Webinars

_{Michael Kalinowski}:  Okay, for those that are joining, welcome. Come on in. We'll officially start in just a moment.

Well, good morning and welcome to this LigoLab webinar and AP LIS product tour. It's something that we're excited to be involved in. We're certainly happy and excited to have all of the participants that will be joining this call. And we're especially happy to have Allison Still with us, LIS product specialist and a person that really knows the LIS software inside and out, has worked in the professional laboratory world, and then we luckily stole her away from that a couple of years ago and really utilized her talents here at LigoLab.

So, Allison, welcome. Thank you very much for coming on in and taking some time out of your typically busy days to help us out here with this product tour. 

^{Allison Still}: Thanks. Happy to be here and show everyone the software. 

_{Michael Kalinowski}: All right. Perfect. So I think just a little housekeeping here. We want this to be interactive, so if possible, can you save your questions till the end?

We're going to take about 30 minutes for this product tour. If you see something during the course of those 30 minutes, certainly take note and then bring it up at the end when we have that question and answer session.

First a preview of what's going to be covered today. Here's the list, grossing touchscreen, histology work log, error tracking, case assignment and distribution, QA and statistical reporting, and then as mentioned just a bit ago, your questions in a Q& A session at the end.

So, I think without any further delay, let’s get started with Allison taking over.

^{Allison Still}: All right here I have the grossing queue open, and so we're going to start with the grossing. 

We have the specialized Touchscreen tool for grossing. As the name implies, this screen is intended to be used with a touchscreen. So you'll notice the buttons in here are a little bit bigger. As we know, grossers are frequently at a workstation where they might not have keyboard and mouse. First step here will be to scan a bottle that is brought to the grosser's workstation.

The information about that case will populate. Here you can see our demographics populated at the top. Some information about the case. We got some extra windows of information opening. Here we have attachments. We can envision this as our requisition that was scanned at order entry so that the grosser can reference that while they're working.

They don't need to have the physical paperwork in front of them when that travels to the lab. It can get damaged or lost, so here it will always be a convenient place for them. The other window that it can open is the history viewer. So here this is showing, you know, on this case there was also a lab.

This shows not only information from this same case, but also previous cases that are linked with this patient's history. Alternatively, if maybe you don't have a lot of screen real estate, both of these windows can open as additional tabs here, the same as we have Test Info and Images. Now I'm going to go to the Test Info tab.

Here, we'll find the site description as it was typed by the accessioner at order entry. And then the grosser is going to choose specific site area and operation options that match the specimen from the database that is loaded in this particular environment. So when I click here on the site, you'll see some are highlighted in green, I scroll down the others aren't.

Here, it is reading what was typed here, and it's bringing options that it thinks might match that to the top of the list. Let's go ahead and go with our first option. So you can see that populates our site and area. And then for operation, again, let's go ahead and choose Cone Biopsy. Here, when the operation was chosen, it prefills some additional linked information.

First of all is the grossing description. This is the like macro template dropped in this text. Here it automatically pulls the patient name and the specimen received text. And then this three question mark character is highlighted, prompting the grosser to fill in this value. Our LIS system uses this character to, as like a placeholder for values that need to be filled in.

They can use this keyboard on screen to fill it in, or a physical keyboard that they have. Say this is 5 centimeters. We can also see, linked to the colon biopsy operation, that some other information was applied via automation, a histology protocol, here that's one block and two levels, as well as an added CPT of 88305.

So now if we go back to our specimens tab, we will see that histology protocol that was added. The cursor can always manually apply a protocol in addition or instead of one that was automatically added. Then go to the stain table, see the full list of all the stains that the lab performs, and you can also include send out stains.

Here we can drag and drop additional specimens onto our cassette as needed. The grosser can enter how many pieces are going in this block, and we can even you know, specify which hopper this block should print at. Maybe all of our female reproductive cassettes should print onto pink cassettes, and those are loaded in hopper 1, so it can specify that.

And this is the most convenient time to print the cassettes. So the grosser would save and print the cassettes at this time. I'll go ahead and save now. It alerts me that I haven't printed the cassettes here at my home workstation, but that's okay. As soon as that's saved, all the cassettes will appear in the dedicated block queue, which is a real time queue of all the blocks that are waiting to be processed.

And all the slides will appear in the slide queue, their respective queue for processing. 

Now the next thing that I'll be looking at is the histology work log. So I'll tab over there. This is a log that it's like basically a detailed audit of specific histology actions that have performed from grossing to blocks to slides.

Open here, and you can see some of the steps that I have selected here. If things were scanned correctly at specimen verification, searching timestamps for when blocks were embedded, and such like that. Here you can see some from earlier. So, if for example, I go to the block queue, And I open my embedding window, and I scan a specimen that's not a block.

Here it says no block with that barcode. It's fine, no big deal. But the work log will track that information. So here it shows. The me, admin, scanned a block without this ID. Of course, there's time gate stamp associated with all of these actions. So, in this way, you can really easily see the exact order, how much blocks are processed, if a user, you know, scanned an incorrect barcode by mistake.

If there are any errors, it's going to have to be backtracked where that error may happen.

Also on the issue of error tracking, for error tracking we like to utilize what we call workflow actions. A workflow action can be thought of as a flag that is applied to a record. A record being a specific specimen, maybe a lab order, a report some of the most common ones. So here in the histology module let's say they are processing blocks.

And when they're in this processing window some issue is detected with this block. The user can go into the tags and workflow actions. They'll find pre configured options for issues that they might want to track. with this block. Maybe the tissue was too thick. We'll go ahead and add that on and then that will be tied to that block.

You can pull stats based on who added the tags, who processed blocks that had errors, and so on and so forth. I also have some configured in the block queue. You can also access them directly from here. Let's say, maybe there's a floater on this slide. The tags and reflections can be specific. You can, there were like different options in here for slides, different options in here for blocks.

Or especially with the specimens, they could be more general. Maybe you know, any specimen could be tagged with like the discovered patient name, for example. You can see in here we have both tag and workflow actions. These work very, very similar. The only difference is that a workflow action is going to be a little bit more robust.

This is going to facilitate a workflow. By adding this, then there will be a queue of all descriptive patient names that a user can then handle all at one time. And with the workflow action, the user can put in a comment, maybe you know, patient name spelled as Sarek. Something like that. And then again, I will show you at the end how to pull stats in accordance with these tags and workflow actions that have been added.

Tags and workflow actions can frequently be seen from the queues. Not all can. It depends on your preference. Maybe some are more for background logic, and some you know, you want to be in your face whatever That type of workable action will be used for. 

Now let's go on to case assignment and distribution. There are many opportunities to assign a case in the anatomic pathology LIS module. You might have noticed there was an opportunity on the grossing touch screen to do so. Another common time is to do it at slide completion. The user has the option to assign a pathologist but primarily we have dedicated case distribution queue.

So here you can, we'll see a full list of all of the results that are unassigned. And on the right you can see current caseload of the various pathologists. You can see the filters at the top which can be used to narrow down the list. For example, I had already pre filtered to the specific statuses I want to see.

This will, by default, show everything, but for my use, I don't want to see things that are still pending groups. In this queue, you know, we can see case type, you can configure weights for all of these cases, which can help you, you know, determine caseload for all of the various pathologists. And these filters here at the top, case type, state.

Prefix, client, and payer can all work in conjunction with pathologist preferences for the types of cases they should be reading. So for example, maybe, you know, the Florida pathologist is only certified in Florida and other states in that area. So if we pick, let's see, cases in California, our list will get filtered of cases as well by list of pathologists to pathologists that are eligible to read those cases.

So, even if you don't in this way, even if you don't filter the queue, and let's say I try to assign something to pathologists, if there's any conflict, you have the option of getting either a warning or a prevent. This is a prevent, so I don't have the option of assigning to them. Alternatively, it could.

Say, you know, just so you know, this pathologist isn't certified in this state, but the user will have the option to override it. So, in general, the method for assigning is to drag and drop cases across. Here, this one is a warn, right? So, our DERM plan isn't credentialed for GI cases. Would you like to assign it anyway?

If at any time you assign a case, you always have the option to undo it down here. Additionally, you can use the shift and control key on your keyboard to assign multiple cases at the same time. Say we'll assign all those to Petros. Now, right now, the stats mode over here on the right is incumulative.

These are all the cases that are currently assigned to these pathologists. The other option here is daily, just what's been assigned today. So you can see it only shows those which I just dragged over to Petros right now. Here we're going to get different additional columns of information, total case count in addition to just what was assigned today, number of blocks, number of cases that have either more than two blocks or less than two blocks, total block count, daily block count, the daily slide count.

Here it's also displaying information about the case types that have been assigned to these pathologists. The case types again, would be customized by you and whatever case types you want to work with. There are some defaults, such as like any clinical results or guidance cytology, as those are distinctive result types.

But otherwise, these would all be whatever makes sense for you. That particularly pertains to prefix, right? Prefix is a very you.

And then help ensure that cases are assigned to the right pathologists. In the Payer. menu, we'll have insurances. We need to filter to cash cases, for example, and see, you know, who wants to read cash cases and who doesn't. Same with client. Maybe we only want to see cases that are complete, and it'll filter.

The case is in real time. Let's assign another case so we can see how that compares the information. I'll just tab over to the pathologist setup for this quickly. So in the pathologist menu, all the users in the pathology lab software that are designated as pathologists. Here is where this case assignment credentials are configured.

Right, so here we have that this user has only certified in Florida. They can read, looks like all case types except for clinical. They don't have any prefix specifications, they don't have any client limitations, and then they do not want to read cash and patient pay cases. So this would all be set up by your LIS medical admin ahead of time so that when you are in the case distribution queue, all those rules are set up for that user already.

Now, let's look at QA and statistical reporting. First let's go to block stats, and I have a search template set up to show the grossing feedback tags that I showed adding at the, in the block queue, right? So we added some of these tags to some of our blocks here the each stats report is specific to an entity, so you can see I have block stats separate from slide stats, and we'll go through the other ones.

And I have it set to Embedded by Histotech so I can see, you know, of the six blocks that this user embedded in the set time period, the last 30 days four of them had tags added. We can see one, two, and three. As well this user Histotech did three blocks in this time period, and then only one of theirs has a tag, which we can see was for fixation.

In any of these charts, you know, you can print this as a, as a PDF for your records. You can also export these to Excel if you would like to do your own manipulation on it. There are additionally many more options for summary by, you know, I chose embedding histotech. Maybe it should be end processing, end processing histotech.

If we can refresh that and see some different data. Maybe you want to look not just the last 30 days, but the last 60 days. Once you adjust the filters to a configuration that you like, you can save this as a search template.

And then this will be in the drop down list so maybe you will instruct just your supervisors to come in here and pull your template, you know, at the end of each month. Let's go to slide stats now and see a similar report. For the slide tags that we added as this is the slide stats, the reports, the summary by the options you have for filtering here will vary slightly by the record that you are dealing with.

So here I have the tags report summary by completing HistoTec, completed within the last 30 days. You can also see a summary of that search here. So, anatomic pathology software Admin completed four slides in the last 30 days, and none of them had tags. Histotech completed 10, 7 of which had tags. We can go see those.

Also, whenever you see those details at the end, that means we can go to a list of those slides. We can go see the slides that, that Histotech completed in the filtered time period. And there are a lot of different options in here for Summary By. As well as these can be have multiple levels added.

Let's say you know, we are a large facility that also has many facilities. So we want to buy facility and then buy lab tech. We'll change it to a tree and refresh

and we'll get information about that.

Maybe we want to add cyber questing facility.

So we only have one facility in here that I primarily process. slides from. So it's just showing the one facility, right? And then we see the same demo ad in the same histotech underneath here, where there's another LIS healthcare facility. And then they will just be listed under here. So this can be a nice way to visualize the data as well.

Let's go to case stats now. This case stats, these are guidance cytology cases. In the guidance cytology LIS module, there are an even larger number of use reports. To work with, work with. Here, let's see. I had one, let's see, let's do our QC detail. So this is a QC detail report summary by cytotech.

We can see demo admin QC or no red primary screen. 50 cases in the time period, 28 of which required review and 22, which did not. 4 got forced review either most likely by, you know, they were abnormal results, which is configured to automatically go to review. And then, which left 18 for QC of the 10 that were QC'd 5 were required and 5 were random.

And we can see which percent, so for this user, 100 percent of their cases were QC'd. And for this user, none have been yet. So yeah, the, there are a lot more variety of reports in the guide module, just as a demonstration. The reports can vary. I think Cytotec is one that makes sense here.

Another good one here is like pathologist. Yeah. Now let's go to order stats. This will be like your accessions or your orders. Nice report here is client volumes, or which should show client volumes that they ordered over time. I was just missing that field designator there. So here we can see summary by client of the activity, which is like the number of orders received. It's broken up by month. We could also break it up, you know, by like quarterly or weekly, however you want to see this report.

You can easily tell I enter most test cases with this test client. So, you know, we received 13 orders for them in January, 28 in February, and so on and so forth. You can see the totals at the bottom, and we could adjust the months as you like. Then again, this was easily saved as a template, so it could be brought up easily in the future.

The other stats reports for order are what you see here. Let's see, another one, another good one, let's see, might be created user, that's going to be taken to main accessioner but yeah, most of them are done by the, the demo admin, which is the same user I'm logged in as right now. Final stats report I have to show is test result stats, so it's individual test results for your AP, it's pretty much going to be like one test per case, right, your surgical test, or your guide case, or.

ATT& CK only, those are all like one results, but for clinical, molecular, things like that, there's going to be multiple tests per case, so it's kind of the difference between the order and the test there. And, yeah, let's see, my abnormal volumes by test, right? So, received in the last 30 days from my clinical tests.

You can see what percentage of those were normal. So for example, you know, candy to albicans we received 5, and 1 was abnormal, which is 20% of all the candy to albicans. Candy to albicans was 2. 81 percent of all of the tests in this time period. So, at the bottom it'll always be 100. Of all the tests that were pulled, 0.

