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Webinars

Utilizing Digital Pathology to Help Offset Today’s Laboratory Challenges

It’s no secret that the business of pathology continues to experience extreme challenges. From inflation and skyrocketing labor costs to record-setting caseloads and a serious shortage of qualified pathologists and medical laboratory technologists to handle all the cases, it’s clear that traditional anatomic pathology workflows are no longer sustainable.

Join Westley Bernhardt (Managing Partner, OnePath Diagnostics), and Suren Avunjian (CEO, LigoLab) for this on-demand webinar as they discuss how pathology groups across the country can merge modern LIS systems with the latest digital pathology technology to boost caseload capacity and reign in operating costs.

WATCH

Michael Kalinowski: Thank you for joining today's webinar. We appreciate you being here and we're also really excited about this topic because our goal with these webinars is to pick and talk about subjects that really interest laboratorians across the country, and this one certainly checks that box.

Utilizing digital pathology to help offset today's laboratory challenges. Suren Avunjian, CEO of LigoLab will be one of the hosts, along with Westley Bernhardt,  Managing Partner of OnePath Diagnostics.

Here is what we're planning to cover today. 

  • The importance of this collaboration between laboratory information systems and digital pathology solutions
  • The reasons behind OnePath's decision to move forward with this integration
  • How OnePath is using enhanced automation and AI to help with the workflow.

We also have Dr. Sheva Khalafbeigi with us. She will be doing a demonstration of a case sign-out a little bit later on, and we'll have a quick discussion about where we're headed as far as lab innovation. Then we'll also close things out with a question and answer session, so if you have questions, please just leave them during the presentation.

With that, I'll turn it over to Suren, who will take it from here. 

Suren Avunjian: Thank you so much Michael and our panelists and everyone who's joining us today. Let's explore the cutting-edge integration of LigoLab and Lumea and the partnership we've built with OnePath Diagnostics.

This has been a significant leap forward in the realm of digital pathology, so let’s start by reviewing the evolution of the revolution of digital pathology from microscopes to digital platforms. The journey is remarkable. It was not easy, smooth, or quick.

It did happen rather quickly with COVID serving as one of the catalysts and a lot of us having to work remotely, and then of course the easement of and advancements of regulatory changes really drove the adoption. Four years ago, around this time, one out of 20 laboratories that came to LigoLab would even bring up the topic of digital pathology.

This was true for the 14 years that we had been involved in digital pathology before that. Today, 19 out of 20 labs that come to us ask us about digital pathology. Not only to ask us about it but also to learn more about the best practices and recommendations of hardware and laboratory software vendors that we work with.

It's been a big change. We've lived through many different waves of digital pathology, and 14 years ago, we built the very first LIS system for digital pathology integration with a little company that was known as BioImagene.

This company four years later was acquired by Ventana and now Roche for over a hundred million dollars. We were the first LIS company to integrate with them. We saw the potential of digital pathology but back then, the industry was just grappling with other significant challenges.

The cost of whole slide imagers was quite expensive. There was a lack of standardization and tools and of course, it added an extra step in the anatomic pathology lab workflow. Who wants to spend money and add extra steps? There were also concerns over image quality and fidelity, and the cost of storing these images was also a factor. There was also a lot of resistance from traditionalists.

People were skeptical about the reliability and effectiveness of digital methods compared to conventional microscopy. So a lot has changed in these 10, 14 years. 

Now with imaging technology significantly improving and cloud storage and hosting costs dropping, it’s making things a bit more affordable, and now with AI tools potentially cutting turnaround times, this has become a tool to enhance laboratory operations. Of course, the regulatory approvals are also boosting the current adoption.

With AI and digital pathology together, they can stand at the forefront of laboratory technologies and what pathology groups are capable of doing. AI and machine learning are the latest buzz, right? We're hearing about it all day, every day, more and more, and we're even seeing some practical applications of it.

We can see that algorithms are analyzing images for patterns and better abnormality diagnostic markers with speed and accuracy that surpass human capabilities, so this has become a good supplementary tool for pathologists to improve their diagnostic process, helping pathologists identify classified diseases more quickly and accurately.

With this revolution of data interpretation, improving diagnostic speed and accuracy has become a reality. That impacts and improves patient care and it helps curtail the shortage of staff and pathologists, streamlines the overall process, and allows for remote participation and collaboration.

There's a lot of future potential here for continuous evolution into all aspects of the pathology lab workflow. This automation and digitalization transformation is the founding vision of why LigoLab was founded about 17 years ago, our vision was pretty clear to revolutionize the world of informatics, especially the laboratory.

This is our domain with a pioneering platform and service to embody the utmost flexibility and interoperability. This has been true since day one and it’s a core value of ours. Our mission is to help laboratories modernize with digital transformation so that they can scale and thrive faster.

We set out to create not just the solution but a transformational platform to seamlessly integrate all kinds of tools, products, and existing workflows, and help evolve the field. We do this by uniquely meeting all of the users and any organizational needs and modeling this in our system as closely as possible.

We view digital pathology and AI tools as innovative and disruptive technology, but not products. They are the tools and technologies that need to be seamlessly built into the lab workflow with informatics platforms to truly be full products that become usable. Nobody wants to log into multiple places and copy-paste things.

You want seamless integration, and this again is our ethos, right? We believe rigid laboratory information systems (LIS software) limit the efficiency of organizations and users. We want to empower users with a laboratory information system (LIS) platform that evolves with them as well. So not just made for yesterday and today, but for the future.

The LigoLab platform is designed to break down these barriers, the artificial barriers of growth and barriers of inefficiencies, facilitating streamlined communication and data exchange. This improves overall the industry, and the organization, and also significantly enhances patient care by ensuring that critical information is available and where it is needed the most. 

Now into our 17th year, we're serving 250-plus laboratories nationwide spanning pathology, clinical, and molecular diagnostics, empowering them with growth and maximizing automation for them to gain the competitive advantage they need in the marketplace today.

Ethos of partnership and growth through overcoming challenges leads us to the remarkable story of our collaboration with OnePath, also known as OPDX. 

So next, let’s introduce Wesley Bernhardt. We started our partnership less than a year ago. Wes is the driving force and a visionary behind OPDX. We’re excited to meet and work with folks like Wes because they help push our boundaries.

When Wes came to us, initially, I was quite hesitant with his vision and the level of depth of the integration that he wanted to make. So my first reaction, to be honest, was to push back, but he kept pushing forward with his vision.

That initial reaction turned into the collaborative effort that we see today. Kudos to Wes for his unwavering determination and the clarity of his purpose, right? That propelled us today to have this transformative endeavor, and a pivotal aspect of this collaboration was our integration and partnership with Lumea.

Both viewing and resulting capabilities have been truly embedded in the LigoLab platform. This is a one-of-a-kind integration so far and I hope this scales through to a lot more LIS systems (LIS meaning medical), not just LigoLab, but other lab information systems (LIS medical) so that we can help the overall industry work seamlessly, and have more of this open interoperability between digital pathology companies and laboratory information system vendors.

So with that, I’ll pass it off for Wes to tell us a little bit more about this integration and share his journey. 

Westley Bernhardt: Thanks, Suren. I appreciate it. And that was a very nice way to say I've been a royal pain in the butt.

I get it. I know a lot of people have said that before, but thank you so much. Your vision and your partnership are what helped us to get this to happen. I appreciate your support. It was finding great partners. That was really what we needed to make all this happen in a time when we see shortages in pathologists and shortages in histotechs.

The labs are really crunched. You've got an inflationary period where costs have gone up. But remember our reimbursements haven’t. We're still challenged by that same dollar that we have that we're going to make. Medicare is not going to pay us more.

Every year we see adjustments, sometimes in our favor, sometimes not. But typically, the numbers relatively stay the same. And we have to fight and work to keep our costs down as best we can and adjust to the times. That's what we looked at OPDX when we started this process, how do we solve the problem of a shortage of pathologists?

How do we do better as a company to deliver the best subspecialist pathologists to everyone that needs them, to the patient, to that diagnosis, so that treatment can happen quicker and better with more reliability? To do that, we saw the future with digital pathology. I was fortunate enough some 20 years ago to be part of the digital transformation in radiology.

