Benefits and bumps of shifting to Beaker

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• Integration of “OpTime,” which is Epic Systems’ operating room management system, is not optimal because information is not always bidirectional between Beaker and OpTime.
• Many pathologists cite too many mouse clicks for stain ordering or other ancillary tests.
• Case tracking is a bit too cumbersome for reviewing overdue specimens and accessioned cases.

Among the items on Dawson’s wish list for Beaker enhancement: For compliance with the CAP and AJCC 8th edition cancer staging system, she believes it would be useful for Beaker to have fluid staging and synoptic forms. “We have a very automated version today from a homegrown program we built ourselves. However, the addition of Epic’s oncology application, called Beacon, could potentially solve some of our problems.”

Other items she would add to the Beaker suggestion box: an audit trail for the random query generator database to support interfaced proficiency testing and other workflows; improved documentation of final specimen disposition; validation of autoverification processes for regulatory purposes; and the ability to cancel, edit, or correct data en masse.

When Beaker was first proposed as an add-on to the University of North Carolina Health Care’s Epic EMR, the laboratory voted thumbs down. UNC was operating with a homegrown EMR when it conducted an EMR analysis in 2012, choosing to go live with Epic in 2014, says Herbert Whinna, MD, PhD, who has been medical director of laboratories at the UNC system since 2010. “The UNC system decided that the cost of trying to make our homegrown EHR meaningful-use-certified—versus purchasing some other product with that certification—was such that it was better to go ahead and go forward with a third-party vendor.”

At that time, the laboratory was using SCC Soft Computer for its clinical pathology LIS and Cerner CoPath for anatomic pathology, and did not wish to change. After looking at various Epic modules, “we decided the version of Epic Beaker they had was not robust enough for us as an academic medical center.” In addition, Dr. Whinna says, “UNC had a very aggressive implementation timeline and there were just not the resources to do that extra module.”

After Epic was implemented successfully at UNC during the spring and summer of 2014, the IT department came back to talk to the laboratories. “The IT folks discussed the fact that our health care system had a road map that included four other affiliate hospitals going live with Epic in summer 2016. And they said three of these hospitals would need new LIS systems because their current LIS was embedded within the EHR and could not be pulled out as a separate thing.” The IT group proposed bringing Beaker in at the smaller affiliated hospitals, getting it up and running, then down the road bringing it up at the large UNC medical center.

But after talking with another laboratory director at a hospital that was already live on Epic, Dr. Whinna had a different take on this proposal. “We both agreed that the idea of building an LIS for a smaller community hospital, then trying to rework it back into an academic or larger hospital, was going to be problematic. We thought the reverse direction was a better way to go.”

By then, Epic Beaker had advanced two versions from what Dr. Whinna had looked at earlier. As a result, “We felt that the pros of going ahead and implementing Beaker here first, then doing Epic for the smaller hospitals, made it the best strategy going forward.” And that’s what UNC did over the next 18 months, kicking off the project in late 2014 and going live in April 2016.

There are definite advantages to having an integrated single system, Dr. Whinna points out. “The orders for lab tests and access to patient information in one system are better and easier. It’s also easier to see some of the things our clinical colleagues are doing and their needs. Especially for our core lab functions, the system has worked fine.” Among other pluses, the mobile printer to scan and print patient ID labels at the bedside when a specimen is collected has been a win, and the laboratory was able to move positive patient ID onto the nursing floors as well.

Beaker handles well the more ordinary lab functions in chemistry and hematology, Dr. Whinna notes. “We had a cytogenetics and molecular lab and we were a little concerned about how they would fit in as well. They were not as robust with Beaker. However, our cytogenetics lab embraced the process and came up with a system and ability to track specimens in a paperless manner that they feel is better than what they had pre-Beaker.” The molecular lab is in about the same place as before, but Dr. Whinna is hopeful that Epic’s work targeted to genetic testing in future versions will bring improvement.

In microbiology, too, Beaker was not as mature as the system UNC had with Soft. “Part of the reason is that our microbiology department had worked very closely with Soft for many years to customize their system, and they had it very much the way they wanted it. So far, they are not back to the level of functionality they felt they had before Beaker. But we didn’t get there overnight with Soft either.”

The other big area where UNC’s laboratory took a step back in functionality was anatomic pathology. “If you talk to physicians about Epic in general, you will hear a lot about how many clicks it takes to do any given thing. With CoPath, the pathologist used a single-page Word document to make a pathology report, while with Epic you are moving between different fields, and it’s not as smooth and it’s more time consuming.” Epic plans to offer a single-page editor in a future version.

In Dr. Whinna’s experience, Beaker is equally good on both the clinical and operational sides. “Before, we knew where in our accounts receivable system to look and find denials, and we had to learn those places within Epic. But with our old third-party systems, you had to look to see whether you were getting paid. Now the reports tell us that, plus they show the productivity of our staff and the work they’re doing—although it may take some time to learn how to best leverage those reports.”

Other institutions of UNC’s size, such as Duke University, are almost all making the move to Beaker when they go live with a new Epic system, Dr. Whinna is finding. “Epic’s lab package was somewhat behind the EMR package as far as functionality, but as more and more places have Epic, there are real advantages to being with an integrated system.”

He feels fortunate that UNC hospital administration and IT staff included the laboratory in conversations about switching to Epic and Beaker. “We were able to say in the first go-round that we will not be able to function with this. Then when we were getting ready to go live with Epic at several affiliate hospitals, they asked us to revisit it. Looking at the improved functionality for Beaker LIS and the prospect of reworking a rebuild for the smaller hospitals back into a bigger medical center, we decided to say ‘Go ahead’ and we agreed to implement Beaker.”

It’s helpful if there are staff who combine IT expertise and health care expertise, Dr. Whinna believes. “Our health care system, at the time of the first Epic implementation, decided that if you were going to be a builder in the Epic project, you would have to come out of your home department. So if you were a nurse or lab tech or information specialist, you would have to come out of that department and take the job in IT. In 2014, we had four full-time, LIS-only staff, and we lost one who chose to work on the Epic implementation, but the good news is that they were also there helping make sure we weren’t left out of the process.”

Something similar happened on the Beaker installation. “Almost all of the IT team building Beaker were former medical technologists and had the best interest of the labs in mind, and making that work.” Across the seven-hospital system, there are now eight or 10 such laboratory experts.

That connection is key to any conversion to any new LIS, he says. “Where I’ve heard that it’s gone bad, laboratorians haven’t been in the conversation early. Someone just tells them, ‘This is what we’re doing.’”
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Anne Paxton is a writer and attorney in Seattle.