23 percent were abnormal. Which is a lot. Here in the test results and especially you're going to have a lot of different filters, you know, just show me data from a specific client just show me data about a specific test for example. The reports here it's common to, we have our turnaround times here which are pretty nice.

And then lots of different summary by options again, common options apply like client facility, pathologist things like that. And that is the last stats report that I have prepared to show you today. So at this time I will take any questions that you have. 

_{Michael Kalinowski}: All right. Perfect. Very informative.

And I, I suggest at least for the moment keeping the pathology lab reporting software application open. For those attending, if you do have a question that you would like to ask Allison utilize the chat option at the bottom of your of your Zoom screen. And we can take the time whatever time is necessary to answer your questions.

I have some familiarity with this laboratory report software, but nowhere near what Allison has but I, I find it interesting sitting in on demonstrations and, and hearing what anatomical pathology software labs need and what they go through. You touched upon it earlier, the tags and workflow actions. It seems to me that they're so very flexible, so versatile.

Is it almost like, hey, we've got an issue. Is it the first place to look, plugging in tags and workflow actions? Is that fair to say? 

^{Allison Still}: Yeah, so I would definitely say that's our kind of first line of defense against issues. You know, every entity also has the option for free text notes if it's more informal.

But the text and word collections are very powerful, yeah, because you can pull all these stats on them. It's always going to record, you know, who added this and when, or who resolved this and when. No need to initial anything or I know with legacy LIS systems and legacy LIS software vendors, people are often like initialing these comments on like when they left it, but there's no need to do that kind of thing in our anatomic pathology LIS system.

_{Michael Kalinowski}: Awesome. All right. And we do have a couple of questions coming in. One is anatomical pathology software reports. Do you utilize CAP templates for these? 

^{Allison Still}: We do. We have an integration with CAP templates in our LIS software. You do have to have a subscription with CAP to be able to use those templates but if you do, basically they will provide you with some XML files, which can be imported in actually on the front end here.

You don't need to ask a developer to do it, though if you are one of our clients, we will update them on a schedule. If you're familiar with CAP templates, you probably know that they update them quarterly, so whenever they have updates, then we are also update them for our customers that use those. 

As far as using them in the laboratory information system LIS application, there's kind of what we call a wizard for walking through those. If we have time, we can show it, but I do feel like that probably would deserve its own session because it's a pretty comprehensive, but it'll walk you through answering all the questions that CAP has and which answers are required and which ones are not.

_{Michael Kalinowski}: I enjoyed the the look at the case distribution in the LIS software. One of the questions that we have here is when can case assignment happen? 

^{Allison Still}: It is honestly extremely flexible. It can kind of happen whenever is convenient for you. Again, I think for large labs, the devoted queue is the best option.

Though again, when any users like in the touch screen or in an individual result, they'll have the option to do it then. But any case that is unassigned will appear here. So it can happen as soon as the case is accessioned. Additionally, depending on your laboratory workflow, if it's not assigned and the pathologist opens it from their queue, it's going to just automatically assign to that user.

So maybe depending on the size of your organization, you don't need to do the full dedicated case distribution step. It's just very flexible depending on what works best for you in your lab. 

_{Michael Kalinowski}: Next question. How does LigoLab platform work with voice recognition? This individual says they use 3M fluency direct. Is that compatible with legal lab platform? 

^{Allison Still}: LigoLab  is very compatible with voice recognition software. I personally am not familiar with the 3M, but the customers that I'm familiar with use Fusion Narrate and Dragon, and I know that those two work very well. The screens most common to use with that are the touchscreen, which I showed, as well as the pathologist resulting screen. We have numerous clients who'd use the dictation to, to drive the laboratory workflow on the screens in their entirety. 

_{Michael Kalinowski}: Next question if one doesn't fill in the question in the canned text, what happens? Require entry? 

^{Allison Still}: It doesn't do that by default but we have written rules for clients in the past that like just a rule if it detects that there's like a three question mark and then there can be any kind of behavior based on that condition that you would like.

Maybe it just has a pop up for the user when they try to save or again maybe without a workflow action for someone to go back in to see that entire body text. 

_{Michael Kalinowski}: Another question here, and please feel free to continue if you have any utilizing that chat option. Question is, from an integration standpoint, which EHRs can LigoLab integrate out of the box for bidirectional order and result exchange?

^{Allison Still}: LigoLab can integrate with any and all EHRs. We've never encountered a laboratory software system that we couldn't integrate with. We have numerous clients that have. EMR connections with any EMR you can think of. 

I'm trying to think of other interfaces types that we might accept, but... Yeah, that's a very customary part of our business. We have a dedicated department for handling integrations. And they do that all day, every day. They're experts in that. 

_{Michael Kalinowski}: We do have an interface engine that is part of the platform and I can go through some of the formats. Essentially, as Allison suggested versatility when it comes to formats, HL7, obviously, and then let's see, FHIR, XML, X12, CSV or PDF, flat file, ASTM, RESTful API. So, I think we can say with confidence when it comes to integrating with other laboratory software systems, we feel pretty confident if it can be interfaced with, we certainly have the team and the expertise to do so.

Alright, I will give the people attending one last chance to utilize the chat. To throw in a question before we wrap up, and Allison, I see a question in the Q& A section from Dennis. 

^{Allison Still}: It’s about if we are fully integrated. So yeah, even though my presentation today focused on the AP portion of the pathology software application, Clinical Laboratory is also fully integrated.

You can see over here on the sidebar, even though I had all the tabs I wanted to show preloaded. All of these actions or screens were accessible here primarily on the sidebar as well as across the top so you can see it, yeah, there's devoted AP and clinical sections fully integrated and for example, when that patient history came up with the grossing, if there were any clinical or microbiology tests also associated with that period, that patient, you would also see them there at that time.

And then the same applies to lab RCM. It's fully integrated when the order succession is the 1st point to potentially enter lab billing information, and then all of that will flow downstream into the RCM module and RCM cycle. 

_{Michael Kalinowski}: And here's my opportunity. I'm a marketing guy, so I can throw this out. We like to think that we are the the one and only all in one laboratory informatics platform. We call our LIS system an informatics platform rather than a laboratory information system because a full integration one united database for LIS activity, lab revenue cycle management, a direct to consumer, something that was, was quite valuable during the course of the The recent pandemic with COVID, so we like to think that if you have a need for a laboratory solution within your laboratory facility LigoLab can certainly fill the need and be a good partner for you.

Well, with that, I think we have gone through the questions. Appreciate the attention that everyone showed during Allison's expert navigation of this LIS system. What we will do in the very near future is we will have a recorded version of this.

Oh, I see a question about enhancements. How do enhancement requests work? 

^{Allison Still}: It really depends on the scope of the request on how long it will take for us to implement and so our developers will assess that depending on the scale, yes, there might be some development charges associated with that, and then if you If you would like to pay for it, then we will work on it immediately, and it will become available to you as soon as we can roll it out, and you can test and approve it.

If it is not an urgent request, then usually it gets just rolled into our regular product pipeline, so it will get assessed with all the requests that we've had. And then any and all enhancements to the LIS pathology software platform are available to everyone as soon as they upgrade to that version. And it's true, you can see we are a versioned application and this is the latest version that I'm showing you.

Frequently the latest enhancements are only put into the newest version, so you might be required to do an anatomic pathology software update to get access to them.  

_{Michael Kalinowski}: That's a good subject. Can you paint the picture of what we recommend as far as LIS software updates over the course of a year? When are updates available and when should laboratory partners consider doing so? 

^{Allison Still}: Sure. So you can see this is 2023. 2. And the two, that second part there can be considered the quarters of the year. So in a given year there should be like four you know, 2023. 1, 2, 3, and 4. And so we're on 2 and we haven't closed out for 2 yet. So as soon as their version is what we call closed out at the end of the quarter, then it is eligible for clients to upgrade to it. You know, it really depends on the client when they might be interested in upgrading. Let's see, I would personally recommend upgrading at least once a year.

_{Michael Kalinowski}: And I think I missed this one earlier, so I apologize. But last question, is there an option for automated case assignment? 

^{Allison Still}: We can configure any number of rules and automation with our powerful rules and automation engine to assign those cases. We would work with you to figure out what conditions and criteria you might want for that. Again, is it based on just the criteria we have available by default, or maybe you have more complex logic so it'd be a custom option that we would work with you to form through our rules engine.

_{Michael Kalinowski}: Great questions. This is the first of what we hope to be many on a regular basis. Showing the anatomic pathology LIS, showing the clinical module, and show the lab RCM module.

Plenty to show, plenty to see, and plenty to demonstrate. So continue to tune in for what might be coming up next. Allison, I know your time and expertise are valuable so thank you very much for taking some time to field those questions expertly. 

^{Allison Still}: Absolutely. You're very welcome. And thanks everyone who had time to join. Glad to see so many attendees.

_{Michael Kalinowski}: If anybody here on this call has any follow up questions, utilize this email address right here, info@LigoLab.com. One thing we always are looking for is suggestions for future product tours and webinars.

With that thanks for all who attended. Allison, thank you very much for your input. 

Everybody have a wonderful day.

_{Michael Kalinowski}: Okay, let's give the folks a minuteor two. We have participants coming on in. Thank you very much.

_{Michael Kalinowski}: Give it a few more seconds and we'llget started.

_{Michael Kalinowski}: Okay, I think we're ready to begin.So first off, welcome to today's webinar. We know for everyone, their time isvaluable, and we really appreciate the folks that have joined this webinar totake a little time with us and go through this presentation. We have industryexpert and advocate Stan Scofield on, and the presentation of this webinar isentitled Healthcare Disruptors and Transition Strategies forSuccess.

_{Michael Kalinowski}: Now, most people probably alreadyknow who Stan is. Former president of NorDx Regional Laboratory Corporationwithin the Maine Health System. Also founder and managing principle of TheCompass Group, a federation of 32 regional laboratory corporations within thelargest and most prestigious healthcare systems in North America.

_{Michael Kalinowski}: Actually Stan's role with that groupis head of new product, technology and evaluation. Our audience here, independentclinical laboratories and pathology groups. So we've tailored this presentationto hit on points that should resonate with you. Without further ado, welcomeStan. We do appreciate your time and we really look forward to this.

^{Stan Schofield}: Thank you, Michael. Good afternoon,ladies and gentlemen, or good morning, wherever you might be. It's a pleasureto be here today. I'm coming to you from Portland, Maine.

^{Stan Schofield}: So let's kick it off. Healthcaredisruptors and transition strategies for success. There's a lot going on inhealthcare in general, and, we're all working to do a better job. Hopefullytoday we'll give you a roadmap of the things that are happening in thelaboratory space.

^{Stan Schofield}: Today's lab world is vuca. What isvuca? VUCA is a military term. It means volatile, uncertain, complex, andambiguous. Sounds a lot like the world I live in and work in every day.

^{Stan Schofield}: Disruptive themes we live in ata  time of disruption…

^{Stan Schofield}: Workforce availability, can you findanybody?

^{Stan Schofield}: Stability, will they stay?

^{Stan Schofield}: Reliability, will they show up?

^{Stan Schofield}: Competition, we used to take fromhospitals and restaurants and movie theaters for entry level people but theyall have 401k plans now and they all have health benefits and so now we'restealing from each other. On top of that, other industries are stealing from usbecause they're paying better.

^{Stan Schofield}: Compensation is driving everythingand wage pressures are mounting. Just in our organizations, we've seen 14, 16,18% wage pressure increases in the last two and a half years. Automation iskeeping services open and operating and this means machines and technologywhere there are no people. It also means getting things digitized,computerized.

^{Stan Schofield}: Pathologists don't want to run all over to two or three or four locations. They want theslides and they want to electronically render the diagnosis. Insurance payersare getting very powerful. They're used to be 40 insurance companies 25 yearsago you had to deal with. there's probably five or six big ones now, andthey're all trying to take over each other and they're hiring and employingphysician groups and medical office and computer system people. They areturning into a major threat.

^{Stan Schofield}: Government payers, we've all hadmassive cuts, somewhere around 50 to 52%. All revenue per test in the lastseven years has been lost.

^{Stan Schofield}: You got Medicare, you got Medicaid,and then on top of all of that, the insurance companies are trying to driveeverything below Medicare rates.

^{Stan Schofield}: Financing's got a whole new wrinklewith the economy in the last year and interest rates, increasing bondcovenants, debt structures for hospitals, health systems and businesses ingeneral are problematic. People haven't come up with more money. The cost ofgetting money is a lot more than what people have had. We had a pretty good runthere for 10 years, almost zero interest consolidations.

^{Stan Schofield}: You got large commercial labs buyingall these other clinical labs and pathology groups. You've got hospitals buyinghospital systems and joining with systems. It's all about scope and scale andtrying to reduce costs. At the same time, the insurance companies and thegovernment payers are trying to reduce cost and pay you less margins.

^{Stan Schofield}: We've touched on that. Hospitals andhealth systems have historically run at about a 3-4% margin. Private business.If you don't do anything more than 10%, you shouldn't be in business. Largeindustrial complexes, 20 or 30%. You get places like it and informatics, andthey're running 60% margins.

^{Stan Schofield}: Margins are being lost because of labor costs, decreased reimbursement andsupply chain. Material costs going up more, re more of the disruptive themes.We've talked about mergers and acquisitions, lost mergers, contract labor costsare the number one reason. Hospitals, right now, 50% of all the hospitals andhealthcare systems, the United States are in the red.

^{Stan Schofield}: The consulting group just releaseddata yesterday that things are looking better because a couple of months ago,it was 60% of the hospitals losing money. But the margin now for healthcaresystem hospital networks in this country is at 0.3%.