You knew when they were able to scan at the right speed, get the cost of storage down, and be able to deliver something that could replace the microscope speed-wise and quality-wise that yes, it was going to move forward because of all the benefits of having a digitized slide.

We knew once we saw that it had reached that point, that we were here for this paradigm shift in what was going to happen in pathology. From there, we had to find the right partners.

Number one, you've got to have the ability for your doctors to read quickly. We do a lot of dermatopathology, and we do a lot of GI. These doctors read high capacity and they've got to be able to move as quickly as they do on a microscope. We were very fortunate to find a partner like Lumea. They have a quality digital pathology software system. The images are fantastic.

They're just like LigoLab. They have a great team that can help to customize and automate. I think that's what's important. This field is going to be changing so fast over the next few years. It's not just about what you have now and what you buy, but what are you going to change as things continue to develop?

With partners like LigoLab and Lumea, we've been able to meet those needs and develop a system that has been quite special for our team. Bringing that together, it's challenging because everybody is used to how they've done things in the past, and how we do things now is different.

It was crucial to number one, replace that scope, and also to have our doctors work specifically and only inside of the Lumea system (the digital software). We wanted to have a lab workflow where they go in, view their slides, diagnose their case, order recut specials, and do everything else they need to.

They can see the requisition, they can see the gross, they can see the slide labels and to make it simple for them, load their macros. That took some work, but it took work on both sides. It was that integration that was crucial because we wanted to automate ICD-10 and CPT codes as much as we could so that they could work from home because again, we're dealing with a specific and finite reimbursement.

We needed to create a better quality of life so that we could still work within the confines of what we have and what we can pay our physicians to be able to still make a profit and deliver great care. So that's what we did. We brought Lumea together with LigoLab. 

Everybody had differences and opinions on where we wanted to go, but eventually, it was, hey, the doctors work in Lumea and the staff works in a high throughput, and really good LIS system that allows us to automate a lot of what we do and really manage it along with interfacing and customization.

The beauty of the LigoLab system is that we can do anything on our own. We can build our interfaces. We can take advantage of the Mirth interface engine and manage those interfaces and more importantly, manage those costs. This goes back to the whole process and we're able to do that. I think that's really important. So we built that out.

We've been able to customize our pathology lab management and continue to customize it on a daily, weekly, and monthly basis. It's been fantastic, and it's all about the partnership.

It's all about finding the right people with vision and people who are flexible and can help us to continue to grow and change with what we see coming because it's going to be a crazy time over the next few years. There are going to be more LIS software vendors and more digital pathology solutions. It's going to get quicker. Storage is going to get cheaper.

Everything is going to change. Just like when cameras went to phones and technology went haywire so quickly. It's going to be similar in that respect. So everyone's going to have to pay attention to the process. I just stress to people out there, to make sure that when you work with your laboratory software vendors, you're working to get what you want, not what they want.

I think what's great about LigoLab as an LIS company is they listened to what we had to say and helped us to build what we wanted and integrate that. What we did and what this diagram shows is we built it out so that LigoLab is the face of what we do. That is our laboratory information system software (what is LIS in healthcare). So everything starts in LigoLab.

We have most of our orders come in through HL7, and we build our HL7s through the Mirth interface engine. Our team does that, so that saves us money and helps us get those projects done more quickly. Orders come in, and if it's not an HL7, then it's a manually accessioned order.

We've also used AI in some circumstances to accession. We built an AI bot that can accession the cases when they come in on a computer-generated requisition. So you've got manual accessioning by personnel as well as AI accessioning if they're manual orders, then you've got HL7 orders coming in, too. Once they come in, the gross is done and it's completed inside the LigoLab system (LIS medical).

It then goes through your typical histology processes. It's going to be processed, embedded, it's going to go to microtome, H& E staining, and then from staining, it's going right into the rack. You pull it out, it dries for a little while, and you load that same rack right into the scanner.

What we found is a lot of companies sell scanners, digital software, and so forth. For us, we bought one type of scanner. We bought a P 1000 3d HISTEC high capacity. It’s a great workhorse that works well for us. We have Lumea doing the digital pathology software and we have LigoLab as our medical LIS.

It's hard to do all of it and be great at it, so we went and looked for what we thought would be best for us, and that's what we settled on. It's worked very, very well. Once those things are scanned in, they move to our doctor inside the Lumea system.

That was an incredible integration where we had to pull together the slide label. Our team worked on that with LigoLab and Lumea to make sure that the label was printed out in LigoLab’s LIS system (lab pathology software), viewed and recognized in Lumea, and populated to the cases for our doctors to be able to read.

Once that does, it pops right up in Lumea, you've got dashboards, you've got access, and they go in and do when reading a case. They see the images, their macros are there, and they can diagnose the case, order recuts, specials, and immunos. It all flows right through.

The most important thing is we're not slowing them down. That was the key. If it slows the doctor down, they're going to be less likely to continue with the process that costs them money, time, and effort. We want to make it as fast as possible. As things continue to progress, it should only get faster.

That's how we built it. That's what we did. And our partners, Lumea and LigoLab have been fantastic. It's not that everybody has to know the answer when we start, but we're all willing to see the vision and strive to get there. I think that's what we did and what made it so special.

Suren Avunjian: I might add, or maybe suggest that you add some of the next phases of this lab workflow management and the technologies we're adding to OnePath on the grossing side and also the case distribution automation that LigoLab is also helping out with as well for pathology workloads.

Yeah, great points. It's really interesting to see how many places AI is going to be involved in the future. It's going to be everywhere. One of the unique places that we see it has huge benefits is in the gross examination. We just recently began a partnership with a company called Vistapath. Vistapath was started by a histotech. It is a camera that has AI that takes pictures of the gross examination.

When it takes a picture of that gross examination, it can measure that gross examination. So it doesn't eliminate the personnel being involved in the gross examination but assists tremendously with taking the pictures and populating everything into the laboratory information system (pathology software) before transferring it to the Lumea system.

Both the staff and the physician have access to the gross, but instead of a text description, we now have a picture and the AI has done the measurements for us. Really interesting stuff, and it only gets better as AI continues to learn

We're excited about this partnership with Vistapath. A very good company, and they're going to be a great partner. In addition to that, some of the other things that we're doing inside because it's tough in the lab business and we have shortages in pathologists, histotechs, and the costs have gone up.

There are a lot more labs demanding more of these techs, and so it's harder to find them. It's harder to find some who typically are qualified to do the type of work we need inside of a traditional pathology lab.

So you do get into a position where you have to start making some changes, not replacing personnel, but making them more efficient so they have assistance, and it's not reliant on labor hours to do it. So with our partner Sakura, we've brought in the Sakura (slide stainer) and we're currently working through the process with that. We think that has great potential. There's also some potential opportunity in automated microtomy. I think that the AI and the automation in grossing is a great start and embedding as well. We see that having a big place in the future.

Suren Avunjian: Thank you, Wes. I wanted to add also the functionality of taking into fact the insurance and specialty of a pathologist as customer preferences that could drive the workload and assignment of pathology. These examples of laboratory information systems’ functionality are going to help OnePath with this level of automation, so nobody has to sit there and think about and remember all these features and settings.

You can set up the different levels of importance, which also takes into consideration the availability of pathologists and their caseloads. So the LIS system software knows what kind of specimen is going to them, what is the weight of this specimen, and helps with load balancing for the daily and cumulative work of the pathologists.

Westley Bernhardt: That's exactly right. OnePath is a national company. We don't have any geographical limitations as to where we work. That's one of the beauties of digital pathology, even though there's a shortage in pathology, there is no reason that your patients and your clinicians can't get the best subspecialist care.

We can connect them using digital pathology, but it does have some restrictions, right? Just like you said, state licensure has to be there. Specialty has to be there. What's the type of specimen? What is their load? Who are they contracted with by the insurance companies? So all of these things are considerations. 

We need to understand how to automate that distribution because once again, if the computer can do it and they can automate how those cases are assigned that makes it much quicker, the process is better, and fewer errors. We're excited about that pathology reporting software feature and it's going to be very helpful to us. 

Suren Avunjian: One thing I want to highlight again about this integration is how contextual this integration is.

