mayo clinic overview - executive war · pdf file© 2010 mayo foundation for medical...

© 2010 Mayo Foundation for Medical Education and Research. All Rights Reserved.

Department of Laboratory Medicine and Pathology

Mayo Clinic Overview



Mayo Medical Laboratories Overview



Our mission is not just words

Extend Mayo Clinic’s reach “Here, There and Everywhere” by enriching the clinical practice, enabling patient care benefits, and providing financial contributions that support Mayo Clinic’s three shields.

The MML Mission



DLMP Business Model

Mayo Clinic PracticeDepartment of

Laboratory Medicine and Pathology

Mayo Medical Laboratories

50%of tests

50%of tests

RochesterRochester

NewEngland

NewEngland FloridaFloridaadsMore than 4,000

health care organizations send

testing to Mayo Clinic

Including all of the

23 milliontests performed

in 2012


Value to Mayo Clinic Practice

Mayo Clinic patients have access to a test menu of > 2,800 tests due to DLMP

Increased volumes due to MML allow for decreased TAT for internal patients

MML volumes expose DLMP consultants to a more complex case load which benefits the practice (40,000 MML consultations of rare bone tumors)

Last year, more than 1,000,000 patients visited Mayo Clinic

DLMP touched an additional 4.5 million lives through its reference laboratory practice (MML)



The Case For Change Two core systems were extremely outdated

• Written in MUMPS• Green screen/simple text, numerically driven entry

Systems could not evolve with the needs of Mayo• Customization at the lab level• 400+ unique workflows• Order centric view of specimens



The Case For Change Difficult to automate rules and processes Growing test menu increasingly penalized lack

of standardization Nature of testing evolved

• Rise of molecular testing• Interpretive comments• Need for integrated content

Multiple LIS like systems needing to process order transactions back to Mayo EMR



Mayo Medical Laboratory’s Growth

Why are we Implementing LabPACE?

Program Objectives and Governance

• Not an “IT Project”• IT is a tool, not a solution unto

itself• Not an evolution of laboratory

operations• This will be a transformational

change to the way we operate• This is a workflow, laboratory,

patient-centric program.

The Journey Begins

• In 2005, Mayo received approval and assembled the program team

• High level governance from the top institutional leadership

• Stakeholder analysis ranged from phlebotomist to provider

• Reference laboratory order/result hub scheduled for simultaneous upgrade

Building Out the Program

• Consider building a house…• Architects, engineers, carpenters,

suppliers, homeowners…and the bank

• You need the house to be ready to live in, but you need to be ready to live in the house.

Terminology: Verification / Validation

ValidationAre we building the right product?

Can the staff use the system as built …

VerificationAre we building the product right?

Does the software meet specifications…

15

LabPACE SPIProgram Overview

Success Requires 100% Congruence

• Product Readiness• Develop software requirements• Coding and testing• Infrastructure readiness

• Business Readiness• Change management• Supply business requirements• Build better systems

How will this be Implemented?

Critical Program Elements

• IT is not something done to the labs• Workflow standardization is

paramount• Engage subject matter experts

• End users -> business analysts -> software requirements -> coding

• Bring the lab into the process at its core

Changes (Challenges?) In Organization Thinking

• Mayo Clinic is first and foremost and academic medical center

• Physician lead, administratively supported

• Organizational structure is based around clinical divisions

• Division chairs, laboratory directors, academic credentials

• MML/DLMP is just one part of the larger organization

Individual research labs

Cell kineticsCoagulation DNA dxHematopathologymorphologyMetabolic hematopathologyMolecular hematopathologySpecial coagulation

Biochemical geneticsCytogeneticsFertilityMolecular genetics

ApheresisAutotransfusionComponentDonor servicesHuman cellular therapyReference labTissue typingHospital transfusion labs

EndocrineImmunologyNucleotide polymorphism labAutomated immunoassayMetalsNeuroimmunologyToxicology drug

AutopsyCytopathologyFrozen sectionHistologyImmunohistochemistryIn-situ hybridizationMolecular anatomic pathologyMolecular cytology & imagingRenal biopsySpecimen processingSurgical pathologyTissue registry

Hospital clinical labsPhysician office labsPoint of care testingRenal testing labRenal studies labCardiovascular med labCentral clinical labCentral processingVascular access teamSpecimen collection Special studies

BacteriologyMycology/mycobacteriologyHepatitis/HIV molecularVirology/parasitologyHepatitis/serologyInitial processing/mediaInfectious disease/serology

Anatomic Pathology

Clinical Biochemistry

and Immunology

Clinical Core Lab Services

Clinical Microbiology

Experimental Pathology

Hematopathology

Laboratory Genetics

Transfusion Medicine

61 Performing Labs

Performing laboratories by Division

Eliminate Divisional Siloes and Barriers to Standardization

• Organized the program around workflows

• Each division shared leadership responsibilities

• Support from business analysis, systems engineers, project management

• Laboratory driven; process understanding paramount

Mass Spec Work Group

Lead by: GeneticsRepresentation From: CBI, CCLS, NE, Genetics

LabPACE Division Road Show 23

Responsibilities of Lab Implementation Coordinator

File Build Build or facilitate build of tests Communicate progress of build Identify and escalate issues or problems

identified during the build process Laboratory “Super user” Verify system requirements

Was It Worth It?

• Investment included:• Financial • Deferred new test build• Lab staff off the bench• Introduce risk to the practice• Significant change management• Crushing workload—driven to

tears!