^{Stan Schofield}: Nurses cost $125 an hour. That is notgoing away. It's gotten a little better. It's not like at the peak of Covid at$250 an hour for a critical care nurse, but there's no new revenue streamscoming into these facilities and they just can't be sustained without newrevenue growth and cost reductions, plus assisted intelligence and informatics.

^{Stan Schofield}: ChatGPT and AI are interesting. WallStreet's going crazy. Anything to do with assisted intelligence, they sayartificial intelligence, but it's not. It's always been assisted. And theninformatics. Informatics is the nervous system of what we all do for our labs anddelivery of services to patients.

^{Stan Schofield}: The never ending cost of informatics.The idea is you used to be able to have a basic laboratory informtion systemand you could do result reporting. No longer allowed. Same time cost ofinformatics, cybersecurity. I know our health system here just spent another 26million on cybersecurity enhancements to its laboratory information management system. It'sjust crazy.

^{Stan Schofield}: Crisis management. We've had thepandemic, we've had the workforce, and you say what's next? Could there beanything else? We've managed to hold on and we're getting our feet back, andthen we got hit, of course, with inflation. Next we're hit with theproliferation of consumer and urgent care delivery.

^{Stan Schofield}: There's competition on every streetcorner for delivery of services. Patients want convenience, but they don'twanna pay for it. They want home testing, but they don't want pay for it. Soall these are big challenges. And then of course, at the end of all this aresupply chain constraints. It was impossible to get reagents and consumables andpipette tips during covid.

^{Stan Schofield}: Then it got hard to get blood drawingtubes with anticoagulant. Supply chain constraints are still difficult andthey've increased all our costs for shipping and delivery of goods. So in thelab world, and this is all labs, independent labs, anatomic pathology labs,even research labs, there are five rules.

^{Stan Schofield}: These are my five rules for success in independent clinicallaboratories and pathology groups.

^{Stan Schofield}: Rule number one, you gotta addclients. Hey, that's good. You gotta grow the business. Rule number two, yougotta keep the clients. It's very expensive to get 'em. You don't wanna losethem cause chances are you can't get 'em back.

^{Stan Schofield}: Create new revenue opportunities.Hey, you can't do the same old stuff all the time and grow and keep clients.It's hard to run a lab. It's really hard to get paid and paid well. Andfinally, you have to reduce expenses. If you don't, you're gonna see what’shappening at technology companies. They're all cutting way back because theyover expanded. They thought they had it all figured out and they know nowthat's just not true. So expense mitigation, expense control is a very criticalfunction.

^{Stan Schofield}: The old school for adding clients,how you did that? You'd do some outreach. You'd be in the community and you'ddo some doctor's offices and you'd do a few local hospitals and it all workedout pretty well.

^{Stan Schofield}: You'd have providers that were yourfriends, they'd practice at your site or used you and it all worked out. Healthsystem. The new school is clinical integrations. If you're working with ahealth system or you're near a hospital or a health system and you have arelationship with them, it's all about clinical integrations.

^{Stan Schofield}: You have to be seamless. You have toalmost be invisible to them. If you're providing the service, you can't be theexception. You cannot be the outlier. Direct contracting with employers. As alab, independent lab or pathology lab, direct contracting with employers is avery attractive option, but difficult to do.

^{Stan Schofield}: It takes time, takes connections, andtakes talent, and it takes data. Direct-to-consumer testing. Sounds good.Here's a box, have 'em, mail it back It’s far more complex. State law.Reimbursement. Who's paying for it? Inventory. Supply chain. All of thesethings.

^{Stan Schofield}: Keeping clients. The old school, itwas like you'd have the account rep or somebody go by and say, Hey, how's itgoing? And bring them a lunch or, a subway order or a pizza. You do an annualbusiness review. How you doing? How you doing? Okay. We're good. We're good.Thank you very much. It was connected. We hook you up to the computer. We hookyou up to the fax machine, and we're good to go. Keep the office staff happy.Keep the office manager happy. Take her Christmas presents today.

^{Stan Schofield}: The new school is strong customerservice. They don't have enough people to do their job and they want you to dohalf of their jobs for them. They don't wanna look up the result. They want youto tell them the result. They will call you and say, what's the result? Theywon't look it up. Tailored metrics programs for quality services. What'simportant to them? You have to ask. Why do you want this? What do you need andhow are we going to do it? And then you have a plan and they want to know howthey're doing on the plan.

^{Stan Schofield}: Balanced scorecard. What's a balancedscorecard? For you as the organization, what's the financial performance ofthis account? What's the financial performance of this relationship? How's theservice going? Is it costing us too much? Are we making any money on thisthing? You need to know because if you don’t you will be out of business.

^{Stan Schofield}: Patient experience. Everybody nowgets an email or a text. How did you like your carwash? How did you like yourgrocery shopping experience? You gotta do this. People are expecting it andthey want a voice when it's not good, they want somebody to talk to them aboutit. And then you have to participate in all payer agreements. If you are notpaying attention to the agreement, somebody else is and they're getting thebusiness. And I've heard all the stories about how they only pay 40 cents onthe dollar. That's true. Maybe your costs are too high.

^{Stan Schofield}: Create revenue opportunities. The oldschool, you'd add an occasional new test. Oh yeah, we've got this new kind ofassay or this new kind of stain and we’re wonderful. You'd add a few localclients, maybe do clinical trials. You kinda work with them, create newopportunities.

^{Stan Schofield}: For new school, it's value-basedcontracting. Value-based is all the buzzword. Everybody's saying, we gotta doit, we gotta do it. Method, equipment validation, clinical trials, clinicaltrial work is very lucrative. It's hard to get into it as a standaloneindependent lab or as a pathology practice, but you can do partnerships.

^{Stan Schofield}: You can work as a site or asatellite. More highly complex testing. It's all about cancer medicine and nextgeneration sequencing. Everybody needs to be doing that because that's thefuture of laboratory informatics. Biobanking and data warehousing, you gottahave scope and scale for this biobanking and data warehousing. It’s verylucrative, but it's very complex and very competitive.

^{Stan Schofield}: You get paid. The old school labbilling operation. We wanna be able to do our own laboratory RCM processes. Wedon't wanna have to count on anybody else, and we don't really need abookkeeper. We need a revenue cycle management system. There weretempered collection efforts. If the doctor down the street didn't really payyou, or the small hospital didn't pay you, you kinda work with them and everybodygot it worked out over time.

^{Stan Schofield}: Political physician relationships.Some things you messed with, some things you did not. And medical necessity was“is this the right test and should this have been done in a fairly rudimentary,lab formulary kind of way.

^{Stan Schofield}: Now the new school is sophisticated revenue cycle management (RCM).That sounds like that's a complex thing. It is. You gotta have smart labbilling capabilities, you've gotta have smart laboratory information systems.You gotta chase the money. You have to have a billing staff, a coding andcollection ability. The old days you didn't see very many coders or billers ina lab.

^{Stan Schofield}: You gotta have themand you know that. They need to get the right kind of access to data andanalytics to help them do their job better. Fighting for what is owed. It's onething to do the work, it's another to get paid, and let me tell you something,the insurance companies are not making it easier to get paid.

^{Stan Schofield}: You have to fight with them, and youhave to have the facts, and you have to have the sophistication and theinformatics that come from advanced laboratory information systems to do it.Static extraction tools. Business analytics. You need to know what you'regetting paid and how much because there are more denials than ever.

^{Stan Schofield}: As we've moved into more of thepre-authorization realm of the insurance companies and all the Z codes that arerequired for authorization of molecular assays, good revenue cycle managementis absolutely critical.

^{Stan Schofield}: Reduced expenses. The old school,you'd cut your FTEs, you'd freeze travel, freeze capital, freeze hiring. Thelast six months seeing all the hospitals, health systems and labs that I knowthat's kinda what they're trying to do but how much is freezing travel reallygonna do to knock down the $125 an hour for a nurse contract labor cost perhour. But anyway today, The new school is about reducing expenses. You gottahave sophisticated metrics. You have daily monitoring. What is the operation?What are your volumes? What's the workload?

^{Stan Schofield}: We have 12 hospitals and we checkevery shift, every work station, volumes, instrumentation, staffing levels,performance. We have this big report card every morning.

^{Stan Schofield}: Nobody wants to work a second shift.Nobody wants to work a third shift. They certainly don't wanna work weekends,but they'll give you a Tuesday and a Saturday for four hours. If they've gotthe skills or they're willing to do it, you can count on 'em.

^{Stan Schofield}: You gotta be flexible. Labadministration, no matter what you do. 30% less senior leadership. Why? BecauseQuest and LabCorp come in and outside for-profit entities come in and they say,I'll cut your expenses 20%, 30% automatically. If you've got lab administrationand somebody like Quest or LabCorp or another national lab comes in and says,oh, we're gonna cut your leadership group out by 40 or 50%, you're just hangingout there looking for trouble.

^{Stan Schofield}: Okay, so those arethe rules. From the rules. We move into the questions that you must be able toanswer in order to be a successful laboratory. How do you enhance your services?How do you improve quality? How do you reduce your costs? And how do you addvalue? If you can do all four, you got a growing, viable organization.

^{Stan Schofield}: You can't, two out of three, two outof four. No. It's just not gonna fly. How do you enhance your services? Firstof all, you gotta know where you are in this world. You need to know how youstack up against everybody else. Because no mama ever had a ugly baby. Whatdoes that mean? It means you think you've got a good organization and you thinkthat you're doing a great job. You don't know what everybody else is doing, oryou think you know, but you gotta have really hard information and informatics.You got data, you need data. You gotta know what your client's expectationsare. You gotta ask them, you gotta meet with them, you gotta talk about it. Yougotta remember it. You gotta have regular contact by service and sales repseven when there's no problems.

^{Stan Schofield}: Client scorecard. What's important tothem and how you've been doing it. It's your report card back to them every sixmonths. Once a year, quarterly, whatever you guys agree on. Remember, know yourclient expectations, management and leadership expectations, your managementand your leadership.

^{Stan Schofield}: The expectations of them by yourcustomers. Need to be well understood. You as an operator, need your managementand leadership. Expectations defined and well established as part of yourculture and your operations and direct to consumer testing, the demand isthere. They want the convenience. What's important, what's legal?

^{Stan Schofield}: How can you meet those needs? How doyou improve? Quality daily operational huddles? As I said, 8:30 am everymorning. All 12 hospitals, the labs are on the phone and zooming and talking toour teams about what the operations are? What happened last night? Whathappened yesterday? What's the instrument performance?

^{Stan Schofield}: Anything going on with the problem?What's happening with any incidents, turnaround times, all that right there,every day on a spreadsheet and people, it takes time to run it and time topopulate it, but it's invaluable for management. Best practices. If you gotta dosomething, like change Laboratory information systems or add a new service oradd new tests, you need your best practice teams who are the best of the bestthat you have.

^{Stan Schofield}: Have them set the standards, don'thave the same old thing done by the same old people all the time. Bring in newblood. Shift it up, switch it up, and get the best out of everybody. Leadershipdevelopment. How do you get the best out of everybody? You develop yourleaders. There aren't any med techs and lab people that are extroverts andnatural born leaders and managers.

^{Stan Schofield}: It comes with time, training andeducation. And how do you do that? You invest in them. Site member meetings. Ifyou have multiple sites for your lab or your department or your pathologyservice, you gotta go to the other sites. You gotta show 'em some love. Yougotta go hang with them a little bit. You gotta go meet with them.

^{Stan Schofield}: What's the issue? What's the problem?Here we are. We're one big family. You gotta know what's going on there too.Participate in operational excellence programs. What is that? First of all, youneed your own program that you're constantly improving. You're trying to enhanceand develop your staff, and at the same time, many of your customers have theseprograms.

^{Stan Schofield}: You need to participate. What's myrole? How do I do this? What can I do to help? You move your organizationforward. Standardization of technology and processes and procedures. If youhave multiple sites, you can't have six ways of doing stuff, or we used to doit this way, but now you know, we don't do that except this one place.

^{Stan Schofield}: They're the outlet. You can't haveit. You need standardization and through the standardization and staffcompetency and retraining, you gotta have people who know what's going on andthrough mergers, acquisitions, transfers, or new people, you can't let theintellectual capital of your organization slip.

^{Stan Schofield}: It's about competency and retraining.Best of class objectives, benchmarking percentiles. You don't know what youdon't know. That I can't help you. But if you know where you're going, how doyou wanna get there is an easier roadmap. If you're operating at the 95thpercentile, good luck and God bless you, and you don't need to listen to thislecture.

^{Stan Schofield}: But if you're running at 50%, okay,you got work to do. How do you decrease costs? Management of the sites. Ifyou're not watching them, they're probably doing okay, but not as well as theycould. Standardization of buying. One of the things that we did no matter what,if we took over another hospital or another laboratory, we could save 20% ofthe cost just because of our buying ability.

^{Stan Schofield}: I'm part of a large trade federation,which is The Compass Group, and we've got about 700 hospitals and we swingdirect contracting deals for equipment reagents and service contracts, and it'sa huge difference. Just remember the national labs. On any given day, theiroperating expenses are 30% lower than yours on your best day because theirstuff they buy is much cheaper.

^{Stan Schofield}: They have more automation, and theyhave scope and scale, and you're competing against them. You gotta measure theproductivity, and that doesn't mean that you need to draw 12 patients an houras a phlebotomist or you need to cut 300 slides a day, or you got a screen 75pap smears a day. What it means is you need to know what's going on.

^{Stan Schofield}: You need to know that the staff youhave is competent and that they're doing a good job. If they're not at the 95thpercentile, that's a management issue and a technical issue, but you have tomeasure. If people know you're measuring, they will perform better. Mix andadjust levels of staffing. What's the right number?

^{Stan Schofield}: Now, what this means is, do I have tohave the most technical qualified M T A S C P stocking the refrigerator?Dumping the trash? No. What's the right mix? Could it be 70% technical staff,30% assisting staff, 50 50, four year degree versus two year? That's not whatwe're talking about. We're talking about you have to have the highly trained,highly educated, and skilled doing what they do best and nothing else.