This is unique because it's not just an HL7 feed. You know, here's the results. Here's the report. No, it's a single sign-on LIS software solution (best LIS). There's full bidirectional capability with connectivity going back and forth as a slide is ordered in Lumea, it's automatically going into LigoLab’s pathology lab report software.

The histology department notifies them of these recuts that are needed and so on as they're handled, right? This goes back to the pathologist queue. They can see that these slides have been prepared. So, as the pathologist is building macros, LigoLab’s lab information system takes this data, generates the report, and handles the distribution of the report to the customers from whom it came.

This is what makes this integration unique and one of a kind, and we hope to inspire many more of these types of interoperabilities. 

Westley Bernhardt: I'm so glad that you mentioned that because I’m trying to create a better quality of life for my physicians too. There are a couple of aspects to this.

Number one, I don't want them to feel that they have to be rushing to a lab where they need their slides right now, and then they're driving home and they want to get their work done to spend time with their family and get back. It can be a long process and it needs to be there right then.

I don't want them to also feel like they've got to be in a cockpit with two screens and sitting in a facility where that's the only place they can read. I want them to feel like they can be mobile and they can do it anywhere. The beauty of what we do with our system is my doctors are reading it and reading it well on an iPad.

They can be totally mobile. Hypothetically, they can do it on an airplane as they’re flying or anywhere. Somebody calls you and a doctor says, take a look at this case. Your iPads with you. You're sitting and watching your child's game. You can pull up a case and say, Yes, I see that.

You can discuss things on the move, giving you more flexibility. Also, it changes the way the laboratory works. Instead of having to batch process and have everything ready at a certain time, you can randomly feed everything. A doctor reads a hundred slides, then decides he or she is going to go and work out or go to a parent-teacher conference. After that, they come back and more work continues to build for them as they go through the day and they work at their pace.

All our doctors are contractors. We have a very special relationship with them. They work at the capacity that they want with us. If they want to work with full loads, if they want to work to only a certain limit, going back to the way that LigoLab’s assignments work, it can meet those requirements.

This allows us to create a better quality of life for the doctors. I think that's really, really crucial.

Suren Avunjian: Should we see how it works off of an iPad? 

Westley Bernhardt: I think that's great. Let's let Dr. Khalafbeigi show that off. 

Sheva Khalafbeigi: Great. It's nice to see or meet everybody watching this webinar.

My name is Dr. Khalafbeigi. I'm a contractor at OPDX. I've known Wes Bernhardt for quite some time. He is one of the most knowledgeable people in the field of laboratory medicine. I've just been so grateful to be a part of this process and the partnership we have with LigoLab (LIS software vendors) and Lumea.

I've been really happy with both LigoLab (LIS system vendors) and Lumea for numerous reasons. I think one, we discussed the flexibility and the understanding of the pathologist's needs, you know, whenever I have said, “Hey, you know, it'd be nice to have this,” they're like, “Yep, we got it. We're working on it for you.”

That's something that I love because it helps make my job much easier. The other thing I did want to add was that going digital, as Suren mentioned, was inevitable to happen and I'm glad that we as a collaborative effort between these companies, are at the forefront of that and it's changed our quality of life. Many of us pathologists have moved around so much for medical school, residency, fellowship, and maybe our first or second job.

It's been difficult to put roots down. This has really opened up endless possibilities as far as being able to sign out from literally anywhere. 

Ok, let me show you guys how I sign out. I'm going to show you a test case.

This is literally from my iPad, and so here we go. Let me share my screen.

All right. So can you guys see my screen? Yes. Okay, excellent. So this is a test case, we have Wesley Bernhardt here. So let's see what Wes has got. 

Westley Bernhardt: And I'm not that old. So, you know.

How I would start my day. I would go under this dashboard section. These are just two different ways that the cases are listed, but for simplicity purposes, we're just going to pull up Wes's test case here. So, the way I begin is I will click on this yellow plus sign, and right here it talks about the morphology and the clinical differential.

Then here we have our gross description. Now when we're gonna use the camera with Vistapath, the photo will pre-populate here, and I will be able to see a picture of the gross specimen, which is great. Down here you would typically click on documents and there would be the requisition form that I would be able to see.

But because this is a test case, we don't have that. So let's go back here. So in this area here, this is where you would have your slides. So we saw in the gross that it said it was completely submitted in two pieces, so one cassette. So we're only gonna have one slide. I'm going to click on that. So you see, it says one H and E.

So now we're going to pull up the slide. You may have to refresh this. Give me one second. Cause I was logged in for a while. So give me one second while I log back in. 

I have not had any problems as far as internet connection goes or anything like that. As long as you have wifi you can sign into the platform. 

Westley Bernhardt: Even on 5G, right? When you're doing it, if you're mobile, you get some vision power to be able to see it and move and work with it, too, right?

Sheva Khalafbeigi: Yes, exactly. Even on 5G. It's wonderful. And you can see here how quickly it pulled up the slide. So I'm using my fingers to move this slide around and I already know this is going to be an intradermal nevus. I don't want to bore anyone with the reasons why it's an intradermal nevus, but that's what it is.

You can see here at low power all three pieces of your tissue which is nice, and it's bisected like we saw in the gross description so I already know this is intradermal Nevus. So I'm gonna go up here to this triangle and I'm gonna click on it and I'm gonna put my macro for intradermal Nevus, which is IDN.

You can see all of the macros that come up that have IDN as part of their macro. I'm only going to use this one, so I'm gonna click on that. And it's going to populate intradermal nevus. Give it a second.

In a case, if your client wants a photograph, you can do that. You would just go up here and click the camera button and it would save that. If there was a case where you wanted to make an annotation, you click on the pencil and I'm just drawing with my fingers what this is, and I would press save.

If I wanted to show this to a colleague of mine, I would say, “Hey, look at the area I circled. What do you think that is?” So it makes it a lot easier. So now I'm going to go to my report and I'm going to see what the report looks like. The report preview. You see I have the final diagnosis, intradermal nevus.

Everything looks good to me, so I will click this button here, generate and approve the report. So there we go. Now the case is gone. It's signed out. If you want to see again what it looks like signed out, you can just click report preview.

And that's pretty much it. That's how I do it. It's very straightforward. If let's say I wanted to order stains on this case, I would click on slide orders and I would click on the block. We only have one block here, but you would just click the drop down and you can scroll through and see whichever one you want to pick.

Let's say I wanna get another level, I would click on that and I would click add a slide. And that would tell the lab, “Hey, I ordered a level on this case,” and it would go through. We don't need to worry about laboratory billing (lab revenue cycle management or RCM process) because that's already pre-populated according to the diagnosis. And that's pretty much it.

That's what I do daily. It's very easy to use. Very user-friendly. The images are very crisp and clear. Being able to move the image around is very easy to do. I don't feel like I'm wasting a lot of time trying to move the image around. And you know, when you're doing a lot of these, you want to be able to do a great job, do a quality job for your patient and your clients, but you also want to be able to work efficiently. And this does that very, very well. 

Westley Bernhardt: Great. Thank you, doc. That was awesome. 

Suren Avunjian: Yeah, I really appreciate it. I hope it was enlightening for everyone. We're getting some questions, so please start sending over some questions.

We're going to get to that shortly, but before that, I want to get some final thoughts from Wes and see where, where we could go with this. 

Westley Bernhardt: Well I think it's an interesting innovation. The next few years are going to be really intense and crazy, and there's going to be a lot of people to come to the market, both on scanners, on digital pathology, on AI, and you're going to see advancements. Things are going to move quickly.

I just recommend that people really know what they are buying when they buy a system. A lot of times you say, “All right, I'm buying it. I'm putting it away.” I constantly make sure I understand what the market has out there because you never know what is going on. You never know who's going to get bought and what's going to change.

When it's moving this quickly, you want to keep yourself in the know. So I think that's important. The other thing, too, is I think the automation is going to continue. We're in a really tough business. We've got market challenges with third-party payers. Nobody wants to pay us for what we do.

If they do pay, they think that Quest and LabCorp are sufficient and they don't need any other options, so we're always fighting that battle. I feel that pain out there. I just think that we should all work together. I'm always available to talk to anyone. We as a partner out there help other labs to dip their toes in the water and understand how this stuff works and even take steps to get digital pathology without having to buy everything with it.

