Editors: Liron Pantanowitz, MD, director of anatomical pathology, Department of Pathology, University of Michigan, Ann Arbor, and David McClintock, MD, senior associate consultant, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
Utility of interactive dashboards in responding to the COVID-19 pandemic
May 2022—An outgrowth of the COVID-19 pandemic has been a need to provide SARS-CoV-2 molecular testing and an increased need to manage workforce shortages, respond to fluctuations in specimen volumes, and shift to digital platforms for diagnostic work and education, among other challenges. To address such challenges, Brigham and Women’s Hospital developed laboratory dashboards and used dashboards developed pre-pandemic. The data for each dashboard were populated by performing a SQL query of the hospital’s laboratory information system database. To easily visualize such data over the Web but behind the hospital’s firewall, the authors employed Tableau software, a popular third-party interactive business analytics platform. The tool allowed them to easily modify the data in the dashboards through such measures as selecting a specific date range, time window, work shift, test, or testing platform. For example, during the April 2020 pandemic surge, a new interactive test-volume dashboard allowed the lab to take reactionary and preventative measures to respond to an increase in blood gas testing and a corresponding decrease in noncritical testing, such as vitamin D. Moreover, the lab was able to monitor how reagent availability, new test requests, staffing, and operational changes affected weekly and hourly testing volumes and turnaround times for SARS-CoV-2 molecular testing and then react accordingly. The dashboards also showed that there was a decrease in ambulatory phlebotomy draws during a COVID-19 surge in early 2020, but after reopening draw sites, volumes surpassed those recorded pre-pandemic. Through these and other examples, the authors demonstrated that data analytics coupled with interactive dashboards are powerful tools in laboratory medicine. These tools can improve turnaround times, supply utilization, staffing, and workflows. Furthermore, they provide objective data that laboratory decision-makers can review with hospital leadership, thereby increasing the laboratory’s visibility within the health care system.
Petrides AK, Conrad MJ, Terebo T, et al. Pandemic response in the clinical laboratory: The utility of interactive dashboards. J Pathol Inform. 2022. http://dx.doi.org/10.1016/j.jpi.2022.100010
Correspondence: Dr. Athena K. Petrides at apetrides@bwh.harvard.edu
Shifting communication strategies and staff duties to overcome a cyberattack
Over the past few years, targeted cyberattacks on health care delivery organizations have, unfortunately, become commonplace. While health care organizations have, in large part, upped their cybersecurity measures in response to such growing threats, cyberattacks continue to disrupt patient care. The University of Vermont Medical Center (UVMMC) experienced a cyberattack in 2020 that led to a complete shutdown of its hospital network, rendering all of its information systems, including the EHR and laboratory information system, inaccessible for more than 25 days. Basic communication and administrative functionality, including email, telephones, and authentication servers, were also affected. One of the lessons that emerged from UVMMC’s experience is the value of having incident command teams (ICT) in place to promote clear intergroup communication when responding to a variety of emergent situations. The authors, all of whom are affiliated with UVMMC and contributed to a four-part series on the cyberattack (published online in the American Journal of Clinical Pathology), describe how the medical center used ICTs to manage its network shutdown and recover from it. In addition to implementing a central incident command team, hospital decision-makers created ICTs to boost communication within the anatomic pathology and clinical divisions and between specialized areas and central leadership. Perioperative services also formed an incident command team that included the chief medical officer and representatives from pathology, radiology, quality, nursing, facilities, supply chain, pharmacy, surgery, and anesthesia. Specifically addressing the AP lab’s efforts to mitigate damage from the attack, the authors reported that the lab turned to alternate forms of communication, including personal mobile phones, social messaging apps such as WhatsApp, fax machines, and paper, during the downtime. These substitute communication processes led to the need to suspend the lab’s standard reporting structure in lieu of a formalized task-oriented leadership structure for taking control of the situation. Therefore, the lab formed an ICT that included the AP division chief, lab managers, and section medical directors, which met twice daily for half-hour huddles to provide updates, communicate needs, and share action plans. Team leads within the ICT were given increased autonomy to independently make decisions to improve process improvement for their areas based on information gleaned from the huddles. Team members created new workflows to accommodate the temporary manual processes, and personnel were shifted from areas rendered defunct by the cyberattack to other areas that required extra support. At the same time, trainee education was shifted from traditional rotational teaching to an all-hands-on-deck approach to keep the clinical labs functioning, with residents and fellows handling essential tasks consistent with their education. The authors stressed that frequent, consistent, and transparent communication was necessary to effect process changes and align expectations between different areas of the laboratory and among laboratorians during the crisis and ensuing recovery period.
Stowman AM, Cacciatore LS, Cortright V, et al. Anatomy of a cyberattack. Part 3: Coordination in crisis, development of an incident command team, and resident education during downtime. Am J Clin Pathol. Published online February 21, 2022. doi:10.1093/ajcp/aqab162
Correspondence: Dr. Anne M. Stowman at anne.stowman@uvmhealth.org