^{Stan Schofield}: I know. They don't want to hear it.They like the variety in their job. If you got enough of those people floatingaround good luck and god bless you. Okay. But the rest of the world and therest of The Compass Group members, which now 17% of all positions in all thelabs of 700 hospitals are open and they don't have a whole lot of MTASCPsaround, floating around with nothing to do, and everybody's trying to get tothe mix and adjustment levels for staffing, which the right skillset, and thatthey're not wasting those skills by, like I said, sweeping the floors orloading the refrigerators.

^{Stan Schofield}: How do you add value optimizing yourpatient testing business analytics? Some people call it pointof care testing. Some it's convenience, some it's same day testing, some it'srandom access. We don't do batching anymore, but you gotta have the data. Yougotta figure out what is it that the lab or pathology practice can really do tomake a difference.

^{Stan Schofield}: We're constantly moving patientsthrough the healthcare system. That does not mean a hospital system down thestreet. It's all of healthcare. Patients don't want to hang around healthcare.You gotta get 'em in. You gotta get them seen. You get them treated. If they goto your lab for any kind of services, you have to be on the ball, on time anderror free.

^{Stan Schofield}: Okay? So you gotta get 'em throughthe system because length of stay or access or appointment time or missedwellness checks and things like that. All score against the deliver andprovider of services. Value-based lab analytics. Now this is where you reallyneed good information, specific studies on the right test.

^{Stan Schofield}: What was the test done on thepatient? For the right patient? The right reason? Do we have any medicalinformation about that? And at the right cost? If you're gonna do contractingand risk contracting for services, you better know what you're gonna do toprovide all this kind of information. Support and analyze data and scorecards.

^{Stan Schofield}: I've been talking about collectingall this data and all this information. It doesn't mean just put it in adrawer. It means look at it what can you do? What's important? What do youreally have to attack? Your clients? Wanna know it, support and analyze yourdata and your scorecard.

^{Stan Schofield}: You gotta share your scorecards. Soif you guys are so good and you have a wonderful organization, wonderfuloperation, don't keep it a secret. Give it to your clients. Share it. Share itwith your insurance companies who are paying you. Share it. Brag about it, butyou gotta have it in a format and a design that'll impress people.

^{Stan Schofield}: Just cuz you say you're good quality,you get a chance with real LIS systems and really good data to prove it.And finally, you need to establish schools and training programs. We gotta growour own. We've been training on our own phlebotomist for 15, 20 years. In aformal way, programs every two months, 20 students, things like that, medtechs, histo techs, they're not growing on trees.

^{Stan Schofield}: They're not coming up through theranks for medical universities and technical schools, and so you have to growyour own. And if you're depending on the local junior college or the localcollege to produce these folks in a formal, recognized, trained, certifiedmanner, you're wasting your time because people are just not going into thesefields.

^{Stan Schofield}: After four years of college and amassive bill for student loans and tuition, they're gonna go after differentkind of job formats. That's the history.

^{Stan Schofield}: We've talked about the five rules forthe laboratory, and I've given you four questions that you need to answer forpeople to really do business with you and for you to have your daily operationscompetitive and help you with the transition PA post pandemic. But reallythere's only three elements now I wanna leave you with, and there's threeelements that are absolutely key to success. The first one, you gotta have someimagination. You can't do it the same old way. You can't do it the way we'vealways done it. You gotta listen to new ideas. You gotta try new ideas. Youhave to have information to feed and fuel your imagination.

^{Stan Schofield}: Now you can have the greatest idea,the greatest concept, and the greatest imagination in the whole world. But ifyou don't do something with it, you put it in a drawer. All hope is lost. You mustexecute. The execution on your imagination is the critical factor. And thenfinally, how do you do that? That's what leadership is.

^{Stan Schofield}: That's why you're on this conferencetoday. You're a leader. Without leadership, you can't execute. You can't havean imagination. And you can't prevail, you can't succeed. Anybody standing onthe sideline hoping that somebody's gonna take care of them usually gets leftbehind. So with that, I'd like to thank you for your time today, your attentiontoday.

^{Stan Schofield}: I appreciate the opportunity to sharemy thoughts with you today, and thank you. LigoLab.

_{Michael Kalinowski}: Thank you, Stan. That that was verywell done and a lot of information, a lot of things to unpack. If anyone in ouraudience attending this webinar would like to have a question answered by Stan,go ahead and use the chat option that we have in this Zoom webinar call.

_{Michael Kalinowski}: A couple of things that reallyresonated with me, Stan. The need for communication skills really came out loudand clear to me. This is a business where if you want to be successful, It'shands-on and it's communication. It's talking to all the differentstakeholders.

^{Stan Schofield}: Absolutely. People don't like to beexcluded and it's hard to cover all the bases, the things that I've had in mycareer that I wish I could do over are areas around where communication was notas strong as it should have been, or as effective as it should have been. Andpeople say, I don't know anything.

^{Stan Schofield}: Nobody tells me anything. You can'tallow that to continue and you can't allow that to happen. As they say, you cannever over communicate and it really is true. And when times are tough, thebetter communication you have, the more success you'll have

_{Michael Kalinowski}: for you personally.

_{Michael Kalinowski:} Wasthat a skill that you acquired over time or was that something that kind ofcame easy to you?

^{Stan Schofield}: I think by hard knocks. One of thethings that happened when I was really young in the lab business, there was anorganization called the Clinical Laboratory Management Association. And I wasat a lab, at a children's hospital, and on the Friday afternoon I was calledin. I was very young and called in and by the pathologist.

^{Stan Schofield}: He said on Monday, you're in charge.And it was like, I had no idea about management. I had no idea. Here I am at afairly sizable children's hospital, 25 years old, being told I'm in charge. Andway back then it was like, oh my God, what do I do? And there was anassociation, C L M A. That I quickly found out about and I went to theirmeetings and for years I would go to the meetings and you'd learn a lot ofthese things.

^{Stan Schofield}: They were management subjects andcommunication subjects and operational excellence kind of programs and processimprovement. And over time I eventually became the president of C L M A and itwas a wonderful experience in shaping and helping me become a better managerand a better leader. But it wasn't natural.

^{Stan Schofield}: It took work and it took resources.And I was fortunate enough that I've been given a lot of opportunities. And youknow what they say? It's all about execution and you take advantage of it andso far I've had a pretty successful career and as leadership goes. I considermyself very fortunate because of the teams that I've worked with and all thegreat people I've been able to be associated with.

_{Michael Kalinowski}: A couple of questions have come infrom the audience. The first one is can you be more specific about how tocompete with large national labs?

^{Stan Schofield}: Sure. Service. Now,I don't know your geography. I don't know what your services are, but they willcut you, slice you, and dice you. So you have to give the service aspect, whichthey normally don't do a very good job. A major emphasis, for us as a regionallab, we have to compete against Quest and LabCorp and ours is around most ofour work.

^{Stan Schofield}: If we get it in by noon, the resultsare out by five, and so it's almost same day service. We have sales andmarketing and support teams that call on clients, build relationships, and alsoa very key factor is, the pathology relationship with the local providers. Thelarge labs cannot and do not have that. If you wanna talk to a pathologist withone of those guys, good luck.

^{Stan Schofield}: If you have a real question about atest and you need to talk to somebody, good luck. So you differentiate yourselfas I am here for you. Can I wax your car? Can I floss your teeth for you?Whatever it takes. It's service to make 'em feel special, because at the end ofthe day, it won't be about price.

^{Stan Schofield}: You have to have competitive pricing.You gotta be able to compete on price and you cannot expect it. I'm special andI'm gonna charge 10% more because we're special. They'll cut you off in aheartbeat. So those are my quick off the top of my head suggestions, notknowing your exact circumstance, but it's all about service.

_{Michael Kalinowski}: Okay. Next question and once again,we still have a few minutes if anybody else would like to try to chime in witha question for Stan to answer. We have a question here. How can a lab obtaindata to demonstrate value when there is no feedback from results provided tothe hospitals?

_{Michael Kalinowski}: What value parameters can labsdirectly measure?

^{Stan Schofield}: I don't know your exact relationship.Are you just serving as a reference lab or are you providing all lab services?If you're a single reference lab or limited services, then chances are you'regoing to get paid from the hospital and they will have the value-basedcontract, and you'll have to meet their reporting criteria.

^{Stan Schofield}: The one thing that's reallyinteresting is everybody talks about value-based medicine and the risk, butnobody wants to do anything about it. Nobody has really good laboratory toolsyet. You gotta get the patient through the health system. But the idea is whatservice do you provide and how can you get the patient into the services andout of healthcare services as fast as possible?

^{Stan Schofield}: So if you only do the test once aweek and that's slowing things down, you gotta figure out how to do it morethan once a week. You know when you're talking about the kind of data thatyou've just asked, you have a great question. I don't know enough about yourorganization and what you're doing to understand your abilities andcapabilities, but let me give you a great example.

^{Stan Schofield}: Tri-Core Regional Labs inAlbuquerque, New Mexico. My really good friends and members of the CompassGroup. They did a study that talked about acute kidney injury based on thedifference in creatinines, on patients on admission and serially for two orthree days when they were in the hospital to see if there was an injury. Andthat the creatinine level went up. And that was along the lines of, okay, wasthe patient dehydrated?

^{Stan Schofield}: Did they become septic? Did they havea drug interference? Did it do something to screw up the kidneys? And they didthe study with the hospital around value base of the lab, and they were able todemonstrate that some of the protocols there did not minimize the risk of acutekidney injury to patients in the I C U and based on the lab data, they wereable to go back and say, if we did this and we changed that we'd have patientswith fewer kidney injuries coming out of the I C U.

^{Stan Schofield}: It was a very sophisticated, veryelegant, value-based, but it was a partnership. So what happened was the labhas ability to measure things the hospital wasn't looking at it, the medicalstaff wasn't looking at it, and the lab stepped up and said, this could be anissue, and they took the leadership of that and they executed that.

^{Stan Schofield}: And the result was the hospital madea ton of money. And the reason they made a ton of money is they changed theprotocol and patients were less injured. And when they were injured, it waslegitimate and they could bill for a higher level of acuity of care, and theygot paid more.

^{Stan Schofield}: So from a value base, the patient didbetter. The hospital did better. I'm not sure the insurance companies didbetter, but that's a quick example, not knowing a lot about your history andyour operational abilities.

_{Michael Kalinowski}: Okay. Very well said. Good example.I have two more questions, but they're both related, so I'll connect them.

_{Michael Kalinowski}: One is how do you think AI willimpact lab operations and services and is it worth it to invest in AI with theexpectation that it will increase automation?

^{Stan Schofield}: That's a very big question. AI isthis big term and everybody on Wall Street's going crazy. Everybody's goingcrazy.

^{Stan Schofield}: I don't know what AI is. Okay. Theidea is can they do things smarter? Can they fill out the forms? For the insurancecompanies on your laboratory billing and revenue cycle management RCM easierand faster without having 10 clerks. Maybe. You have to build the program justbecause it's running around and everybody says it does this and does that.

^{Stan Schofield}: I don't know if you've ever submitteda question to ChatGPT, but the stuff I wanna know, it comes back pretty blandand pretty benign and doesn't tell you a lot of good stuff. So I think numberone, AI in its most sophisticated interpretation, would take those creatininevalues at the lab in Albuquerque and say, Hey, by the way, look guys, we gotkidney injuries here.

^{Stan Schofield}: Did you know what's going on? Andthey would notify you, but that's years away. Okay? Because they're not intothe LIS systems that labs run. It will beembedded. This past week, Epic, the computer company, just said they're gonnastart putting chat G P T capabilities in emergency medicine modules athospitals.

^{Stan Schofield}: And one of the great things I sawabout chat G P T was a clinician trying to describe a complex medical conditionto a patient's family. They were not very sophisticated, and it put it in alanguage that everybody got on board in the family, they understood it and theycarried on the therapy at home.

^{Stan Schofield}: So back to what I think is gonnahappen in lab, could it be pattern recognition and pathology screening? Wealready have some of that with Pap smears and the Hologic Cytech combinationmachines and stuff, but, Could it be really diagnostic? I think we're yearsaway from that. Could it be, flagging of abnormal results or quality control?Probably there'll be the first applications, but it'll be clerical applicationsand redundant paperwork kind of things first and quality control management andalerting and flagging and intervention, second, and then by the time we getdown to diagnostics, I don't know the timeframe because I don't know the FDAand all that kind of stuff, we're not seeing anything here that we're gonna beable to put our hands on and make a big difference in our workload here in thenext two or three years for sure. After that, all bets are off because maybethey'll get chat G P T to design something for the lab that we haven't askedthe right question yet. Good question. I don't have that big a crystal ball.

_{Michael Kalinowski}: We're at the top of the hour now.Stan tremendous presentation and we really appreciate the time and effort thatyou put into it. For the audience, great questions. We really appreciate thatinteractivity and that feedback. Certainly if there are any follow up questionsafter this LigoLab webinar is over you can reach me directly and I certainlycan pass along more questions to Stan if they come in to me.

_{Michael Kalinowski}: With that, I think we will conclude.Stan. Thank you very much. Soon we’ll have this LigoLab webinar available atLigoLab.com for people that want to watch it again or share it with theircolleagues.

_{Michael Kalinowski}: With that, I'll say goodbye andthank you once again.

_{Suren Avunjian:} Thank you everyone for taking the time to join us today. We're excited for this round table and we'll also have a recording of this that you can share with your colleagues. 

^{Michael Kalinowski}: A warm welcome to all of our webinar attendees and thanks for joining us today.