We also help with the staffing of doctors. So those are all areas that we reach out to do different things than we did as a traditional lab before. It is so tough out there and we can feel everyone's pain. So, we want to meet these challenges the best we can and we know how important it is to have as many laboratories out there as possible providing services. There's not enough and we need more.

Suren Avunjian: Great. Today we got a chance to see the fruits of our labor, and the journey to this point is marked by concerted efforts and shared dedication to pushing the envelope. And as Wes mentioned, these cycles are going to start getting quicker and shorter so we have to be able to keep innovating and choosing the right partnerships and the right LIS lab software that will be committed to pioneering these frontiers of digital pathology and overall lab automation and improvement of patient care as we see it. 

Thank you so much for the time today, and the demonstration from our distinguished pathologist. I would now like to open it up to some questions.

Michael, if you could guide us through some of the questions that have come in?

Michael Kalinowski: I certainly can. We have a few that have come in so far. If anyone would like to join the discussion with a particular question, just use the Zoom feature at the bottom of your screen.

The first question is how can labs leverage these technologies that have been discussed during this presentation without major capital investment.

Westley Bernhardt: So it's interesting that you bring that up. When we started our new company, we dove in with both feet. We made that investment. But for a lot of people, they can be apprehensive. 

How do I get into all this without spending an arm and a leg? And it can cost a lot. There are opportunities out there and this is something that we do. We allow people to rent our software and scanners and so forth so they can dip their toe in the water before they jump in with both feet.

So there are ways to try things out and test them before you have to buy so that you know you're making the right decision. I highly recommend that those of you who know you're going digital so be it. We're happy to talk to you if you ever need any advice, but there are ways to rent before you buy and if you're interested in that, please don't hesitate to reach out.

Michael Kalinowski: All right next question is how do you apply these technologies in real life? And what differences have you seen?

Westley Bernhardt: Well for us, we do it every day with every one of my doctors. They never read digitally before we started and they are all reading digitally now. And I can tell you, they don't want to go back. First, you have to get the confidence. I expected that when we started this process, I was going to be sending somewhere between 25 and 50 percent of my slides for review after they read the digital image.

But I didn't have any. I never got a request for a slide except when they had to optimize the slide. That was it. So it's totally different. Bringing your pathologists into the fold, letting them test it, and letting them be part of the decision-making process is important. So they're buying into it, and once they do that, and if everyone gives it a proper opportunity, it becomes a much easier solution. 

Sheva Khalafbeigi: As you can see from the demonstration, the images are much more crisp, and clear. Ergonomically, your neck is also not in a strained position for several hours throughout the day.

You're not staring into something where you just have bright light going into your eyes, literally. That makes a big difference in your overall well-being. I truly believe that. And you know, one of the things that I love about Wes is he respects my opinion and the opinions of our pathologists.

He's open to suggestions and changes, and that helps us implement these things, in real time and real life. So I think that's been a great experience so far. 

Michael Kalinowski: I think this is a pretty good related question for both Wes and Sheva. Does the innovation in OnePath make your business more attractive for pathologists?

Westley Bernhardt: I'll let Dr. Khalafbeigi respond in a second. I'll just tell you from my perspective, I get great feedback from our doctors. If you think about it, I had to hire a lot of doctors at Aurora Diagnostics and there aren't a ton of labs all over, so when you're looking for a lab job. 

You know, like I mentioned, what's your quality of life as a doctor? How many times have you had a pathologist who's got a family at home? He's living where you are and his family's back in another state because he's got kids in high school. He doesn't want to move them or she's got kids in high school or whatever it may be. They don't want to uproot their family and change all of this so that they can move for their job. 

This changes what we do. How many times have you hired a pathologist?

They come over, you don't like their reads, the clinician doesn't like the reads, and you realize you bought something you don't exactly want. This makes it a lot more flexible, it makes it easier. With fewer headhunter fees, you get what you want, and it's easier to exchange something if it's not exactly right and doesn't meet the needs of your clients and your practice.

It gives some flexibility, and it gives these doctors back their lives. I think that's really important because if you've got a doctor who's happy and lives a good life, they're going to make better and more diagnoses for you. 

Sheva Khalafbeigi: Yeah, I have to agree with Wes on all of his points. You know, we are all humans.

We all have feelings and lives outside work. We have responsibilities, whether it's kids, a sick parent, dare I say pets, we all have things that are near and dear to us. And it's been hard to have to uproot several times. I mean, I, I've personally had to move close to five or six times.

I don't want to do that anymore. I want to live where I want to live. And I want to be close to my family. I love working from home. I, I think that's a game-changer. If your doc is happy, it's just going to create a positive environment for the growth and development of the company.

Who doesn't want to be happy and love their job, you know?  

Westley Bernhardt: Let me add this for all those rural hospital-based pathology groups out there or rural hospitals who struggle so much these days. Rural hospitals are getting shut down dramatically but think about this. 

With digital pathology, you can digitize frozens and you can have access as long as you're not going to require them to be on-site, which they don't need to be. Everything can be done digitally. You can have access, whereas in the past, you've got one general pathologist and consults go out every day for heme path, GI, whatever.

Now you can have access to a full slate of subspecialized pathologists to do all of your work. They may work for other hospitals too. That's going to happen, but they're going to work for you. They're going to do your cases. They're going to make it happen. And you can have the greatest pathologist reading for you and delivering care to your patients. That's pretty special. 

Sheva Khalafbeigi: Yeah, it saves a lot of time rather than, “Oh, I know this colleague in this state, let me ship the slides over there, wait a day or two until the slides get there, and then have it go through my colleague's caseload of the day until they get to it.” Instead, I can immediately from wherever I am, ask my colleague, “Hey, can you please look at this?”

“I think it's this, or I'm worried about this. Do you agree? Okay.” They hop on real quick. They look at it. “Yeah, I agree.” “Okay, signed out.” There's no delay in the patient getting their results. So that's important. 

Westley Bernhardt: Yesterday I had a meeting with a group that has a variety of specimens that come in. Some are dermatology, some are breast, and some are heme path. And before when they sent it, it was either a derm or general path that was reading it. And now, as I explained to them, when it comes in if it's a breast, it's going to my breast fellow. If it's a heme path, it's going to the heme path. If it's derm, it's going to the derm path.

You're going to be directed to the subspecialist right away, without delay, and you can have confidence in that diagnosis because of that. So, it's a unique time, and if everybody takes advantage of the laboratory software systems and the opportunity, it's going to be successful. 

Michael Kalinowski: Next question. Do you have a preferred case viewer platform? 

Westley Bernhardt: So our case view. Oh, go ahead, Doc, sorry. 

Sheva Khalafbeigi: No, no, you go ahead. 

Westley Bernhardt: I was just gonna say right now we view our cases in Lumea and Lumea has been a fantastic partner. Our goal in digital pathology is number one, that it replaces the microscope.

Then number two, what are the add-ons? How do I automate and eliminate some other costs? There is a cost to it, but how do I eliminate other costs? Eliminating those costs means no more admin assistant, no more transcription. We automate that entire process and use the coordination of the digital software and the LIS system to accomplish that.

Automating the coding. That's part of it too. And Suren and the team at LigoLab have been so great in helping us put that together. Both the LigoLab and Lumea teams have been fantastic in helping us create those customizations. 

Sheva Khalafbeigi: I'm very happy with how their viewer is and what they've built.

Michael Kalinowski: all right, and let's go with one more and it's a rather important one. Can you talk about reimbursements? How does that work within this workflow? 

Westley Bernhardt: I can and what's interesting is there are reimbursements out there. You need to check with your own Medicare max to see what they're doing. We were being reimbursed by Medicare well. There are NCCN guidelines that state one unit per type.

So if you've got a one-part biopsy, you get one T code for the 88305. If it was a five-part biopsy, you still get one. If you have one immuno, you get the one. You get one special, you get the one. It's limited to one. That's the NCCN guideline. 

Recently, First Coast Services decided they're not paying it anymore so we went from being paid at 20 plus per clip, from First Coast Services to nothing. So we're gonna fight that. They added all the new T codes this year, but we continue to get reimbursements from some of the private payers. Some private payers do not pay it. They consider it already included, but some do, and some do fairly well.

