The information flow in the laboratory between instruments, devices, and interconnected systems outside the lab is the connective tissue of laboratory operations. The data flowing between these systems is the life blood of any health care organization and supplies the majority of clinical information for the medical record systems and for the clinical staff treating patients.
More than ever, laboratories are feeling the pressure to ensure they are managing their software systems and workflows to improve laboratory efficiencies, reduce turnaround times, and eliminate costly errors. If we have learned anything from the pandemic, it's that laboratory processes, the quality of the data, and its speed of transmission are critical factors in serving patients and populations.
What is laboratory informatics stewardship?
Leadership brings the lab and the IT software tools together so that the workflows that govern the testing and results are managed appropriately. It’s the bridge between the clinical aspects of generating a test result and the digital methods of processing and reporting.
The stewardship component of laboratory leadership is creating that space and process where clinical experts within the lab can express how they do what they do to IT professionals in a way that it can be produced and managed electronically. What is often missing between laboratories and their IT departments is the framework and opportunity to build and nurture this connective layer so that both parties can understand each other and aim for mutual goals.
How do lab managers see their role as IT stakeholders?
Clinical Lab Manager conducted a survey in April of this year and found that only 50 percent of the clinical directors and lab manager responders say they are actively involved in lab software purchasing decisions. These same respondents indicated overwhelmingly (> 60 percent) that they want to get even more involved in laboratory software and informatics data management decisions.
Respondents further shared what prevents them from participating in laboratory software purchasing decisions: i) a steep learning curve in the understanding of software systems; ii) a lack of communication with their IT department; and iii) a lack of knowledge about which products to purchase.
The survey results revealed that there is interest on the part of these laboratory managers in overcoming these challenges by: i) improving dialogue with their IT counterparts and ii) gaining a better understanding of system requirements; and iii) the desire for a shared partnership in selecting software for the laboratory.
Lab leaders as stakeholders in laboratory informatics stewardship
Where then does the responsibility for laboratory informatics stewardship rest? Many would argue that it sits with either the clinical power users and IT scientists, or with the technical IT staff assigned to support and service the laboratory software systems. Some describe data stewards as the foot soldiers of data governance and others see them as referees, coordinators, or liaisons between lab clinical operations and IT.
Based on the results of the survey, this may not be enough. Engaged laboratory leaders know they can benefit from greater involvement. The question is how. We asked three experienced laboratory professionals to share their perspectives and advice.
How can lab leadership participate as informatics stewards?
GET INVOLVED IN SOFTWARE DECISIONS
If you sat on the sidelines for the last software purchase, this is your opportunity to engage and work in partnership with your management, cohorts, and IT department on the next clinical IT project. “Every lab needs a clinical leader that is actively engaged in the purchase of laboratory software systems that reflect the clinical test and workflow requirements,” explains Angela Martin, manager of laboratory information systems at Norton Healthcare in Louisville, Kentucky. “The ultimate success of any IT project that impacts laboratory workflow, data creation, and utilization depends on aligning goals and objectives between the clinical and informatics teams. No one person from IT can represent all your laboratory’s needs and requirements, no matter how much domain expertise they may have.”
SEEK OUT AN INFORMATICS MENTOR
One of the common complaints of laboratory professionals is that they don’t understand how to choose what software products to purchase or what software upgrade features to implement. While laboratorians understand the criticality of data quality, integrity, and movement, they may not believe that they understand the full picture of the data flow within the laboratory as it relates to their operational workflow and how this data flow moves across the organization.
One of the best ways to learn is to seek out mentors within your organization or professional network. Ideally, seek out other laboratory managers who are well-versed in both lab and IT, and are willing to be a resource for you to fill in your knowledge gaps, or who can point you in the right direction. Alternatively, partner with one of your organization’s lab IT analysts with a lab domain background. Mentors are generally eager to share their successes and the lessons they learned in their journey toward IT and software literacy.
PARTICIPATE IN A CROSS-FUNCTIONAL TEAM WITH DATA STAKEHOLDERS
If a laboratory informatics stewardship cross-functional team does not exist in your organization, this would be a great time to create one. A leadership team comprised of clinical lab and technical stakeholders that is focused on connecting lab requirements with IT capabilities raises the quality of decision making and maximizes the benefits of the software and systems used by the laboratory. No one person can anticipate what an organization needs. Given the natural complexity of the laboratory and the inherent complexity of implementing IT solutions, a cross-functional team will aid both groups in achieving mutual success goals as well as positioning the organization to better adapt to change.