^{Michael Kalinowski}: We’re certain that the next hour will be well worth your time. We have a really awesome expert panel that's been put together to discuss the present state of technology in the laboratory industry and then what the future will look like as innovation and emerging technologies take hold. The goal of today's discussion is to help our laboratory colleagues prepare for the future and also move forward with confidence after gaining a better understanding of the tech tools now available and the innovation on the horizon.

^{Michael Kalinowski}: Today you'll hear from a collection of experts with varied backgrounds who all believe that the most successful clinical labs and pathology groups will be driven by technology. These tech enabled labs will enjoy lower operational costs and increase productivity, and the technology will allow them to become market leaders who are better able to attract and also retain more customers and improve net collections.

^{Michael Kalinowski}: Please also note that we've set aside some time at the end of this webinar for a question and answer session. And we welcome your questions and interaction throughout this discussion. Please submit your questions via the chat function during the Zoom call. 

^{Michael Kalinowski}: Now let's introduce our expert panel.

^{Michael Kalinowski}: First, let's introduce Bruce Friedman, Professor Emeritus, University of Michigan Medical School. Stan Schofield, Managing Principal of the Compass Group. Khosrow Shotorbani, President, Executive Director, Project Santa Fe Foundation and Lab 2.0. Dennis Winsten, President, Dennis Winston and Associates Healthcare Systems Consultants.

^{Michael Kalinowski}: Our moderator for today's discussion is Suren Avunjian, LigoLab Co-Founder, and CEO. 

^{Michael Kalinowski}: Let’s start with Suren. He'll have some opening remarks. 

_{Suren Avunjian}: Thank you very much, Michael, for the warm intro. Ladies and gentlemen, esteemed colleagues and fellow professionals in the field of laboratory science, it's a pleasure and an honor to welcome you all to today's discussion with this all-star lineup of industry thought leaders and members of the LigoLab Advisory Board on the current state of technology and its impact on future laboratories. As we gather here today, we stand at a precipice of a new era in laboratory industry, driven by rapid advancements in technologies that promise to revolutionize the way we work, collaborate, and innovate. 

_{Suren Avunjian}: In recent years, we've witnessed the digital transformation across various industries, and the field of laboratory business is no exception. From artificial intelligence to laboratory automation and digital pathology, technology has profoundly shaped the landscape of modern laboratories.

_{Suren Avunjian}: Today, clinical laboratories are experiencing disruption due to various factors such as technological advancements, regulatory changes, and evolving healthcare landscapes. Laboratories of the future will increasingly resemble technology companies as they leverage advanced tools and systems to improve efficiency, accuracy, and collaboration.

_{Suren Avunjian}: To build a solid foundation for this vision, laboratories must consider several key factors. Laboratories need to invest in state-of-the-art equipment, software, and hardware to stay at the forefront of technological advancements. Future laboratories must implement robust data management systems to handle the growing volume and complexity of lab generated data decision making, and to unlock its valuable insights.

_{Suren Avunjian}: To facilitate seamless data exchanging collaboration, laboratories must prioritize interoperability and standardization to accelerate innovation and stay ahead of the curve. Laboratories should actively seek partnership with technology companies and other stakeholders in the industry. The laboratory of the future must be agile and adaptable, ready to embrace new technologies and methodologies new business models as they emerge. This requires a flexible organizational structure and an open-minded culture, and a willingness to transform with novel approaches. By focusing on these key factors, laboratories can establish a strong foundation for their future vision as a technology driven organization, equipped to navigate the rapidly evolving landscape of laboratory technology innovation.

_{Suren Avunjian}: As we delve deeper into our round table discussion today, we'll explore the current state of laboratory technology and examine the most promising emerging trends poised to reshape the future of lab. We'll also discuss the challenges and opportunities that these innovations may present, and the strategies that can help us harness their full potential in pursuit of excellence.

_{Suren Avunjian}: Together let us embark on a journey to envision the laboratory of the future. A space where cutting edge technology, human ingenuity, and a relentless pursuit of knowledge converge to push the boundaries of what is possible. 

_{Suren Avunjian}: Thank you all for joining the round table today, and let us begin our exploration into what we need to do today to be better prepared for tomorrow's exciting world of emerging technologies and their impact on the future laboratory world.

_{Suren Avunjian}: So with that I'd love to kick it off with Stan and find out in terms of market trends, what are the top laboratory issues today and for the next five years as you see it?

_{‍Stan Schofield}: I would say first of all, the lab has just plenty of challenges, but probably the top three and going into five years, it's gonna be around staffing, automation and reimbursement. Today, staffing. There's fewer staff. 

_{‍Stan Schofield}: Many of us are training our own staff as laboratory technicians or machine operators. The world of having clinical laboratory scientists at every workstation is very difficult, if not impossible these days. Cost are very significant around labor pools, and being able to attract staffing.

‍_{Stan Schofield}: It's not just the technical staff, it's the pre-analytic staff, the phlebotomy staff, support staff, lab assistance. Staffing is the biggest issue. The Compass Group, which is 33 health systems and almost 700 hospitals that I work with, we're running about 15 to 17% vacancy in most lab, and it's probably not gonna get a lot better over the next five years.

‍_{Stan Schofield}: People are gonna have to go to more onsite training programs to build their own kind of staff and have it available. If you go to automation, everybody wants nice machines. Automation actually, is fewer human touchpoints. We don't have the people so you've got to try and get the equipment. Even the smaller facilities are looking at more automated solutions and pre-analytic processing lines for specimen processing.

_{‍Stan Schofield}: Another area of automation that's in high demand and high cost is digital pathology. Where does it fit? Everybody would love to have it, but it's very expensive and hard to maintain. And I don't know that the hospitals and all the facilities can afford digital pathology. It's the future, but it's a tough  road financially right now.

‍_{Stan Schofield}: Faster processing's required through automation. Everybody wants all the results yesterday and for free, and that's not going to change. The demand of service and performance of the labs reached a pinnacle during covid, and it hasn't backed off. And then finally, reimbursement. It's hard to run a lab, but it's even harder to get paid these days.

‍_{Stan Schofield}: And the reduction in reimbursement through the various government agencies and the insurance programs. In the last six or seven years, we're down about 55% reimbursement per test than we were back in, 2012, 2013, and 2014. I think that preauthorizations are way up, with more molecular assays requiring greater validation and approval, making it easier for insurance companies to deny payment. So what you need is a very robust laboratory revenue cycle management (RCM) aspect to your operations. In the past you had hospital operations and lab billing and it wasn't very sophisticated. If you're a lab today, you need your own RCM tools and RCM processes. So those are the things that I think are most important today.

_{‍Stan Schofield}: I think another area, and maybe we'll talk on it a little bit, is value and what's the role of the laboratory and value contracts? We’re moving from fee for service to payments for value, and it's getting traction. I think that's something that more and more labs are gonna be facing as far as the reimbursement window.

_{‍Stan Schofield}: So over the next five years, there's plenty of challenges, but the big three I think are staffing, automation and reimbursement or getting paid for the services you provide. 

_{Suren Avunjian}: Thank you, Stan. You brought up really good points and I wanna poise a question to Dennis as far as laboratories utilizing multiple systems and what does it mean to have things interfaced and having one source of truth?

_{Suren Avunjian}: What's your vision on these disparate systems and the integration between them in a siloed lab data exchange world? 

^{Dennis Winsten}: That's a good question, and coordination and the correlation and consistency of laboratory clinical and financial data is really a key factor to better efficiency, quality and improve productivity.

^{Dennis Winsten}: Now, lots of times I hear comments talking about laboratory information systems being integrated, and in fact they're not integrated, they're interfaced. Interfacing is not the same as integration. Interfacing requires the transmission of transactions and messages between the systems, whereas integration is all contained in the same system.

^{‍Dennis Winsten}: And again, they're not the same. Clearly a lot of interfacing is done with HL7 interfacing to instruments, which of course is required. But when you look at some of the challenges associated with interfacing relative to integration, if there's a change made in either of the systems that's interfaced, that's going to require retesting, it may require some downtime.

‍^{Dennis Winsten}: It certainly requires remapping of the system. So there's always this issue. There's also an issue of terminology. Sometimes the two systems that are interfaced don't really describe their data in the same way. So there's some inconsistencies. And another issue that can occur is if one or both of the systems goes down. How do you know which system is current and which system is the actual source of truth? But with regard to integration, there's basically one comprehensive system. All the data's there.

^{‍Dennis Winsten}: You don't have a silo of financial information and a silo of clinical information and clinical lab and anatomic pathology lab for example. You can get real time data access throughout the system. You're assured that the data you're using is consistent and it's unambiguous because again, it's in one system.

^{‍Dennis Winsten}: And another factor, we'll talk about business intelligence and AI later, but one thing about having an integrated system is that your business intelligence, your business analytics, can work across the realm, across the scope of data that's there, across that spectrum of both clinical and financial information.

‍^{Dennis Winsten}: And you don't need to work on reconciling distance, the information between, for example, a lab information system and a revenue cycle management system. So there are differences, and it's important to understand that interfacing is not integration.

_{Suren Avunjian}: Thank you, Dennis. 

_{Suren Avunjian}: Bruce what is your vision on the role of the LIS? Will it be constant even as new technologies become available? 

_{Bruce Friedman}: That's an excellent question, Suren, and relatively easy to answer. I think the first thing we all need to understand is that lab data is the biggest bargain in healthcare today.

_{Bruce Friedman}: Typically, in a large health system, the budget for the labs will be about five or 6%, but yet lab data contributes to something like 70 or 80% of all clinical decision making. And that's because the labs have been automated for several decades. So I consider the LIS a part of this automation of all the labs.

_{‍Bruce Friedman}: Now, what we're seeing is AI creeping into what I would call the subsystems, which I would define as the individual laboratories like chemistry and hematology and microbiology. AI and automation of course took anatomic pathology by storm, but it's now being deployed at the level of individual laboratories.

_{Bruce Friedman}: Now we need some kind of agent, an AI agent that oversees all of the work of all the different laboratories. In the case of most LigoLab customers the question is very easy to solve because LigoLab will provide AI support as we go forward in the future. However, for large health systems, it's a little bit more complicated because essentially for many hospitals or pathology departments, the LIS module is a port, is a portion or individual unit within the overarching overarching EHR, and I don't wanna be too pessimistic about this, but I believe that the EHR companies like Epic are very broad and they have a lot of people to satisfy.

_{Bruce Friedman}: And I suspect that AI will come probably first to some the clinical hospital operations and not to the labs. So I believe there will be room in  the laboratories for some kind of overarching AI presence or agent that would be there to take the data from all the individual laboratories and integrate and interpret.

_{‍Bruce Friedman}: And this has always been the case. We've had rules in the labs for decades. So there are always rules operating at the analyzer level and the overarching total lab operation. So I don't know who's gonna provide this large overarching AI agent that will oversee the work and the rules operating at all the individual laboratories.

‍_{Bruce Friedman}: I think the IVD companies, for large health systems, may provide this solution that would include large companies like Beckman and of course and Roche. So I think I'm very optimistic about the future of the labs in terms of AI. We've been using rules for many decades.

_{‍Bruce Friedman}: We'll continue in that realm and for many of you listening to this broadcast LigoLab will provide that solution for you. That is that overarching agent that will control and interpret the data coming from the individual labs. So I'm optimistic about the future and automation in the labs.

‍_{Suren Avunjian}: That's a fantastic point and sets us up for the topic of AI. But before I dive too deep into that, I think it's really vital to discuss the curation and aggregation of lab data because without that you really can't build proper AI models. Khosrow, what's your vision on how that can improve laboratories operations and finances?

^{Khosrow R. Shotorbani}: I think Stan covered quite nicely the challenges facing lab, not to mention reduction of the payment in the severe fashion. I believe that current business model may have reached a strategic inflection point.

^{‍Khosrow R. Shotorbani}: But I'm gonna borrow something from Bruce, what he said. Optimism. Even though our industry is facing the most dangerous commoditization, I feel quite bold about the role of the clinical lab in the future state of healthcare. If we are aligning ourselves, as Stan talked about, the space of the value, if it's translated into managing clinical risk, I really think that we are moving from the the notion of reactive confirmation of what the diagnosis is to a proactive prediction of what that's going to be. We know the current P and L, and we have to reduce our cost because our payment is reducing significantly. But we had to put a stepping stone into business of the value in the space of managing both clinical and financial risk.

^{‍Khosrow R. Shotorbani}: That payer, including Medicare and Medicare Advantage, is going to require and demand of us. We're not ready to that, and I think the runway is about three to five years. We gotta get up, optimize the current process of the clinical lab. We gotta diversify our top line so we're mitigating the risks of the changes in our reimbursement, but we really gotta start transforming and utilizing the longitudinal data, which AI could help as a stepping stone in the future model.

^{‍Khosrow R. Shotorbani}: This basically allows us to do proactive risk stratification, even at the asymptomatic stage. That's going to be a requirement for value-based care. 

‍_{Suren Avunjian}: We have a question that we received from the chat. In what areas of anatomic pathology workflow can rules and automations replace human resources?

‍_{Suren Avunjian}: Anyone want to answer that? 

_{Bruce Friedman}: I would say in terms of image analysis, which is now starting to hit the market in terms of approved systems starting with prostate cancer. And there's gonna be explosion of these various packages that will interpret the images obtained in the digitization of the image.

_{Suren Avunjian}: Speaking of images, I wanted to note that all the images you're seeing on the slide deck today were generated by AI. They were all using mid journey. So that was a little fun tidbit. 

_{Suren Avunjian}: So with the discussion of AI, Dennis how do you see artificial intelligence revolutionizing clinical laboratory workflows, particularly in the area of data analysis and diagnostics?

‍^{Dennis Winsten}: As everyone knows, artificial intelligence is exploding. Examples of it every day. You just mentioned the images that you're showing. Siri. Alexa, there's auto driving online ads that are specifically focused to you, and I'm sure I've gotten mine already this morning and I'll be getting more for the rest of the day.