It's really going to depend on who your payers are. You're going to need to check it yourself, but there is reimbursement out there. Some of it more than others. But I can tell you the dollars have been coming in on those, and I recommend you to test those to see who's paying you and who's not.

I can tell you off the top of my head that we've seen some things from United, Humana, and Cigna as well.

Suren Avunjian: Let's take one more question. I believe there's a question about images. The digital image itself. So from my understanding, OnePath did not need to do any kind of upgrades and its bandwidth. The image viewer technologies typically are built in a way where you can think of it as like Google Maps, right?

You're not downloading the entire world map all at once to the browser. As you zoom in, it's just downloading that particular section. So this type of technology and viewer allows for no limitation by the constraints of normal bandwidth.

I don't think there was a need to necessarily have massive improvements or upgrades in your bandwidth, right, Westley?

Westley Bernhardt: Yeah, we invest in our internet, but that's for many reasons, right? Number one, we want the laboratory information system (pathology lab software) to perform at its highest capacity. We don't want our people to start typing as it's getting it in.

We want that to work as quickly as possible. We want the digital movement to be as quick as possible. So we have high powered fiber internet, but it's nothing that you can't buy right off the streets anytime. So we just go through Comcast for that. We haven't had to make any changes. Lumea's system is a web-based platform.

They manage all of our storage. So it's been very, very simple. 

Suren Avunjian: Keep in mind that pathologists are signing out from all over the place, right? They're not even in the library and, as Westley mentioned, they could be signing out using a 5G connection or LTE, and that should be enough to get these out.

Westley Bernhardt: That's right. The images populate well, as Dr. Khalafbeigi said, she's been all over and seen images and they populate quickly. 

Suren Avunjian: Yeah, they do. Thank you. 

Today we got to explore all of the newest innovations that we've put together. You know, the relentless focus of the partnership between all these companies has brought on the flexibility and the Interoperability.

I think we're not just responding to changing landscapes. Our vision is to help shape it. So I hope we have inspired some of you and we're here to answer any more questions. I believe we have another slide here. You scan that QR code. That's one way to reach out to us.

The website's also available. We have OnePath’s website that we can share as well. Wes has contacts as well with Lumea, so feel free to reach out with any questions or anything we can help with. 

Westley Bernhardt: thank you so much. We appreciate your time today. 

Suren Avunjian: Thank you all. Have a wonderful rest of the day.

Sheva Khalafbeigi: Thank you. Bye.

Learn How to Expand Your Lab’s Services and Add Revenue with Direct-to-Consumer Lab Testing

Is your laboratory seeking innovative strategies to enhance its brand visibility and unlock new revenue streams through expanded testing capabilities? Are you curious to learn more about direct-to-consumer lab testing and how it might benefit your lab operations? If the answer to these questions is “yes,” download this on-demand webinar featuring Jenny Bull (COO, Avero Diagnostics) and Adam Carlin (Product Manager, TestDirectly). 

During the webinar, Adam showcases a number of DTC workflows that support all forms of diagnostic testing and patient outreach, and Jenny adds insight from the customer perspective while also commenting on current trends.

WATCH

Michael Kalinowski: Thank you very much for joining us for this direct-to-consumer lab testing webinar, focusing this time on expanding lab services and adding revenue. We're talking about improving patient outreach within the clinical laboratory. I'm very pleased to have a couple of very important guests with us for this webinar, starting first with Jenny Bull.

Chief Operations Officer at Avero Diagnostics. Welcome, Jenny. We do appreciate your attendance today. 

Also Adam Carlin. He is a product manager for TestDirectly (TestDirectly.com).

TestDirectly is a direct-to-consumer lab testing web portal that is part of the LigoLab Informatics Platform. Welcome, Adam. We thank you as well for joining us today. 

Jenny was involved and has been involved with Avero Diagnostics before and during the COVID-19 pandemic. One of the themes I think that we're going to touch upon a lot during this webinar is how important it is for medical labs to be at the forefront of new laboratory information system (LIS) technology.

Avero Diagnostics deserves a lot of credit for being there. In the very early days of the COVID pandemic, knowing that there was a real problem with testing patients and testing them safely and at a very high volume, they grabbed hold of technology and put themselves in a position to not only improve the visibility of the laboratory, which was secondary at this point but to help patients that needed a very high volume of direct-to-consumer lab testing.

So, Jenny, talk a little bit about the spring of 2020. We're just starting to understand what Covid was going to be and how it was going to affect the laboratory, talk about your position there and some of the things that you were dealing with at the time.

Jenny Bull: Thank you, Michael. Going back to the spring of 2020 and the pandemic. We've been working with LigoLab since 2014 so we were six years into our relationship and found ourselves needing to service a fairly large contract with the state of Florida, in which they needed the ability to have healthcare workers order and set up their own direct-to-consumer lab testing and get their own results (TestDirectly results time), but they also needed their long term care facilities to be able to be tested and managed by the state of Florida. We had a situation where we were wholly unprepared as a laboratory located out of Washington state, but we got together with LigoLab and talked through what was needed and what could be done.

TestDirectly (TestDirectly.com) was just in its infancy and we were able to pivot very quickly to provide services, both direct-to-consumer lab testing and the ability to test long-term care facilities and manage results on both sides.

This put us at the forefront of testing for COVID-19 and gave us the ability to be responsive and to be accessible. I think Adam will go through a lot of the details behind it, but it was just the start of the efficiencies that it brought into our lab to be able to meet the turnaround time and the need.

LigoLab and Testdirectly were very dynamic and very instrumental in our success during COVID and Adam, I'm happy to chime in as needed as you go through the presentation, but that's where it started and we still use it today. 

Michael Kalinowski: Here is the rundown of what we're planning to cover today, primarily Adam will be taking you through some clinical laboratory workflow such as patient outreach, patient self-registration, getting payment and insurance info up front, and home test kit testing, tracking, handling, and fulfillment.

After the presentation, we will open it up for a question and answer session where you can take advantage of the chat or Q&A option here on the Zoom call and ask questions of Jenny and Adam. 

So with that, Adam you can go ahead and share your screen and kick off the direct-to-consumer lab testing presentation. 

Adam Carlin: So as the previous slide showed, we're going to go through multiple elements of the laboratory information system software and what is possible by using TestDirectly (TestDirectly com). So we're going to start with the home testing kit registration solution. 

One thing that became apparent during the pandemic was the idea of testing from home. We have developed and deployed the TestDirectly module, as you can see here, where the kits are pre-packaged. And so within the home testing kit, it's going to have a QR code, which is tied to this URL. So, essentially, the patient opens the package, scans the QR code, and that brings them directly to this screen.

So, as we can see here, we have details about the collection that we can provide, we can modify these photos, and we can add context on the site here, but as you can see here, simple instructions on how to collect your draw. So the first piece of information that we need from a patient is an email address.

Once a patient enters that here if indeed the email they entered is correct, they're going to receive a confirmation code. I'm going to pull that up right now.

Once confirmed, the patient will then enter demographic information. So another key addition, something that we've recently added, is the scan ID feature. We want to mitigate the potential chances of error, obviously for the patient and subsequently for your lab, so when we click on the scan ID button because I'm doing this from a laptop, it's going to ask me to pull a local file. But if we're doing this from a smartphone or a tablet, let's say on-site, it's going to automatically open the camera from that device to capture and scan that image. As you can see, we here are using a sample driver's license.

It pulled all this information. If it looks ok, we click ok, and that creates a profile for the patient. Now, let me just reload that page for one second. We're just going to register as a patient so we're going to re-send our confirmation code. I was signed in as another user, hence why it refreshed the page. So once we get back to the point where we are scanning our ID, we're going to pick it up from there. 

So as we can now see we've moved on to the next phase. After scanning and pulling all our bio details, it also pulled the address Information from the ID. Previously, a patient or staff member would have to manually enter all this information instead of it all being pre-populated. The key benefit in my eyes is ease of use and we're also mitigating any potential chances of error. 

So now the patient's information is in the laboratory software system (pathology lab software). The pre-packaged home testing kit is going to have an external barcode within the package and so from there, the patient is going to enter this information without the barcode or the dashes.

