Feature Story

Tying up loose ends with a lab project database

May 2002
Karen Southwick

In 1999, while consulting on an LIS installation for Allina Health System in Minneapolis, Gary Braley was stymied by how difficult it was for the dozen or so committees overseeing the massive project to communicate.

Although this was one of the "best-managed" projects he had ever worked on, "organization of information was a major problem," recalls Braley, a longtime consultant on lab management and president of Braley Consulting Services, also in Minneapolis. Time after time, he’d go to a meeting with one group of people and wind up dealing with the same issues that another group had raised. "They didn’t have convenient access to each other’s information and may not have known others were discussing the same topic," he says.

Those who attended various meetings had to remember where subjects had been discussed if the information was to be communicated well, Braley adds. But relying on memory to link information from numerous meetings wasn’t the best solution, and "meeting minutes are only useful if you know the subject was discussed and have convenient access to the minutes," he says. The problem only got worse when the technical documentation resulting from the vendor selection process had to be turned over to the contract negotiation team.

In conjunction with Allina, Braley developed software to track the details related to the lab information system installation, and he has just begun to market a "significantly enhanced" version of it, he says. "I decided what you really need is a database to link the information," Braley says. Traditional electronic files consisting mainly of word-processing documents and spreadsheets are "no better than paper files if you can’t remember where something was discussed or documented. With a database you retrieve information by subject or committee," he says. Most important, information about a topic is integrated from all the discussions.

The program, called Management Tracker, is sometimes compared with project management applications like Microsoft Project, but the focus of Management Tracker is "entirely different," Braley says. Project management programs make it easier to plan your work, but Management Tracker "helps you accomplish the work," Braley says.

"A major task such as HIS-LIS interfacing shown as a single bar on a project management chart might involve hundreds of issues and dozens of meetings, and the Management Tracker records and tracks the detailed content of these issues and the discussion and conclusions of each meeting," Braley says. Project management is "only a small part of what managers do," he adds, and Management Tracker accommodates the other activities such as routine staff meetings, announcements, frequently asked questions, proposals, complaints, reports for executives, new system specifications, and contract documentation.

"I haven’t been able to find a management tool that works like this in the lab, or any kind of business," Braley says.

The difference, he says, is that most project management software assigns and schedules tasks that must be completed by certain deadlines. Management Tracker, by contrast, uses a database (you must have Microsoft Access to run it), and the user therefore can track not only a single project but also agendas, work assignments, and daily or weekly activities. For example, a problem that pops up, such as a resource shortfall, can be identified as an issue, put in a meeting agenda, assigned to a committee, and tracked to completion. "The entire history of that discussion is immediately and permanently available," says Braley.

A variety of reports are offered including executive project summaries, numerous detailed listings, and statistical reports to help isolate trouble spots. For example, if the chemistry team has 39 outstanding issues on an LIS implementation or lab remodeling project and 10 of them are "go live critical," Braley says, something needs to be done. Similarly, the complete maintenance record on any piece of equipment or the status of issues with a client can be reviewed on screen or on paper.

"Other programs facilitate movement of documents, organizing of meetings, tracking of clients, et cetera. I have not seen one that actually integrates the content of management work the way the Tracker does," Braley says. In those programs that manage documents, the information is still contained in word-processing or spreadsheet files—not in a database. "That’s the big leap—to put management information in a key word searchable database, not an electronic filing cabinet that still has subject matter scattered around to be collated with assistance from a better filing system," he says.

It took Braley two-and-a-half years to perfect his software and to generalize it so that it applies to more than just an LIS implementation. He looked at all the activities a manager engages in such as meetings, projects, and client relations, and he integrated them.

Among the uses for Management Tracker: listing tasks by responsible person, by committee, or by deadline, such as everything due in the next two weeks; creating a meeting agenda and inserting notes attached to the various items; preparing for periodic events such as a CAP inspection; logging equipment maintenance problems; and monitoring interactions with clients.

Early users of the software say they’re intrigued by its possibilities. Kathryn Holmes, the lead business analyst for the Allina Health System’s project, which involves installing and integrating an LIS in 10 hospitals and a large clinic, is one of the first users.

"I’ve seen Gary’s product evolve a lot," Holmes says. "We’ve used it as a sophisticated issue log" for the four-and-a-half year project. In particular, Allina has a number of teams with different accountabilities. "We can put all the teams and all their issues in the software and make sure each one gets followed up," she says. Each team can pull out of the database its priority list and time frame, and Holmes can follow all of them.

Although she has used Management Tracker only for the LIS installation, "I certainly can imagine many ongoing uses," she says. One example from her own experience at Allina: Teams are able to prioritize all the multiple items they must contend with. Some items are reviewed weekly or monthly, while others are "put in a parking lot" for future evaluation. Compared with Microsoft Project, "this is just more user friendly, more intuitive, and more flexible," she says.

To Holmes, the advantage of Management Tracker for lab managers is its ability to organize multiple activities, everything from instrument upgrades to meetings. In short, "any activity that requires a diverse group of people who need to be coordinated," she says. "If I were a lab director, I think I’d buy this software."

Another person evaluating Management Tracker is Frank Schafer, manager of information systems for the Clinical Laboratory Management Association in Wayne, Pa. Braley demonstrated the software and offered CLMA the option to try it out in an open-ended way. Schafer bit.

"We have a bunch of committees that do everything from plan educational meetings to setting up our annual conference," he says. "A lot of times the communication between them isn’t very effective." CLMA will use the software to keep a log of each committee’s meetings and to avoid overlaps.