^{Dennis Winsten}: But yeah, it's exploding and there are a lot of issues associated with it's exploding, not only in healthcare but across our whole society. But as far as AI in laboratories and in healthcare, there are a number of different application areas, if you will. One Bruce mentioned already, digital pathology, scanning slides and identifying anomalies in the slides with a high degree.

^{Dennis Winsten}: Another one is pattern recognition, which involves looking at large databases, large longitudinal databases of clinical information. Being able to discern patterns that humans would not have the time or necessarily the ability to detect, and being able to point out those trends and those indicators.

^{Dennis Winsten}: Another one is clinical decision support in terms of being able to provide predictive analysis. And that also applies as far as the laboratory is concerned in business management. That is giving laboratory managers the insights and advice they need to operate their laboratories more effectively and efficiently.

^{Dennis Winsten}: And another one that's rarely brought up, and I know we can have some more discussion about this later because it's a big issue, is cybersecurity. That's another area. But I do wanna comment on the analytics side, if I may because if you look at business analytics and business intelligence, you'll look back at kind of what we have now and what we've had in the past, and that's been descriptive data.

‍^{Dennis Winsten}: That is the systems will summarize raw data for interpretation and specifically it will describe what has happened. And it's basic statistics and the reports that you see, the dashboards and the graphs. So what we moved into now with artificial intelligence is a predictive model.

^{Dennis Winsten}: That is, you have enough capability to be able to determine what could happen, what is likely to happen based on the analysis of historical data. And this is using analytical tools including statistical modeling and other algorithms. So that's very nice. Predictive is good, but I think the next step is even more important and that's prescriptive with artificial intelligence and machine learning, where the machine is learning from the data and the new data that it's getting to be able to alter what it suggests.

^{Dennis Winsten}: And prescriptive says it's going to suggest decision options that are the most likely to optimize the outcomes. For example, prescriptive indicates what should happen or the best course of action. So this is a very powerful tool in using mathematical based techniques. 

‍^{Dennis Winsten}: So there's a heck of a lot of things that are happening in AI that are gonna be beneficial to the laboratory, but not without some risks. And we'll talk about those I bet a little bit later. 

_{Suren Avunjian}: Bruce, you wanted to add a comment?

_{‍Bruce Friedman}: I look upon what Dennis just spoke about. I look upon this as reflex testing on steroids. And we've had for two decades, essentially reflex testing on 24 hour cycles. But I think that this is gonna be compressed with AI such that the cycles will be more like four or five hours. Now the labs will have to keep up, but I think that there will be testing to a logical endpoint in the diagnosis within a 24 hour period.

_{Bruce Friedman}: Now, this is not without some risk and some political attention because the clinicians, I think many of them, particularly the older ones, will not allow this. They're positioned to do this, but I think the younger docs are overworked and will be very happy to set reflex testing to a diagnosis within a 24 hour period.

_{‍Bruce Friedman}: And AI will be greatly able to do that. 

^{Dennis Winsten:} They, the old guys won't be around too much longer. 

_{‍Bruce Friedman}: And where does this webinar go with that?

_{Suren Avunjian}: It will be the customer of the process. You mentioned cost outside of what are other current limitations and challenges in implementing AI technologies in clinical laboratories and how can these be addressed? 

‍_{Stan Schofield}: Lemme just say that I think the average laboratory has to depend on technology from a third party because they don't have the intellectual capital, the experience to develop AI kind of tools. So what we would be doing is working with other sophisticated organizations to develop the tools and adapt them to our workflow or our environment. In other words, we'd have to go shopping for the technology, developing it, writing code and training machine learning devices. The average laboratory can't do that.

‍_{Stan Schofield}: It's just is too complex. It's too costly to do that from scratch. So we're gonna have to be end users from the development state, steps from pharmacy developing it, then diagnostic companies will be developing it, and then the laboratory will be the end market user and they'll have to buy it, and they may be able to modify it or customize it, but I don't think very many laboratories outside of one or two of the national commercial labs will have any kind of resources to devote to this kind of technology development in the next five years.

_{Suren Avunjian}: Khosrow, would you like to expand on this? 

^{‍Khosrow R. Shotorbani}: Yeah, I agree that the average lab may not have the sophistication, but average lab's gonna have to learn it. That's basically the rule of thumb. But I'm gonna go back to what Bruce just said. If the LIS system needs to be the central repository of the raw material called data, that's a foundation. AI to me, needs to come in when we are able to aggregate, clean and correlate the foundation of the longitudinal view. And AI basically becomes the intelligence gathering for us. The foundation has to start with “can we truly aggregate and curate the data real time?” Because harnessing the real time of the lab data is the actionability.

^{‍Khosrow R. Shotorbani}: Zero latency of the data is our value proposition. But if it's gonna take six months just to gather the data, we just lost our value proposition. Gathering, curating, correlating the fundamental foundation of the repository of data, then AI comes in the layers on top of it to tell us, okay what does all of this mean?

^{‍Khosrow R. Shotorbani}: And later on, maybe I can share an example of it, but the foundation isn't there yet. We're so fragmented when it comes to data. We can basically connect the dots and say this is the actionable intelligence, but I don't think AI is gonna help in there. I think we need to start curating that repository first where AI wraps around it, in my opinion.

_{Suren Avunjian}: Let's go to Dennis and then Bruce next please. 

^{Dennis Winsten}: I think one of the key things about the AI is gonna be its ease of use. And in addition to the ease of use, the validation. That it’s working properly is going to be another important factor in in its acceptance by the laboratory and by the healthcare community.

_{Suren Avunjian}: Bruce, would you like to dive deeper into that? 

_{Bruce Friedman}: Yes. Just very quickly, I have total confidence that the lab industry will absorb AI almost effortlessly. And in my whole career, I've seen the lab being a driver for technology, for automation and technology. So I have no qualms about this. I feel very confident because by and large laboratory personnel and professionals are very comfortable working with automation and technology, and our industries will provide that for us.

_{Suren Avunjian}: Dennis, please. 

^{Dennis Winsten}: I think clearly one of the issues we have to deal with, and I think we're still having problems dealing with it today, is how do you assure that the data that you have in your longitudinal database is validated?

^{Dennis Winsten}: Because AI is only as good as the data it's going to operate on. And I'm not sure that today, and maybe this is an area where AI can help that, is to be able to look at data that's coming into the system to say, is this data inconsistent in any way? Is this data, does this data not meet, quote, the standards for that type of data element or that type of information.

^{Dennis Winsten}: And I think that as a front end may be very helpful for AI to assure that data coming into databases in the future is validated as good data. The old expression goes back 30 or 40 years, garbage in, garbage out and artificial intelligence is not gonna solve that if it's dealing with garbage.

_{Suren Avunjian}: Bruce, go ahead.

_{‍Bruce Friedman:} I wanna get a little bit even more with the future of science comment here, and it's not gonna happen tomorrow in terms of AI. But predictive analytics in two to three years are gonna look at a patient's variation within a normal range and predict based on large data, what diseases patients will be developing in the future, say 10 years or 15 years.

_{‍Bruce Friedman}: Hence, this is not something we need to worry about now, but predictive analytics is gonna take us in that direction and that's gonna have very powerful social implications. Not tomorrow, but perhaps in five or 10 years. 

_{Suren Avunjian}: Khosrow and Stan, maybe in that order I'd love to get your input. Is it practical to have AI driven personalization of patient reports to improve the clinical decision making process and patient outcomes for the providers and the patient?

‍_{Suren Avunjian:} What do you think about helping patients instead of the patient going and Googling, all of the lab input helping the patient with the summarization and personalizing that report to them? 

‍_{Stan Schofield}: Let me jump in there. I think the potential of that and the functionality have great opportunities, but systems and providers of healthcare want to control information so that they are managing the patient through a process rather than the patient saying, oh, I know what the answer is, and I don't need anybody now.

‍_{Stan Schofield}: And I think physicians, health systems and providers want to stay with the patient stuck to them and needing them and relying on them because that's their role in their function today. Because the sophistication of technology giving the patient the correct answer, what are they gonna do with it?

_{Stan Schofield}: So they're not trained in dealing with it and they may not be sophisticated to deal with it. And those are the challenges that systems and providers have to work with. The technology companies and AI data providers have to come up with some reasonable guardrails there because, in my opinion, giving a patient a full roadmap won't help if they don't know where the first road sign is and what to do with it. 

_{Stan Schofield}: If you wanna get out of town, any road will take you there. But if you wanna get to your vacation, you gotta take the exact route. And usually it takes some training and some mapping, and that's the role of the providers transforming this information into guidelines and a roadmap with the patients rather than leaving them out in the woods by themselves.

_{Stan Schofield}: So I don't think it's wrong. The patients have more information and they will become more sophisticated. The younger generation is certainly technologically adaptable to this. But once again, the continuum of the aging in the population, you know what people at 25 can do with information and data far exceeds what most people at 70 can do.

_{Stan Schofield}: And there has to be some kind of normalization of a process, and I think the providers are gonna be the universal translators and guides in the healthcare journey for many years to come. 

_{Suren Avunjian}: Khosrow?

^{‍Khosrow R. Shotorbani:} Let's face it, AI been around since 1950s. It's the latest shiny objects. And I do agree with Stan.

^{‍Khosrow R. Shotorbani}: This may not be just technological advancement, but it's cultural change The US is actually tracking behind and not leading in this process. In other countries, including the Middle East, the lab report is not a numeric value standalone. In fact, there is a page that shows the trendline and how the delta changes over time and the individual actually tracks it. So my definition of personalized medicine is about how did the individual change compared to their themselves, above and beyond within the normal range. 

^{‍Khosrow R. Shotorbani}: Let's take an example. Creatinine. Often the value has gone up 50% within the normal range. We're not even flagging it yet until it's out of the range.

^{‍Khosrow R. Shotorbani}: That requires change of the pathology. Prescriptively what Dennis said, Hey, this is actionable. Do something about it now. We have to be part of the care to get to that point. That means we have to no longer be passive. We released a result, but we have to assure that there was a diagnosis that someone needed to take in action.

^{‍Khosrow R. Shotorbani}: That's a culture transformation here, not technological transformation. 

_{Suren Avunjian}: That's a great point. Thank you, Khosrow.

_{Suren Avunjian}: Dennis, any closing remarks on this slide before we move on? 

^{Dennis Winsten:} It isn't the artificial intelligence we have now with machine learning. It was based on logic and algorithms in the past, so we have an advantage now in that machine learning will change the algorithms and what it does based on new information that it receives and in terms of personalized medicine. 

^{Dennis Winsten}: I can give you an example.

^{Dennis Winsten}: My son's a psychiatrist and as most of you know the drugs that are given for different symptoms vary and their impact on patients vary significantly to the point of either making them feel better or causing them to commit suicide. So we have a lot of data, and again, assuming the longitudinal data is good, we're gonna have more and more information.

^{Dennis Winsten}: We're gonna have more genetic information, we're gonna have more past history information, which should allow both the lab and clinicians to be able to say, again, this is predictive. This is the best course of action for us to take, whether it's testing or whether it's therapies because of the information that is being analyzed and being presented to the clinicians and to the laboratorians.

_{Suren Avunjian}: I think really to cause a major shift in the way we run laboratories, we're gonna see a larger shift in how we get paid. 

_{Suren Avunjian}: Although there's several good reasons to shift healthcare to value-based model, the transition will require significant changes to healthcare as we know it. So what will it take for value-based care to become the dominant form of care? 

^{Khosrow R. Shotorbani:} Clearly we're actually referring to this as lab initiated care model to elevate the laboratory out of the basements, assume a seat at the table and help design the care model future that is driven by clinical intervention, clinical prevention, and cost avoidance. 

^{Khosrow R. Shotorbani}: If this was all about data, Google would've solved it 10, 15 years ago. The two basically creates a new toolbox that we begin not waiting for the order to arrive. We begin proactive risk, stratifying the data that we're sitting on. We're looking for that needle in the haystack, and we're basically looking for where was the gap in care that was missed.

^{Khosrow R. Shotorbani}: Did we prevent something? And on the financial side, what were the total cost avoidance, such as readmission or hospitalization? And did we adjust the risk? So if I can just conclude with a case that we're about to submit to the National Kidney Foundation, we all know that CKD is a huge prevalence with comorbidity.

^{Khosrow R. Shotorbani}: Roughly about 37 million suffer from that. 95% of these conditions are missed within the primary care. That's what we will actually indicate via our study. And by the time that we, the individual reaches the stage four, the individual is going to be on dialysis. Lifespan of the dialysis is between one to five years.

^{Khosrow R. Shotorbani}: Here's the beauty. What the lab really can do within the first three stages. Asymptomatic stage lab is the essential part, measuring the very basic biomarkers of the lab that are telling us something, but we're not catching it. 

^{Khosrow R. Shotorbani}: How do we get paid for risk in the future? We haven't evolved that yet. 

_{Suren Avunjian}: Thank you, Khosrow. 

_{Suren Avunjian}: We have a question from the attendees and  I'll propose it to Stan. 

_{Suren Avunjian}: What can my lab do today to prepare for this major shift to value-based reimbursement? 

_{Stan Schofield}: Okay. It's a great question and many of us are still struggling with a clean answer, but let me give you my best advice at the moment.

_{Stan Schofield}: Get closer to the patient. Yep. The lab, many years has been relegated to the basement or a commodity. Lab work has drawn results, come back. Nobody ever sees the lab get closer to the patient. What does that mean? It means take an active role and helping drive the patient through the health system and the provider network efficiently and cost effectively and quickly. 

_{Stan Schofield}: The big mantra is length of stay. Every hospital is trying to cut the length of stay, so what the lab needs to do, number one, you have to have the lowest possible cost, okay? Per test. You have to be efficient, you have to be automated. You gotta get paid, so you don't have a lot of risk loss, and you have to have the right staffing combination to keep the cost down.