Then we're going to click on place order, but nothing occurs. Why is that the case? So we can add multiple layers of terms and conditions here. This can be related to one specific test or one specific provider, and this can be multi-layered, but as you can see here, this is where your liability waiver with testing terms can appear.

So a patient will not be able to finalize and create this order without agreeing to the terms and conditions. As we can see, it’s a very quick process upon registration, and the patient will land on this page. This gives them a chance to review their information and check if everything is up to standard.

So in terms of patient registration of a kit, it's as simple as these two pages and very straightforward. Once the patient has completed this, it does create an order in the system. So these kits originally can be distributed in any manner you see fit. So working with different clients the lab won’t need any of the patient information up front.

That's all gathered here. And once the patient has registered their kit, it will create a patient profile for them. It will also create the order that we just ran through. So from here, we've looked at this process from the patient's standpoint. If there are any questions at this point, more than happy to answer them before we jump on to the next screen.

Michael Kalinowski: Just a quick one from me. Direct-to-consumer lab testing during COVID-19 was pretty self-explanatory. It was a lot of PCR testing (molecular LIS) for infectious results. For a workflow like this, Adam, what type of testing would this be most suitable for? Jenny can also certainly comment on that as far as what trends there might be in the laboratory world.

Adam Carlin: Really good question. The beauty of this, in my opinion, is that it opens the TestDirectly system up to all specimen samples. Anything that can be collected safely and HIPAA compliant, we can build any test into the TestDirectly system.

We just looked at saliva self-collection, but the specimen can be from urine, blood, and anything else that's compliant. We can collect this and test this with TestDirectly. 

Jenny Bull: I would just add that we see trends right now for health and wellness testing, gut microbiome testing, STI testing, and pretty much anything else that a patient could go in and order for themselves.

I think it's important to note that this system (TestDirectly and TestDirectly.com) can be used for physician ordering too. So if you have a physician that's going to be placing an order for you and you just need to go in and complete your registration and get the collection, then they're still going to be doing your follow-up care.

So TestDirectly is a vehicle that can be used both as a direct-to-consumer and a physician-directed lab testing solution. One thing we talked about too that might be worth mentioning is this LIS system software can be used for things like vaccinations. It doesn't just have to be lab testing. You could schedule a flu clinic or, it's also a good vehicle for getting the patient registered, tracking the specimen through the lab, and getting results back to the patient, regardless of the type of test or the collection workflow.

Michael Kalinowski: Absolutely. The dynamic of how important it is to get payment upfront has also changed since the end of the pandemic, right? 

Jenny, can you talk about how important it is to get the correct payment information and insurance information, upfront to make sure that the lab gets paid for the services rendered?

Jenny Bull: Yeah, very important. So you're right. A lot of this when it was government-funded would come through. People could enter HSA information if they had it, they could enter just a code if it was being done through an employer, for instance. 

Labs can verify that insurance information upfront to make sure that they're not putting in false or bad information and that when it gets to the lab, we still have the QA process that tends to hang things up at the upfront processes to ensure that we are getting good information.

Adam Carlin: As Jenny just pointed out, we do have a payment validation module within TestDirectly. So there are two levels to this. The first level is it can be done manually. So this, again, is depicted by a queue, anyone who entered insurance information will go into that queue, and this can be a manual process that's built into the LIS software and deployed out of the box. For the automatic version, this can be run in the background. so this would check any insurance that is submitted. If it does clear, then it will not pop up in the queue.

if it wasn't cleared automatically, it will flag. In that instance, a rep can reach out to the patient if there's something wrong, or something doesn't match up. So that's all built into the TestDirectly system. 

Michael Kalinowski: OK, great. Adam, feel free to continue showing the next direct-to-consumer lab testing workflow.

Adam Carlin: Perfect. So a really good segue into a couple of things that were just brought up there. We talked about payment processing, and, on the previous slides, we talked about the address search functionality, geo-services, et cetera. So the page that we are now on is the TestDirectly (TestDirectly.com) patient landing page.

If a patient arrives on this page, as we can see here, there are a couple of different manners in which they can search for a location. They can do the zip of the city or a specific facility name. So for now, we are just going to input a San Francisco zip code. We're going to search. And as we can see here, there is one patient service center available in this demo that we set up.

So as we can see here, there is room for your lab branding. This is the name of the location and we can see a couple of things here that we're going to walk through. First, we do have Google Maps built in here. So we click on the link. If we are on a smart device, it's going to bring us there no problem.

We can also check when the next available appointment is. It's presented here, but we can also click on this link to go through the booking process and choose our appointment time. If we click here, it's going to bring us to the available schedule. All this is fully controllable by you as a lab.

For example, if there were certain days in which you were closed, shorter schedule, whatever the case may be, we can have a different schedule for every day of the week, as well as having holidays built in. So Thanksgiving, Christmas, whatever, you’re never going to have the unwanted scenario where people have booked and you don't have anything available.

Okay, the final piece here is if we go back to the zip code entered of 94103. Based on the zip code entered, it's going to tell the patient how far they are away from a certain location. So if we take an example like New York. There may be a lot of locations. So from there, the patient is going to be easily able to see and select the closest option. So this is one way in which a patient can find a physical patient service center. Again, the first full workflow we looked at was registration on the external home testing kit. This, we're dealing with an actual patient service center.

If they come here, they can search, and this can be even more unique. So, what do I mean by that? As we can see here, TestDirectly com forward slash testdirectlypsc. We can also create specific URLs that are linked to either one site or to you as a lab providing testing in a physical location.

In this scenario that we set up, there's only one available item, so we were able to auto-fill that into the cart and save on clicks for the patient from here. As we can see, there is an area for additional information for branding and so forth.

Also, for a specific specimen type or test, you can add your imagery, and we also have the ability here to add instructions. Again, we showed them on the previous, screen in terms of saliva collection. So that is possible here, of course, from the PSC center. If we need to capture any required information, we can do that very, very easily from here as well.

Jenny Bull: I think it's important to also talk through how TestDirectly during COVID handled parents coming in with underage children for testing. 

Adam Carlin: Oh. Yeah. Thank you for bringing it up. 

There were scenarios in COVID where we had family testing. So in solving that problem, it's very easy for a patient, for a master account holder to add as many dependents as they are needed. So as we can see here, the scan ID functionality of course is available.

Once they've set up their initial master profile, they're scanning ID, they wouldn't have to use this, but they can also just use our primary address and copy that across. If we create a dependent here, the same button will appear. So we can create as many family members or whatever as needed.

And then from there, once they are created, we can choose which person we're testing for from here. So again, we talk about mitigation of errors. We don't want the wrong person's name on the wrong specimen and so forth. So this is how we solved that headache for want of a better expression.

You'll see a mix of questions with the aspects and then questions that don't. So if we try and move forward without entering race and ethnicity, the TestDirectly system's going to kick us back because these questions are indeed mandatory. So here, we're going to enter our values and we're going to move on to the next part.

We talked about on the previous page that we were able to choose our available appointments first. It doesn't matter in which order a patient does this. They want to do it first. That's fine. But again, if they don't, if they click on to site as we did, it will bring them to the same scheduling menu.

And so anytime a slot here is filled out, that slot will gray out. So again, there's no chance that we only have eight patients available for 30 minutes. We have 10 booked. That's not going to happen. So for now, we're just going to choose 11:30. And then again, something that we talked about that came up a minute ago was payment processing within the TestDirectly platform.

So a couple of examples we set up here. As a lab, we can relabel any payment source as needed. So, for example, this was just a macro template in the background that we were able to relabel as cash. And we can also put instructions for each payment method. So, again, This is dependent on us paying when we get to the location.

So our credit card processing is run through Stripe. So we're asking for the cardholder's name and the card number, and we're making sure all this information is valid before we move forward. Again, if some of this information is not valid, a patient will not be able to save a credit card.

And then last, but certainly not least, we also have insurance. So as we can see here, once I clicked on the drop down, it drops me into all available options. And this list, you guys have autonomy over what's presented here. So for you specifically as a lab, we can build or you can build your adequate list of insurance vendors.

Okay. So if we click here, we have the opportunity to enter this information manually, but as we can also see. We can scan an insurance card. Same technology, again, mitigating errors. 

