Editors: Raymond D. Aller, MD & Dennis Winsten
‘Tech savvy’ members essential to lab stewardship committee
December 2024—In a casual water cooler conversation, while standing around a coagulation analyzer to be precise, Lisa Daniel listened to her laboratory colleagues and a hospitalist, who happened to stop by the department, discuss their frustration with duplicate and other unnecessary tests. This led her to start a small committee, which in eight years has sextupled in size and undertaken numerous cost-saving measures.
Daniel, then a laboratory manager, initially pitched her “little” lab stewardship committee concept to the new chief quality officer at Parkview Health. (Daniel now serves as Parkview’s director of corporate lab services.) He was very progressive, Daniel explains, “so it took about 10 minutes talking to him and he was ready to go.” Chief medical officers at the Fort Wayne, Ind.-based health care network also strongly backed the program, which got underway in 2017, Daniel said during a 2024 Executive War College presentation on the laboratory stewardship committee and in a conversation with CAP TODAY.
At first, “it was important to be under the radar,” says Daniel, who, as coordinator of the committee, runs the meetings and prepares the annual report. The program, which initially consisted of Daniel, the aforementioned hospitalist, an information services manager, and “a couple of other managers,” picked projects that were noncontroversial “because we didn’t want to tick people off at the beginning.” Daniel also went to the chairs of various hospital departments and asked which of their employees might be interested in participating on the committee. “We didn’t want people that got voluntold,” she notes. “We wanted people who were passionate.”
The committee now numbers about 30 people and has representatives from numerous departments, including cardiology, gastroenterology, oncology, neurocritical care, hospital medicine, intensive care, family practice medicine, nursing, information services, and finance.
On the laboratory side, the committee has representation from such areas as accreditation, compliance, chemistry, microbiology, and hematology. A representative from the laboratory consulting company Hc1+ Accumen has also participated for about the last five years, offering experience gleaned from working with Parkview and other health care systems. “I’ve worked at Parkview my entire career. This is all I know,” Daniel says. “So it’s really good to have an outside view.” Hc1+ Accumen helps identify potential projects, benchmarks Parkview’s data against those of other clients, and conducts literature research, she adds.
The committee’s monthly Microsoft Teams meetings draw at least 20 people. “For our size of an organization, the committee needs to be big,” Daniel says. Parkview has 14 hospitals and approximately 15,000 employees across northeast Indiana and northwest Ohio.
In between meetings, Daniel and the laboratory’s accreditation specialist follow up on ideas that have been shared, in part by collecting and analyzing data. Initially, the committee focused on inpatient care, Daniel explains, because acute care tends to generate bigger groups of tests.
One memorable lab stewardship success was driven by a committee team member working on a project with nursing leadership at the same time the lab stewardship committee was investigating unnecessary urine cultures as a potential new project. In an effort to reduce false-positive cultures, the nursing department had spotlighted the process of collecting urine from a catheter that was already in place. This led the lab stewardship committee to explore ways to combine the projects. In the end, the information technology department inserted a step in an EHR algorithm to warn doctors not to order the test for inpatients unless the patient is symptomatic and requires a new catheter. Consequently, Parkview reduced the amount of money spent on unnecessary and false-positive cultures.
Daniel knew from the outset that having information technology representatives on the committee was essential because they would be most adept at addressing the program’s technical needs. The team’s two IT members have, for example, helped expedite the health care system’s ticketing process for the committee. Previously, Daniel explains, she would file a ticket for assistance from IT, wait for it to get to the top of somebody’s queue, and then have to explain her issue in detail to a random staffer, which sometimes led to a series of meetings. The IT representatives on the committee, on the other hand, “know what Epic [Parkview’s EHR] is capable of, what the lab is asking for, and they know the IT resource [person] to talk to for input,” Daniel says. “There is still a ticket placed, but the time for information gathering is cut way down.
“When we know what we want to do, the IT analysts help us figure out how,” Daniel continues. In the case of vitamin D testing, for instance, the analysts added a step to the algorithm in Epic that automatically flagged the order and asked clinicians to enter an appropriate diagnosis if they wanted to proceed with it.
A representative from the order set team also played an important role by contacting clinicians for their permission to take the vitamin D test out of Epic’s automatic order sets. In general, Daniel explains, “if we want a particular obsolete test removed so it isn’t used anymore, the order set team finds all the order sets that use that test.” Once the change for ordering vitamin D was in place, “all of a sudden our denials went down from 2,000 a month to a couple hundred,” she adds.
The committee’s information technology analysts and order set team know what Epic is capable of, Daniel says, and they have been able to assist with not only removing tests, such as the obsolete MTHFR test, from automatic order sets but also setting time limits for repeat testing. An example of the latter was to set a time limit of seven days before repeating Clostridioides difficile testing. “We also created a pathway for C. diff testing that better aligned with best practices,” Daniel explains. “The pathway required a positive C. diff toxin result before performing an individual PCR gene test for the infection. We removed the PCR C. diff test from our large stool panel to require the provider to use the new pathway.” The result of the change in test ordering: a savings of approximately $600,000 in the first year.
Daniel feels fortunate that a couple of Parkview’s laboratory scientists who joined the Epic order set team are now members of the lab stewardship committee, “so they can tell us what orders are in the Epic system and what we have to do to change all of the order sets.” For a hospital setting up a lab stewardship committee that doesn’t have such an advantage, Daniel advises seeking out technology-focused staff members who have an interest in developing cost-savings measures for the laboratory and can fit such a commitment into their workload.
“Having committee members who are tech savvy and developing a process for working with the IT department,” says Daniel, “has made all the difference in brainstorming ideas and achieving the committee’s goals.”
—David Lewellen
Healthbit launches lab system for molecular diagnostics
The lab informatics company Healthbit has introduced the molecular pathology-focused laboratory operating system LabOS.
The cloud-based LabOS platform serves as a laboratory information-management system and incorporates worksheet management, inventory control, instrument management, patient and physician portals, quality management, training and competency tracking, compliance monitoring, environmental monitoring, handoff communication, and kit logistics.
“Built on secure AWS cloud infrastructure, LabOS enables seamless workflow from accession through result delivery,” according to a company press statement. “The platform supports a wide spectrum of molecular diagnostic applications, including pharmacogenomics, next-generation sequencing, and whole genome sequencing.”
Healthbit, 409-457-2879