IMPROVE YOUR TEAM’S DATA LITERACY
Your input will be valued more when you share with others how your data is meaningful and how it should be used. Take this opportunity to teach your technical cohorts what is considered good to optimal clinical and operational data and what data might be discarded.
Martin explains, “we follow an important dilution management workflow, where input of a clinical liaison is critical in determining how to manage the dilution series in our laboratory information systems. Without a clinical expert guiding IT on the concentrations, units, and factors to use, we would not have captured the data flow correctly to ensure the dilutions were appropriately calculated for the final result.” Sharing the clinical protocols as well as how the data should be managed from the source to downstream systems will facilitate a better understanding of data-driven decision making. Your team’s growth in understanding data quality goes a long way in making better informed decisions whether building or modifying configurations or when purchasing or replacing existing clinical software systems.
MAP OUT BOTH WORKFLOWS—OPERATIONAL AND IT
One of the outcomes of the Clinical Lab Manager survey is that many of the clinical lab manager respondents do not feel they understand their current IT systems or data interoperability or simply how the data flows in the lab. This deficiency of IT knowledge in combination with a lack of communication with their IT counterparts is seen as a major source of frustration. “One way to bridge the gap is to ask your laboratory technologists, who are the experts in their domain, to map out their clinical workflows,” explains Rhonda Emerick, a former enterprise IT director and current IT manager supporting TriCore Reference Laboratories. “They are invaluable facilitators who can help bridge the gap between operations and IT.”
These documented workflows become the basis against which data flows can be mapped by your IT counterparts. The cross-functional team now has an operational tool that forms the basis for a common language between two disparate groups. Emerick warns that without an equal effort by both groups to meet in the middle, “successful projects can fail and there may be no recovering from that over time.”
ADVOCATE YOUR NEEDS TO IT LEADERSHIP
Your requirements can be balanced with corporate priorities when your voice is heard. But when IT leadership does not hear directly from the clinical and business units, decisions may be inadvertently made in isolation. Often IT leadership won’t know to reach out; instead, the lab should lead by reaching in. Become an “IT advocator” for your laboratory and help ensure your voice is heard to facilitate projects that require their support and funding.
“I took the initiative when I was hired to merge two labs,” says Heather Maske-Hall, laboratory manager at Brown Clinic in Watertown, South Dakota. “I knew we needed strong support from IT, so I reached out to our chief administrative officer, educating him on how the lab uses informatics to gain efficiencies and save labor. The effort paid off. We were able to convince our leadership to invest in autoverification software and implement chemistry rules within six months. The solution significantly improved our result turnaround time and operational efficiency. Since that experience, leadership are now looking for other similar initiatives that the laboratory can accomplish using IT optimization. It’s been a terrific internal partnership.”
By engaging in the process, involving leadership, clinical support teams, subject matter experts, and vendor partners, you are better positioned to set priorities that best fit your short- and long-term goals. Be sure to include your front-line clinical teams and involve them throughout the design and implementation process. Build experience within your clinical teams to facilitate long-term confidence and “skin in the game.” Consistent involvement in current and future lab software projects is key. Informatics stewardship is not a one-and-done exercise but a long-term commitment to protecting your most valuable assets in the lab.
Clinical leaders must become informatics stewards
According to the National Committee for Laboratory Stewardship in their 2017 special report,1 test utilization management is the primary goal of controlling laboratory costs and improving the quality of patient care. Informatics stewardship programs that support the overall test utilization initiatives require that data and software management systems involve leadership commitment from all levels of the organization. This includes the clinical lab managers and directors having direct involvement in software system priority acquisitions and lifecycle management. These clinical lab leaders are essential stakeholders in the contribution of expertise and requirements to improve laboratory test data utilization. Clinical leaders can and must become laboratory informatics stewards by educating themselves their staff and their leadership stakeholders on how to identify informatics opportunities that help them deliver peak laboratory performance.
- Dickerson, Jane A., et al. "Transforming laboratory utilization review into laboratory stewardship: guidelines by the PLUGS National Committee for Laboratory Stewardship." The Journal of Applied Laboratory Medicine 2.2 (2017): 259-268.