in real time, while also keeping up with the day to day issues facing the POCT staff in busy physician offices. – This allows questions to be asked and answered often the same day the

incident occurs instead of days, weeks or even months past the event.

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