‍_{Stan Schofield}: The second thing is efficiency. Drive the patient through the system quickly, if that means point of care instrumentation. I've always thought the central lab, it's much cheaper, it's this and that. But Covid changed my mind. Having covid testing at a molecular level at a hospital two and a half hours away was very efficient compared to, half the cost going to the core lab, but 12 to 16 hour delay in care and therapies for the patient and or special infection control, isolation, moon suits and things like that in the emergency department. So I think, embrace it. Make it a good business analytic decision and participate. All the hospitals and the health systems are working towards contracting.

_{Stan Schofield}: Get involved. Get a seat at the table. Work with your data analytic people and your financial people that are doing the contracting. But first of all, you gotta know your costs. You gotta be efficient in your cost per test, but then you have to raise your hand and say, Hey, Let me help you on the lab side and work with the data and the contracting people because they don't understand what the lab is and the value that the lab might bring.

‍_{Stan Schofield}: So those are the things that you can do today and over the next year or two and make a difference. 

_{Suren Avunjian}: Bruce, please, 

_{Bruce Friedman}: Stan is getting closer to the patient. Is that gonna cause friction within the system with a clinician saying, that's our job? That's not the lab's job. 

_{Stan Schofield}: No. I don't mean like standing at the bedside, but the idea of having some of the things working with the chief medical officer and the medical director of, let's say, internal medicine around the example of would be the kidney markers that Khosrow, just talked about.

_{Stan Schofield}: Very easy. To get involved. And it doesn't mean you're gonna be sitting on the end of the bed with the patient waiting for the clinician. What you're gonna be doing is be proactive and pick up some of these markers and pick up these standards of care and help champion them and make sure that the lab is trained and that the lab information system (LIS) flag these things appropriately and bring the attention to the medical officers and the nursing officers of the systems, not just being left in the basement.

_{Stan Schofield}: And once in a while they remember the lab because of covid. You need to be a little more active in that. 

_{Suren Avunjian}: Dennis, you wanted to expand on that? 

^{Dennis Winsten}: Yeah I think, and this goes back a ways, one of the reasons the lab is often unappreciated overall with regard to a health system is basically the lab hasn’t needed a directional link to patient care.

^{Dennis Winsten}: That is the lab takes these tests, does the tests, gets the results, and they send those out. But the lab rarely finds out specifically the outcomes. So here's the cause, you've determined that you've sent out results to the clinicians. Theoretically they take actions and 70% of clinical decisions are based on lab data.

^{Dennis Winsten}: But rarely does the lab ever have any follow through that says, because we provided these results, going back to, Khosrow’s comments about preventing, for example, preventing having doing a dialysis lab. The labs don't get the feedback they need. I think to really be able to establish what benefits actually took place because of the data that the lab provided. It's unidirectional. They don't get that feedback that says, because you came up with these results, these good analyses, the patient was saved or the the length of stay was reduced or the morbidity was reduced, whatever. So the unidirectional nature of the lab, I think has been a problem for a long time.

_{Suren Avunjian}: That's true. Thoughts on that? 

^{Khosrow R. Shotorbani}: Maybe piggyback on what Stan just talked about.

^{Khosrow R. Shotorbani}: Getting out and having a seat with value-based care, we need to advance ourselves to a level that no health system should ever sign a value-based care contract without the labs input in. Often they already have the intelligence in their hand on the outreach, what we call, which we need to retire that phrase and that's that the intelligence should be fed whether the value-based care agreement is to be signed or not. That to me is the most sacred ground that we have got to be in. Number two, I do agree with this, Stan, and regarding the question that Bruce just talked about, I honestly do not see a friction between clinical lab pathology and physicians.

^{Khosrow R. Shotorbani}: Not to mention, especially with primary care lab, is a catalyst to unleash the values of the population held, but it puts the primary care on top of its game, especially now that we're into the telehealth. To me, that's just another reactive mechanism. If we don't put intelligence around it, it's just instead of going to bricks and mortar, you're now zoom calling.

^{Khosrow R. Shotorbani}: If you don't put that environment with this value on the slide we're talking about putting the focus of the physician where to focus and where not to focus. We're gonna put them on top of their game, and the last piece, in my opinion, we need to start talking about just a test and start talking about the change in a test, which is basically that longitudinal data even within the normal range.

^{Khosrow R. Shotorbani}: It really is no longer about a test and we may not get paid for a test in the future anyway. I think we need to embrace the longitudinal view as the holy grail of laboratory medicine.

_{Suren Avunjian}: Bruce, would you add some closing? 

_{Bruce Friedman}: Yeah, I'd like to just slightly extend the remarks about longitudinal database and earlier diagnosis of chronic kidney disease. The logical extension of that is the diagnosis of pre-disease, probably on a community basis. And we're not gonna see that for a decade or more, but what that means is that a lot of our drugs will have to be retested for pre-disease as opposed to clinically manifest disease.

_{Bruce Friedman}: And that's gonna really turn healthcare on ts on its axis. 

_{Suren Avunjian}: What a fascinating discussion. If there aren't any questions, we're getting close to the top of the hour. I wanna make sure we're respecting everyone's time. So yeah, we reached the conclusion of our enlightening round table and discussing the future of clinical laboratories. 

_{Suren Avunjian}: We'd love your feedback on future topics of webinars as well, and I'd like to take a moment to express my deepest gratitude to our esteemed speakers and our attendees for your invaluable contribution and active participation.

_{Suren Avunjian}: Thank you all. We are really looking forward to learning more on how we can help the greater community and the industry with topics that will drive more value, and we're truly fortunate to have this opportunity to learn from you and the wisdom that this roundtable brings to our attendees.

_{Suren Avunjian}: Thank you again for your curiosity and diverse perspectives you brought to this conversation. Your questions and comments foster the stimulating and dynamic exchange of ideas, and as we move forward let us continue to collaborate and innovate harnessing the potential of technology, AI, and personalized medicine to shape the future of clinical laboratories and ultimately improve patient outcomes.

_{Suren Avunjian}: The insights and the connections we've gained through this roundtable will undoubtedly be the contribution to our collective efforts in achieving this goal. But once again, thank you all for being part of this insightful roundtable. We hope to see you at the future events and wish you the best in your endeavors to advance the field of clinical laboratory industry.

‍

_{Suren Avunjian}: Hope everyone is having a good startof the week. And this is the start of a new webinar series. We're looking forward to putting together for everyone inthe industry. We'll have two types, one that discusses how technology can helpimprove the overall workloads, workflow, the industry, and then other ones thatare very industry specific.

_{Suren Avunjian}: We will be inviting industry guests tocover burning topics for the industry. So we're really excited to startbringing this series of webinars to you and also we'll have this recorded andwe'll share it with all the attendees.

_{Suren Avunjian}: Feel free to share it with yourcolleagues as well.

^{Michael Kalinowski}: Our hope, as Suren mentioned, is to makethis interactive. So hearing from you, hearing your opinion of what you see isvery important to us and for the group attending here.

_{Suren Avunjian}: Throughout the presentation, feel freeto submit some questions that you would like answered. We'll also have a pollthat'll capture some of the questions we wanted to get a better feel for, aswell as we'd love to get some topics that you would like us to cover in futurewebinars.

_{Suren Avunjian}: So with that, lets get started. We'lltry to keep these as brief as possible so that you can get on with your day.

^{Michael Kalinowski}: Yeah, we'll get to the meat of theagenda here sooner than later, so welcome good afternoon and Good morning,depending upon where you might be joining us.

^{Michael Kalinowski}: My name is Michael, and I am going toset the table here off before we get to the experts.

^{Michael Kalinowski}: Suren is CEO and co-founder of LigoLab Information Systems, and then Petros, our Client Success Director, is heavilyinvolved in implementations and has been with the company for 10-plus years.

^{Michael Kalinowski}: All right. So let's take a look at theagenda real quick. As Suren mentioned, we do have poll questions and we'd liketo hear from you during the course of this webinar. First we are going toestablish the problem although if you're in pathology, if you're in thelaboratory business, these problems shouldn't be a shock to you.

^{Michael Kalinowski}:We'll have Suren's remarks, a LIS software demonstration led by Petros, andthen a chance for an interactive Q&A with both Suren and Petros after the LIS softwaredemonstration.And we'll close it out with key takeaways that we hope you gain from attendingthis webinar, and of course share that with your colleagues after the fact.

^{Michael Kalinowski}: So let's start by addressing the problemof pathologist burnout and the lack of qualified medical technologists. Thoseare two serious interrelated issues that all pathology labs are facing daily.And so the first question is, how did we get here? Well, if you're apathologist, chances are you have felt burnout at some point during yourcareer.

^{Michael Kalinowski}: In fact, there's a really good chanceyou might be experiencing it today. That's according to a recent poll conductedby the American Society of Clinical Pathology. Pathologists remain, as we allknow, the unsung heroes of our healthcare industry. They play a prominent rolein diagnosing diseases and determining the best course of treatment while, inrelative terms, only accounting for a tiny portion of what's spent onhealthcare annually.

^{Michael Kalinowski}: Now, this important role is even moremagnified today as pathologists deal with work-related stress caused by severalfactors, and that includes rising caseloads, increasing supply costs, shrinkingbudgets, and a lack of qualified support staff and staff turnover. All this inaddition to the constant pressure that they feel to deliver accurate caseresults and short turnaround times.

^{Michael Kalinowski}: Simply stated, burnout can have severeconsequences for the pathologist, his or her practice, and the patients as itraises the likelihood of a mistake leading to an inaccurate diagnosis ortreatment.

^{Michael Kalinowski}: So what can be done to beat burnout andstaffing issues? Well, one primary way to relieve the stress on pathologistsand their practices is by automating routine tasks with the help of a modernlaboratory information system (LIS), one that can serve as the central hub forall laboratory information and increase lab throughput without the hiring ofadditional support staff.

^{Michael Kalinowski}: Modern LIS systems are rule-based. They enablepathologists and lab technologists to build simple to complex rules and actionsto replace inefficient and mistake prone human intervention with automationspecifically for the pathologist.

^{Michael Kalinowski}: This level of automation and userexperience allows for the entering of a result and the releasing of a casewithout a single mouse click, something that we will demonstrate to you in justa little bit. A modern LIS  is a valuabletool that pathology groups can leverage to automate routine tasks and lessenthe potential for burnout related job stress, and a lack of qualified supportpersonnel.

^{Michael Kalinowski}: During our upcoming LIS software demonstration,we'll show you how this modern lab information system can eliminate bothrepetitive and redundant steps and provide comprehensive LIS solutions enablingthe pathologist and the technologist to focus on what they do best, diagnosingdiseases and improving patient outcomes.

^{Michael Kalinowski}: So now with that, let's hear from Suren,co-founder and CEO of ligoLab Iinformation Systems to get his view on theseimportant issues and where pathology practices can turn for help.

_{Suren Avunjian}: Thank you very much Michael and forall the attendees. We're very excited to bring you this series of monthlywebinars to discuss how implementing modern technologies can help scale yourorganization efficiently and drive staff satisfaction to lower turnover rates.

_{Suren Avunjian}: With over a thousand job openings onthe market, only 500 are entering the workforce each year. Practicingpathologists are overburdened with case volumes, and the burnout rate is amongthe highest in the medical field. More than 35 percent of pathologists havereported burnout. By simplifying pathologists' daily work as much as possibleby adding automation to remove redundant steps and clicks that are performedhundreds of times a day, a modern LIS can significantly impact productivity andmore importantly, job satisfaction. So pathologist burnout is a multifacetedissue that requires a comprehensive approach to address effectively potentialsolutions for the pathologist.

_{Suren Avunjian}: Burnout can include increasedawareness of burnout symptoms and risks within the pathology community.Encourage open dialogue of this issue. Implement strategies to balance theworkloads, and create a more sustainable work environment. This may includeredistribution of tasks, equitable case distribution, and integratingautomation and digital technologies to streamline workflows and reducerepetitive tasks.

_{Suren Avunjian}: Offer flexible work hours and remotework options by implementation of digital pathology to accommodate individualneeds and preferences. Promote healthy work-life balance by encouragingreasonable work hours, time off, and vacations. Ensure that staff members areable to take breaks and time off without feeling guilty or overwhelmed uponreturn.

_{Suren Avunjian}: Foster a supportive, inclusive, andcollaborative work culture. Encourage teamwork, open communication and peersupport. Provide opportunities for professional development and growth. Conductregular assessments to monitor the wellbeing of pathologists and staff toidentify early signs of burnout, and encourage feedback and implement necessarychanges to improve the work environment.

_{Suren Avunjian}: Recognize and reward hard work anddedication, acknowledge achievement, and provide opportunities for advancementin career growth. Implement technologies that provide a positive feedback loop.Regularly review and update your policies and practices to address the evolvingneeds of pathologists and adapt to the changes in the field.

_{Suren Avunjian}: Modernize laboratory technology to remove asmany unnecessary clicks and redundant steps in the daily workflow to improvejob satisfaction. Addressing pathologists burnout requires a combination ofthese strategies, tailored to the specific needs and circumstances of theindividuals and the organizations involved.

_{Suren Avunjian}: By taking aproactive approach, we can reduce burnout rates and improve overall jobsatisfaction and the wellbeing in the pathology field. At LigoLab, we'verecently hired top UI and UX researchers and designers to continue ourcommitment to improve the product and the industry. We're currently conductingextensive user research with dozens of pathologists within our client advisorygroup and laboratory staff to take the solution to the next level by Q4 of thisyear.

_{Suren Avunjian}: Our goal is to improve the LIS userinterface further and reduce the cognitive load on the user base. In today'sdemo, we will review some automation strategies available out of the box tocombat staff shortage and burnout.

_{Suren Avunjian}: Please take it away. Petros.