LabPACE Division Road Show

Risk Mitigation

25

Yes

• NOTE: this will be one slide with graphics

LabPACE Division Road Show

Patient Safety

Specimen centric LIS Orders and tests attach to specimens Each specimen has a unique identifier Each test has a unique specimen type

Serum v. plasma EDTA v. heparin 24 hour v. random urine

Enhanced specimen tracking

27

“Specimen Status”

Responsibilities

• Not collected – Phlebotomy and MML Dock

• Collected and not received• Receipted and not received• Received

Placeholder Slide – Lost Specimens

• Lost specimens – decrease from 0.012% to 0.002%. While the rate remains small, the improvement is significant, due to better specimen tracking with new system.

• Includes courier/client related events • Earlier awareness that a specimen is not where it should

be in the workflow

• Mislabeled specimens – overall decrease• Hold this white space for animation and graph

Standardization Benefits

• 4500 unique workflows reduced to 46• File definition faster and more

efficient• Training time reduced• FTE per test reduced despite

increasing complexity of menu• Reduction in avoidable errors

Workflow Map

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Improved Quality & Safety

• Logic built into each unique orderable test• Container type, routing rules, volume

• Laboratory specifies requirements as part of file definition• Vastly reduced manual entry across systems

• Built in data integrity, collection and catalog instructions

• Unlabeled tube errors – specimen tracking at the container ID vs. “accession” level shows a 90% improvement.

• Every specimen qualified for testing at collection.• Occurred on average with 11 collections per every 1,000

blood draws, this is now at zero. • Eliminates waste (extra steps) in core laboratory.

Improved Quality – Rollup Logic

• Reduced the amount of blood collected from patients• Time to perform the redraw ordering process has

decreased by 80%. • Quantity not sufficient rejection rate dropped from 0.4% to

0.1%• Test level volume management• Clarified preferred and minimum volume• Enhanced ability to manage low volume specimens

Graphic Slide

• White space for animation and data regarding cancels and defects

Improved Quality

• Mislabeled specimens – overall decrease

• [hold white space for charts and data]

Decreased Revised Reports

• Data is more volatile; low rate subject mass events such as reagent recall

• Stabilized quickly after go-live• [white space for charts]

Better Resource Utilization

• Transferred significant pre-analytic work out of testing laboratories

• 60,000 incremental monthly aliquots performed in MML Operations

• Zero increase in FTE• Introduced automation

• Increased sort granularity• [White space for animation]

Electronic Efficiencies

• Critical call back notification process 100% electronic• Embedded quality control module (TQC)

• Reduced need for manual tracking in external systems• Significantly less overall paperwork

• GUI screen reduced need to print hard copies of task lists, batches, and other system data

• Users could read the screen and intuitively navigate

• Mouse driven/clicks instead of significant amount of hand keyed menu functions

• Change management for experienced users• Much easier to train to

Improved Productivity

• New LIS became an enabling technology• Implementing quality control module (TQC)• Integrated with automation

• Specimen processing• Core laboratory chemistry and hematology lines• Immunoassay line • Improved automated sort• Automated aliquot• Expanded autoverification


• Instruments are able to be used more effectively taking advantage of their features.

• The BioPlex is random access analyzer but it was not able to be used that way with Lab3, it can be used as a random access analyzer with Soft.

• Pending specimens are easier to trace• Enhanced tracking ability (specimen level)• Visual stoplights on task-lists• Fewer resources devoted to endless pending list

management

• Automation of Esoteric and Manual Result Entry ( going Paperless )


• White space for productivity charts and animation

System Reliability

• Scalability 2000 to 3000 Concurrent Users• Disaster Recovery and Business Continuity

• Previous system was an increasing and unacceptable risk from a BCP perspective

• Direct connect to instruments accepting Graphs, Charts and all Results and Indices generated by the instrument eliminating instrument lookup

• Eliminating middleware and hardware

• More “trust” in auto-release of results functionality because it was built by the lab.

The Journey Continues

• Legacy system retirement• Lab3 (MCF)• MGS – legacy laboratory genetics LIS• CoPath – Pathologist workflow standardization

• Congruence with both internal and external reporting systems

• Mayo EMR, MayoAccess, International EMR like systems

• Integrated reporting• Dr. William Morice spoke at 2012 War College

• Digital pathology• Enhanced reporting including images

Lessons Learned

• LIS replacement not done to the laboratory• Not done for the laboratory• Project done with the laboratory• [Animation with bullets; not to be presented as such]

Lessons Learned

• Training and practice are critical• Develop effective user guides; include end users in

development• CBT and informal videos are effective• Do not assume familiarity of staff with GUI/Windows style

of computer use

• Executive level support is required• Engaged leadership to drive decisions• Provide support and encouragement to work teams

• Break down communication barriers• Job titles and previous responsibilities of minor importance• Organizational behavior must change

Lessons Learned

• Change management• Information about both knowns and unknowns• Identify stakeholders as early as possible• Multiple communication channels

• Positively reinforce specific behaviors accretive to the success of the program

• Celebrate success along the way• Recognize fatigue among staff• Address counterproductive behaviors

Lessons Learned

• Expect The Unexpected• Pending list process – hard receive in lab• Impact of schedule change – holiday PTO• Flexibility, recovery planning, and collaboration

• Ensure Knowledge Transfer • Staff turnover cannot slow the project• Document activities and map processes (current and future

state)• Train the trainer for successful bench level implementation

mayo clinic overview - executive war · pdf file© 2010 mayo foundation for medical...

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