"From what I’ve seen of the software, it’s more robust and goes into a project more deeply than something like Microsoft Project," says Schafer. Management Tracker can divide tasks into subtasks so that "every little piece can be tracked and cross-pollinated between different departments or committees."

That’s especially useful, Schafer says, for an organization that relies on outside committees that don’t interact regularly with each other. While Microsoft Project has only one main list of tasks related to each project, Management Tracker enables significantly more complex structures. "It also makes it easy to create agendas or keep track of what you talked about and how you followed up," he says.

He’s not yet certain whether CLMA will purchase the software. "We’re going to put it through its paces," Schafer says. However, he can see that "it will be useful from an overall management perspective. It’s good for any business that has to manage a lot of different tasks and departments."

Donald Connelly, MD, PhD, professor of laboratory medicine and pathology and director of health informatics at the University of Minnesota, was intrigued by the concept of Management Tracker as a way to integrate information-rich tasks such as handling meeting records, assigning and monitoring work, and managing projects. And he can see the value of Management Tracker for laboratory directors and others whose jobs entail juggling and following up on a lot of details. But he has reservations about the software in his own application, based on a few days of trial use.

"My problem is that it presumes a certain approach to handling management activities," he says. "If you use that approach and ontology, the software is probably intuitive and easy to use. But for me it hasn’t been. I’m a physician who kind of fell into my own idiosyncratic management approach with little formal training. I’m not saying that my approach to management is better. I’m just saying it’s different and may not match the tool."

Dr. Connelly also wonders if his current work, which involves many unrelated activities, may be a poor match to an approach that uses a database to bring things together.

He compares his initial efforts to use the software to attempts to get physicians to use an electronic medical record. "Unless the benefit is immediate, doctors see it as a roadblock and won’t use it." With Management Tracker, "I don’t get far enough into it to see the benefit before the barriers of learning new processes stop me from using it."

Dr. Connelly, who recently undertook the added job of director of the informatics core at the university’s Cancer Center, says he will persist in using the software because it may have value in tracking the Center’s multiple informatics projects.

"I recognize there are places where I really need help," he says, "so I don’t want to give up. I may be missing the forest because I get hung up on a few little saplings."

He suspects his Cancer Center activities may be a better test-bed for Tracker because many of its projects are interrelated in terms of functions or work groups being served. In addition, Tracker’s shared database approach can effectively tie the members of the informatics core team together and help keep everyone up to date.

He expects that Braley will refine the software as he gets feedback from early users. "I know that Gary’s going to be very responsive and the software will get better," Dr. Connelly says. "He’s worked with so many people specifying what an LIS should do that I know he’s very capable of modifying something so it will represent more than just his thinking."

Another longtime lab management consultant, Hal Weiner, president of Weiner Consulting Services of Eugene, Ore., says he’s impressed with Braley’s progress so far on Management Tracker. Describing himself as a "friendly competitor" of Braley’s, Weiner says he hasn’t seen another product that does everything Management Tracker does.

"There are other products out there that have similar task-management capabilities," he says, or provide a mechanism to track documents and schedules. But because Management Tracker is driven by a relational database, "it’s more powerful and flexible" in offering a "global, multilinear management tool."

Weiner says Management Tracker "absolutely has value for labs," especially if they’re implementing complex projects like lab information systems. "Labs have been hindered for years by not having adequate management tools," he says. "If you look at everything labs need to do, whether it’s meeting the latest HIPAA privacy requirements or scheduling the next CAP inspection, they could use better tools."

However, he cautions, laboratories should evaluate a range of project management software before making a decision. Project software ranges in price from free all the way up to $100,000. He lists a few, all targeted to small and mid-size businesses: eproject.com, iteamwork.com, onproject.com, and pragmaticsw.com.

None of these is aimed at laboratories, Weiner notes. In the past, vendors have taken Microsoft Project and tweaked it for labs, "but that only covers 10 percent of the process that’s required in attempting to manage an implementation like an LIS. What Gary has done is take the concept of collaboration and apply it to more than just project management."

Braley’s first market is laboratories, "because they’re the people I know," he says. But the software can be used in other areas such as radiology and pharmacy. "If the executive over ancillary services could call up status reports for all departments using one program, that would be convenient," Braley says.

His aim was to structure it in a way that wasn’t limited to labs. "I took all those things that managers do involving committees, projects, people, and problems and put them into one database. So, if you have a problem with a piece of equipment, you can use the same approach that you would to track a management task. All this is integrated via the database."

Learning to use the software isn’t difficult. Someone new can be taught the basics in an hour and then have access to many different records, he says. "There’s not one system to learn for meeting notes, another for equipment logs, and still another for client service problems," he says.

Management Tracker is not an additional program to learn, Braley insists. "It’s a replacement for a variety of programs, templates, and filing systems that are the cause of information confusion in complex organizations." His design goals were to improve the quality and availability of information and, at the same time, reduce the effort required to process and retrieve that information.

Management Tracker can be shared over a network and works with any PC that has the Microsoft Access database. It is not dependent on a lab information system.

"You don’t need to change your LIS," Braley emphasizes. "This runs in parallel. It’s a management production tool," similar to what laboratory staff have been using for 30 years.

"You wouldn’t tell your lab staff to type test results into a word-processing document," he notes. "Because we’ve implemented new technologies to assist with our core businesses and management is not a core business, we end up with the highest paid, most experienced individuals using the least efficient technology.

“That needs to change,” says Braley.

Karen Southwick is a writer in San Francisco.

To sample the Management Tracker software, log on to Braley’s Web site at www.braley.com.