_{Petros Martirosian}: Hello everyone. Thank you forjoining our demo. Today, we're going to take a look at some examples on how tosign out some basic cases using step-by-step instructions. These examples willinclude how to sign out a case with a camera, how to sign out a case without acamera, how to sign out using a diagnosis template, and finally, how to signout a case using the pathology software.

_{Petros Martirosian}: Right now we're looking at a cleanscreen. So let's go ahead and launch the software.

_{Petros Martirosian}: So right off the bat, you'll noticethat after launching the LIS software and logging in, it takes me directly tothe pathologist queue. And it's actually filtering all of the cases by thecurrent user. So let's say for example, if Suren logged in then it could be setto see only his cases. Also worthy to note that regardless of what type of useryou are, if you're a pathologist or grossing tech, the laboratory software canalso be configured to take you directly to your default screen, saving you acouple of clicks right from the get go.

_{Petros Martirosian}: All right, so let's dive right in.As you can see, I've already prepared some slides here for our test cases. Thevery first example we're going to take a look at is going to be the quickest ofthem all which is signing out a case with a template. Please pay attention tothe number of clicks and steps it'll take for me to actually release this case.

_{Petros Martirosian}: I'm gonna grab my first slide. I'mgonna scan it into the barcode scanner.

_{Petros Martirosian}: Once the case comes up, the firstthing you'll notice is that the cursor is automatically in the final diagnosisfield. So here I can type in the shorthand for my macro, which in this case isa DMD X one. And as soon as I hit space, this template automatically populatesa microscopic description for the site.

_{Petros Martirosian}: The final diagnosis, it inserts acomment and adds the CPT and ICD 10 codes for this case. You'll also noticethat all of that information automatically populated on the report, in theprevious section on the right hand side here. So now we can just simply clickon release. After you click release, you'll get this pre-release checklistwindow that pops up, which is a last minute heads up display of all relevantinformation such as missing or incomplete interoperative consultations orcorrelations.

_{Petros Martirosian}: The LIS system prompts you and reminds you tocomplete them. An important thing to mention is that the pre-release checklistis an optional window, and it can be turned off based on the user's preference.So after this, you simply click, okay.

_{Petros Martirosian}: The results get released and you'rebackn in your default queue with a list of all your cases. As you can see, thatwas pretty quick. Now let's move on to cases with the usage of a microscope camera and one without. So again, I'm going to select my second case here. I'mgonna scan my slide. And at this point, if you want to capture an imagedirectly from the camera what you would need to do is click on this littlecamera icon on the right hand side.

_{Petros Martirosian}: It'll bring up whatever yourmicroscope camera is showing you. We'll make some adjustments on the microscopehere. And once you're ready to capture, click on this little camera icon again,and it will automatically add the image to the case. And you can add a quickdescription here. So slide image one and click save.

_{Petros Martirosian}: Once we've added the image again,we can go ahead and type in our final diagnosis. Again, I'll do DMD X one andas stated before, all of the information such as microscopic description, finaldiagnosis, report, comment, and the ICD 10 codes have automatically populated.So at this point we're ready to release. We get our pre-release checklist,we'll click okay. And the case is signed out.

_{Petros Martirosian}: Alright, for our next case, we'lldo almost the same thing but this time, instead of using the microscope camerato attach an image we're going to select an actual image file. Let's saysomething that was captured by an external source and sent out to you. So let'sgo ahead and pick our third case here.

_{Petros Martirosian}: Again, I'm going to scan using mybarcode scanner. But this time around, instead of clicking on the camera icon,we're going go ahead on this little folder icon to the left of it. When youclick on this, it opens up an explorer window that lets you navigate your localworkstation's folders and pick the specific image file that you received fromthat external source.

_{Petros Martirosian}: I'll just go ahead and pick one ofthese examples here. I'll give it a quick description, save, and again, you seeit automatically shows up on the report. For the final diagnosis this timearound, I'm going to show you how to navigate the list of templates in case youmight have forgotten the relevant code for it. To do this, we're going to clickon the final diagnosis template dropdown.

_{Petros Martirosian}: Here you see we have a plethora ofdifferent templates that have been configured. You can navigate this list tofind the exact code for your template and double click to apply it, or if youfeel like it, you could just simply shorthand the final diagnosis code, haveall of the relevant information, populate quickly and click on release. You getthe pre-release checklist. Verify that all of the information is correct andhit okay.

_{Petros Martirosian}: And again, the case is now signedout.

_{Petros Martirosian}: For the very last case, we'll takea look at how to sign out a case using only dictation software. So we're notgonna use our hands for the keyboard and mouse, instead using only our voice tonavigate throughout the information system software and sign out theentire case.

_{Petros Martirosian}: So I'm gonna pick up this lastslide here. I'm gonna scan it. I'll go ahead and enable the dictation softwareto start recording. Reactive lymphoid hyperplasia with acute and chronicinflammation consistent with tonsillitis.

_{Petros Martirosian}: Open capture. Capture image. Saveimage. Release report.

_{Petros Martirosian}: And that concludes part one of ourdemo on how to sign out basic cases. We look forward to seeing you in part two,where we'll take a closer look at more complicated cases and how to sign themout.

^{Michael Kalinowski}: Okay. So that was very well done Petros.Very much appreciated. Now we can open things up to questions from theaudience. We want to get your reaction as to what you've seen. Also a reminderthat we do have polls. If you go to the poll option at the bottom of yourscreen here in Zoom you can weigh in on the poll questions that we have puttogether as well.

_{Suren Avunjian}: We have a few questions that have comein.

_{Suren Avunjian}: What voice recognition software areyou using?

_{Suren Avunjian}: Petros, if you could talk a little bitabout the different voice recognition systems.

_{Petros Martirosian}: Sure, of course. So we supportpretty much all of the different vendors that are out there.

_{Petros Martirosian}: The specific software vendor thatwas used in this particular demo is called Fusion Narrate. Like I said, whileall of the other platforms out there are pretty workable, there's a couple ofkey features in there, and these are fairly new features that make the entireexperience a little bit more seamless.

_{Petros Martirosian}: So the the short answer to that isthe solution in the demo is called Fusion Narrate. We do have a goodpartnership with them, so if you're interested in seeing a demo we candefinitely put you in touch with the correct resources so they can get you ademo account. You can start playing around in their system.

_{Suren Avunjian}: Great, thank you, Petros. Yep. Anyvoice dictation system that Petros mentioned can be configured to fully not onlybe able to use speech to text into the platform, but you can also use it tocontrol and navigate through the LIS system and our team has all of theprebuilt scripts to help you get that going fairly quickly.

_{Suren Avunjian}: Michael, do we have some morequestions?

^{Michael Kalinowski}: Yeah. Here's one. Do I have to go backto my queue every time I want to open a new case?

_{Petros Martirosian}: So the answer to that question ispretty straightforward. There is functionality available that lets you set itto a mode so that as soon as you're done releasing the current case, it willautomatically open up the case right after it that's in the queue.

_{Petros Martirosian}: That's one of the modes. There's asilent, open next, which means there's no interaction or any prompts. But also,if you want to take a short little lunch break, there's another mode that saysas soon as you release a case, it'll prompt you saying, Hey, do you wanna openup the next case?

_{Petros Martirosian}: So, a couple of different ways ofdoing it. And, you know, we're always open to suggestions and feedback of howthese options are working out for you. Or if you can provide feedback as to newconceptual ideas that you would want the software to feature, we always haveour ears open to that.

_{Suren Avunjian}: Everything in LigoLab isa real time queue, so even when the laboratory system goes back to the queues,it automatically refreshes. And if there is anything sitting in that queue,that means there's some work to do. So we promote working and in real time,meaning you grab the slide in front of you and there's a scanner, so that wayyou cannot mix up and open up the wrong case. Instead the LIS system opens thecase for you.

_{Suren Avunjian}: We really recommend using the slidemode and if there is digital pathology integrated, we can have contextualintegration where it's opening up the actual whole slide image on the side,you're able to capture field of views, and those automatically populate intothe case as well as the analysis with the future AI tools. So we're reallyexcited about this level of modernization of the LIS platform.

^{Michael Kalinowski}: Here's a good question, one that oftencomes up in software demonstrations. Can I make edits directly on the reportpreview?

_{Petros Martirosian}: So the way the LIS is designed isto make it more error proof. The entire layout and structure of the reporttemplate is pre-configured so that you don't have to worry about, Hey, how canI adjust or tweak this text to take a certain amount of space? We don't wantour users to have to waste time creating tables, dragging where the columnstarts or where it ends. So we basically create the shell in all of thespecific areas where the content should go into, so that the end user, all theyhave to worry about is just plugging in the content as you saw from thedemonstration.

_{Petros Martirosian}: We give you a quick preview of whatthe report looks like even before you enter your diagnosis information,microscopic descriptions, or even comments. But you see in real time, as soonas you start adding all these values in their discrete fields, the LIS systemis smart enough in real time to just update the report so there's really noneed to make adjustments directly on.

_{Petros Martirosian}: I would say we have a hundredpercent success rate on the feedback that we've gotten, especially from some ofthe clients that we're using legacy sort of methods such as using MicrosoftWord to build their reports.

_{Petros Martirosian}: They're like, the difference isnight and day. So the feedback is always a hundred percent positive when usingthis approach.

_{Suren Avunjian}: Yeah. Everything in LigoLab is templatized, so we're able to support based on customer preferences different types of layouts, different formats, graphics, and so on.

_{Suren Avunjian}: And the system is able to basicallycustomize that per customer so no one has to worry about it. Pathologists don'thave to go fiddle with scaling images. The LIS does all these functionsautomatically, and the pathologist always has just one place to enter theresults in their own format and it's the job of the LIS platform to handle allthe richness and the personalization of that report.

^{Michael Kalinowski}: Another one. How sensitive is the voicerecognition software? Will it pick up every voice in the room? We have a fewpeople in somewhat close quarters. This person is describing their workenvironment.

_{Petros Martirosian}: Sure that's an excellent question.So the answer to this is kind of twofold.

_{Petros Martirosian}: Number one, each voice dictationsoftware comes with a little gauge, a setting that you can adjust whether ornot you want it to be super sensitive. Or, to be a little more rigid with whatit picks up. That's on the front. One of the more recent implementations wedid, we were actually in an environment where the histology department, wherethe grossers were actually part of the hospital system and they had a lot ofventilation that was creating background noise.

_{Petros Martirosian}: And the second approach to that, inconjunction with the adjusting of the setting in the dictation software isthere is a handful of different third party software vendors that control voiceisolation. and these were perfectly in conjunction with the dictation softwarewhere you get near perfect results.

_{Petros Martirosian}: As far as noise cancellation, thesolutions that are out there in the market right now work near perfectly. Sothat's a non-issue basically.

_{Suren Avunjian}: Great. I would love to get somefeedback on what kind of workflows you would like to see. We have the LISavailable. We could show any kind of workflows that you would like, or also ifthere's any future webinar topics you would like us to prepare, we would lovethat feedback as well.

_{Suren Avunjian}: We do have another question. If thereis time at the end of the presentation, could you demonstrate more featuresavailable with voice dictation, specifically navigating through differentwindows and or tabs?

_{Petros Martirosian}: Unfortunately we weren't preparedfor a voice dictation demo but it sounds like this might be a very specifictopic that we can base a webinar on.

_{Petros Martirosian}: I would love to have everythingready and like I said, we can demonstrate. And, you know, I'll tie my handsbehind my back just to make it a case in point that you can literally navigatethrough every single piece of the LIS software, whether it's accessioning,grossing, pathologists, sign out send outs.

_{Petros Martirosian}: I think it's a great, great ideafor next webinar to be voice dictation-centric. Excellent suggestion.

_{Suren Avunjian}: And I've shared the video that Petroshad put together for this demo that you're welcome to share with yourcolleagues, and we'll also share this entire webinar with all the Q&A aswell.

_{Suren Avunjian}: So feel free to see the link in thechat that was just posted. That's just a 10 minute clip.

_{Suren Avunjian}: So we're coming to the top of the 30minutes we had scheduled for this demonstration. Are there any last minutequestions?

_{Suren Avunjian}: Michael?

^{Michael Kalinowski}: I'll just throw it out there. The topicof pathologist burnout and also staffing shortages. We worked with Dr. JamesCrawford recently who really spelled out some of the issues on staffing inparticular, and I have shared that document in the webinar chat as well. So youhave the video form of the demonstration that Petros showed us earlier that youcan grab and share with colleagues, and of course you can also take this URLthat I just put up there that goes into detail on why we have a medicallaboratory technologist shortage.

_{Suren Avunjian}: Great. Thank you for that, Michael.

_{Suren Avunjian}: Thank you all for attending. This hasbeen wonderful and we look forward to to many more of these. Have a fantasticrest of the day. And Michael, actually, if you could go through the takeaways,that'd be great.

^{Michael Kalinowski}: Sure. So we were hoping that thoseattending leave this webinar understanding the impacts of pathologist burnoutand staffing shortages. They're widespread. I think there's no argument there.We believe modern LIS software and automation canstreamline and improve overall laboratory performance. Hopefully you agreeafter what you saw during the course of these 30 minutes.

^{Michael Kalinowski}: An efficient user interface can reallyincrease productivity for pathologists. Petros demonstrated that it is in factpossible to result and release a case without a single mouse click. And again,a viable long-term solution to what's causing the stress is within reach, andthat would be working with your laboratory information system partner.

^{Michael Kalinowski}: We really feel strongly aboutpartnership and really like hearing what those who use our LIS system want andneed to have that LIS work even better for them.

_{Suren Avunjian}: Today we covered a very small sliverof LIS workflow. We have really modeled the reality of the laboratory and the LIS platform to cover every life cycle andevery role, and we've put in this level of care as Petros demonstrated just ona few of the different use cases for the pathologist to every operator of theLIS platform. Our goal is to support and positively transform your operation.

_{Suren Avunjian}: Thank you everyone. Thank you verymuch. Have a great day.