We also have the ability for all payment sources to ask up front for a patient upload, like an image of said file. So, as we can see here, please include the insurance card image back up front.

So hypothetically, if we had these up front, again, we could run validation and so on. this can be turned on, turned off, or just supported, meaning a patient has the choice here to enter their information or upload a file. If they don't do it, they'll still be able to place their order.

It's the same thing as we talked about with terms and conditions. We can't place our order without acknowledging it. So once that's done, we place our order. And as we can see, the landing page is slightly different for here. We have the image, and your logo here, and again, this can be modified, if needed. So, in terms of patient scheduling to an actual physical location, I would love to take any questions and any comments that Jenny may have.

Jenny Bull: The flexibility on this if you are doing direct-to-consumer lab testing, like a home test kit, with the geocaching, you can essentially make that available to the entire country. You can include states if you're doing it by insurance where you don't maybe have payer contracts, versus if you're doing it as we did for COVID where you have drive-thru sites and you want to target to people in a local community or county, and then a little bit more to your point of the individual QR codes, one way we used those was when we had employee testing where a university or healthcare institution wanted to be able to send their patients directly to the site to order the tests that they had approved.

They could provide their employees or students with a direct QR code or link to take them to only that one option. So the flexibility, and on the same note, the stringency you can put in place as a lab to control where you're testing is coming from and the front end is, is helpful. 

The other piece is that with what you just went through with the payment insurance, I think it's important to note that that could be interfaced directly with the LIS system. So, when this order comes through to the lab electronically, your staff is not re-entering it. The Data is pulled straight across.

You have their verified payment information, verified address, and ID. So it helps on the laboratory processing side to have all this done and verified up front and as part of the order. 

Adam Carlin: Absolutely. Thank you very much for the comments. 

So the final screen that we are going to have a look at is basically what it would look like from the staff perspective. So we created two different types of orders. Again, the first one was a home testing kit. The second one was an actual appointment at a physical location.

So from a standpoint of processing for the staff, on the backend, we create a profile and assign a username and password. Once a staff member logs in, if indeed they have access to multiple locations, they'll be met with this dropdown. So again, for now, we're just going to have a look at the registration of a home testing kit.

So a staff member comes in, they select the provider division that they want to process orders for. And so if we refresh the check-in queue, we see the order that we created. The ID that we scanned is going to say the test name, and what payment source was entered, and from here, there are a couple of different ways or a couple of different steps that a staff member can take.

So we'll see here two icons. The first one, they're able to review any details. So again, standard protocol during COVID, before we could scan IDs and do things that way, we would run through this with the patient, and make sure everything looks up to scratch again to mitigate errors.

Regardless of which site we accessed upon login, you'll see here address search. So, again, this was pulled from the ID, but for whatever reason, if this needs to be updated, if somebody moved addresses, or whatever the case may be, we can either clear this or a staff member can come in, make a quick modification, click okay, and that will update that address.

So ease of use is very much at the forefront. The payment method was already created because this home testing kit was purchased in advance. Okay, so if we're happy with the data that we've reviewed, we can save and check in this order again. 

However upon check-in of the order, in terms of moving this order from TestDirectly into the laboratory information system. A user simply selects the orders that they want to release, and they release it. The processing queue in TestDirectly is almost like the last stop. This is a queue where we can analyze orders and make sure everything's up to par. 

If we have everything bagged and collected correctly, we release it, and this automatically triggers the EDI transmission to the LIS system. As Jenny stated earlier, all information that we collected here is electronically distributed. 

Now we're gonna change location within this domain, and this is more for the standard patient service center. So, what looks different here? Again, same patient. Same test, but because this is an actual in-person appointment, as we can see here, there is a schedule, date, and time assigned. So we can adjust these queues to show things in chronological order.

So, everything else applies in terms of we're going to check in a patient, we're going to do the collection. Once we've done that, we're going to release the order from the processing queue, and then that order has been transmitted to the lab. If we are creating a new order for a patient, same, everything else applies.

Staff can also use the scan ID functionality as well as patients. So again, in terms of order entry, if we have someone in front of us, we're doing this from a tablet and they've got their ID, this takes less than 30 seconds and has no chances of errors.

There is more here. If somebody isn't an admin, they can do an order search and they can also search via patient. If somebody is already in the TestDirectly system as an existing patient, we can quickly click new order and collect or just recreate and reuse the information we've already collected.

Plenty going on, and plenty of functionality, all available as it stands right now. So with that, I'm going to pass it back to Jenny.

Jenny Bull: I just want to reiterate the simplicity of the TestDirectly (TestDirectly.com) system and scheduling and pulling the information over. I think you did a great job portraying that. 

Michael Kalinowski: All right. Well, I think we are at a point where we can open it up to questions and call upon the expertise of both Jenny and Adam and their experiences in this realm.

One question right off the bat is what's involved with the implementation of direct-to-consumer lab testing? What's needed? What type of training? What's the timeline? Adam, you can kick it off and then we can go to Jenny.

Adam Carlin: So, in terms of a straight TestDirectly implementation, let's say, for example, we're setting it up and we want to use TestDirectly for processing and accessioning of orders. The implementation process can be done quickly. In terms of an actual timeline, based on availability, we can have you up and running within two weeks.

We know everybody's got a different schedule. so usually we give the guideline of between two weeks and a month for a standard implementation. Now, if we're interfacing, with an LIS system and with a laboratory billing component, whatever the case may be, this obviously will take a little bit more time.

But in terms of straight-up TestDirectly implementation, from start to finish, based on availability, we can have you up and running within two to four weeks. 

Jenny Bull: I can confirm that. I think we did it in about three weeks on fire, but we use LigoLab Informatics Platform as our LIS system.

So our implementation was probably a little bit streamlined. But to your point, two to four weeks on just the development side on the background. From a lab perspective, it's quicker than that. You're defining your geography, where do you want this accessible? You're deciding, you know, what time slots you want to do? For instance, during COVID, we could see four patients every five minutes, and that was enough time to get them registered, take their swabs, and process their orders back to the lab.

It's really for the lab to define what you want to do. The training portion is super simple. The user interface is really easy. Pretty much everything that Adam reviewed in this demo encompasses everything the labs going to have to learn. So it's it's pretty straightforward.

It doesn't take technical staff to navigate it, and I'd say the onboarding for the lab and training could be done in one to two weeks, just depending on your clinical lab workflow. 

Michael Kalinowski: Very good. Next question, Jenny, we can start with you.

Based on your experience, what are the must-have elements, from a laboratory point of view, that you need to make direct-to-consumer lab testing not only possible but also effective?  

Jenny Bull: Just understanding what you want to do. I mean, the TestDirectly system can do pretty much anything. So understanding what testing you can offer, what that's going to look like, and what workflow you need. 

One thing we haven't talked about yet is trackability.

So UPS, like if you're going to send a test kit out, the ability to communicate with the patient once they place that order that we did receive your order. We have sent that testing out and we know when it's coming back to the lab. So I think that the must-haves are from a lab standpoint, knowing what you want to market, having that kit ready, and what TestDirectly will allow you to do is collect that patient information, the payment, and then also track that from start to finish right up to the result being delivered.

Adam Carlin: Michael, if I can just jump in at that point, Jenny, a kind of a light bulb went off. So obviously something that labs are always trying to solve is communication with the patient. So I know what we showed was more back end in terms of the actual lab processing, etc. But from a patient perspective, we provide the means for both automated email and SMS distributions.

So, for example, as Jenny said, if we're working with home testing kits and they're being ordered on the site, there are tracking links. There's updated information. We've received your test. Your kit has been shipped and so on. But if we're dealing with a physical patient service center again, once they've confirmed their appointment, they're going to get a confirmation email, which has a copy of their requisition template.

Once their results are available, they're going to receive an SMS message if indeed they opt-in along with a comp or your order is complete. Your results are available and all email templates and SMS messages are configurable for you as a lab. So again, we have standard cookie cutters that are built in there.

But let's say for a specific site or a specific test, we want to provide instructions in the email, whatever the case may be. You as a lab have full control over all of these communication distributions. So Jenny, thank you for bringing that up. 

Jenny Bull: Yeah, Adam, and I think it might be worth talking to you about the mechanism to receive results and when I say that, I think more about the patient getting the result directly, but also situations like we had for testing for, with the penitentiaries and the long term care facilities where somebody else was managing the results coming back. Can you speak to that a little bit as well? 

Adam Carlin: Yeah. Very prevalent during the pandemic. and that use case of is a really good example. If for whatever reason, we need to hold results or specifically if we need somebody to release them, we call it the physician release queue where any orders that are set up with certain criteria.

Let's say, for example, during the pandemic, a test was abnormal. So essentially, any orders of that nature, if they were flagged as abnormal, would go into a certain queue to be reviewed by an admin or a physician, whatever the case may be. So they would follow their protocol in this process. They would contact the organization or contact the patient directly. So they would have control from an internal standpoint before any orders are released and distributed. I'm talking about a COVID lab workflow, but this can be built around anything.

For example, with some of the new technology we have, let's say, a result triggered a telehealth appointment. This can be set up to where a patient's not going to receive their final report until they've had that telehealth appointment. They can talk with a physician, get the next steps, and so on.

We can withhold any results reports based on your needs. 

Michael Kalinowski: All right. Next question. we have tests to offer but do not collect specimens. Will that work with your TestDirectly system?

Adam Carlin: Thank you, Kathleen, for the question. Yes, this is possible. So in the scenario that you described, we would be using TestDirectly for just the ordering process. No problem. Just certain tweaks to what we already have built and available, but that is possible.

Jenny Bull: And I would add to that. There's, there are a couple of options. So the direct-to-consumer lab testing where the kits go out directly to the patient and they test at home, that would work in that scenario. The other one would be if you contracted with a collection agency.

So if you were doing a vaccination clinic or you were offering flu or respiratory testing during the fall, if you contracted with somebody that could do those collections for you, they could still utilize the TestDirectly user interface and process those back to the lab. 

Adam Carlin: Yeah, and just to add to that, let's say, for example, we had a scenario where you just wanted to use the platform for, let's say, scheduling or you wanted to integrate that into your workflow. We can take the value proposition from TestDirectly to you and work that around your workflow.

The TestDirectly direct-to-consumer lab testing system is massively flexible. 

Michael Kalinowski: All right. Time for one more. And then I'll let both of you enter your final thoughts as well. It may have been covered earlier, but we can touch upon it again. How do patients find my lab services for direct-to-consumer lab testing? 

Jenny Bull: They log in to TestDirectly and type in their zip code and it'll bring up any available testing options. It's super simple. we had during the height of the pandemic a situation where a lot of people were using this platform and you could type in a zip code in California where we had a lot of drive-thrus, or in Washington and see multiple lab options, which when you are a patient looking, if I'm lab A and lab B that's 20 miles south of me is offering different testing or similar testing, me as a consumer, I can see what my options are.

So I can see that lab A is offering COVID testing or respiratory testing and what the price is. I can also see any other labs and what they choose to advertise on there. So you don't have to put your pricing on, but you can if you feel like that gives you a competitive edge. You can customize the screen that the consumer sees when they login which might make your lab stand out over other options they have.

So if you want to say same-day scheduling or appointments every two minutes, or we're super friendly and better than everybody else, or our pricing is great. and our turnaround time is fantastic. So there is a little bit of a marketing piece you can do as a lab if you're working in a geography that has more competition than others.

Adam Carlin: Yeah, thank you, Jenny. And just to kind of add to that, the scenario just described is a patient landing on our page and entering their information. But as we previously showed as well, let's say, for example, a patient lands on your website as a lab. We can create specific URLs that will bring a patient to one of your specific sites or they'll bring the patient to your TestDirectly landing page.

So again, somebody comes on your site, they click on your homepage link, and it's going to show them all sites that are linked to you as a specific provider, so it makes it super easy and convenient for you guys to market from your website and then, within one click, redirect the patient back to TestDirectly.

So the open access market, they can find your site, but we can also direct them straight to your TestDirectly landing page via a unique URL. 

Jenny Bull: One more thing I can add to that is if you want to market and advertise directly. So, a couple of use case scenarios, during COVID we had little cards with a URL or a QR code on them that we left with rental car facilities at the airport.

And in hotels, when people showed up and realized that they had to have testing before they could get on a flight or a bus or anything, it was easy for the commerce in the area to hand potential customers a card that said, ‘Hey, here's somewhere you can get a COVID test.’ Similarly, you could do the same thing if you were offering STI testing or take-home kits. You can place them in student health centers or anywhere that you want to reach your target audience.

Michael Kalinowski: All right. Well said. Here’s an opportunity for you both to give your final thoughts. 

Adam Carlin: We as a LIS company learned a lot during the pandemic, and in doing so, we were able to refine the TestDirectly system.

We're always trying to improve and we're always trying to stay one step ahead. Updates such as ID scanning and functionality like this are going to be something that we continue to grow and build out. Our goal is to build one simple direct-to-consumer lab testing platform for you as a lab to connect you with your patients and do this in the most streamlined way possible.

Michael Kalinowski: All right, Jenny. 

Jenny Bull: I think you said it well, Adam, the growth that I've seen in the TestDirectly system since we started in 2020, to where we are now in 2024.

We ran well over a million tests through it so I think that we were responsible or at least, partly, for some of those improvements. The responsiveness from the TestDirectly support team helped make it all possible. 

It’s been a great experience. I love the TestDirectly system. I will attribute a lot of this upfront process and interaction with the clients to our success. We didn't spend a lot of time talking about the efficiencies in the lab, but they are driven by this, too. So, it’s a great product. I'm happy to support it, and if anybody has any questions, I’m available past just today. 

Michael Kalinowski: Awesome. That's a very, very fitting way to finish this webinar. Great info again. Jenny Bull, chief operations officer at Avero Diagnostics. Very familiar with patient outreach and the advantages that come with direct-to-consumer lab testing, and Adam Carlin, product manager for the TestDirectly product provided by LigoLab.

Has Our Laboratory Outgrown its Laboratory Information System? 

Do you view your laboratory information system (LIS) as a limiting factor? Do you feel like it’s time to research alternative LIS systems? Not sure? Then we strongly encourage you to watch this on-demand webinar with LigoLab CEO Suren Avunjian and Independent Consultant Dennis Winsten for tips on how to efficiently evaluate your current LIS solution to determine if an upgrade to a new and more modern LIS system is needed.

WATCH

Michael Kalinowski: Welcome to this LigoLab webinar entitled “Has Our Laboratory Outgrown its LIS? My name is Michael Kalinowski. I will be serving as your host. But the real key people as part of this webinar are both Suren Avunjian and Dennis Winsten. 

Suren is LigoLab’s CEO, and he’s been with the LIS company from the very start. The laboratory information system provider started operations just over 18 years ago

LigoLab is best known for its enterprise informatics solution, the LigoLab LIS & RCM Laboratory Informatics Platform

Joining Suren is Independent Consultant Dennis Winsten. He’s a long-time industry advocate who’s been involved in the laboratory industry for some 30 years.

As an independent consultant, Dennis is somebody who has his eyes and his ears tuned into the laboratory world. It's, let's be honest, a pretty challenging world these days. So your insight, Dennis, will be very valuable here.

As part of this presentation, we'll have a self-assessment document for you toward the end of the slide deck that you'll be viewing. And then please, if you have questions, we welcome them during a question and answer session that will take place at the end of the presentation.

With that, I think I'll turn it over to Suren.

Suren Avunjian: Great. Thank you so much, Michael, and Dennis. We appreciate you being with us. I want to cover and acknowledge a critical fact here. The laboratory industry is undergoing a rapid evolution and we're facing a significant challenge, especially with staffing shortages, dwindling reimbursements, and ever-shifting regulations.

These aren't just minor hurdles for us all. They’re shaping the entire fabric of our industry. So in such a dynamic landscape, it's essential to ask ourselves, how do we not only survive but thrive? This lies in adapting newer platforms and technologies and adapting to change. And we must recognize that relying on the most advanced, automated, and intuitive platform isn't just an option anymore. It's a necessity. So during this webinar, let's explore how the shift is necessary for labs to stay relevant in the ever-shifting world. 

Let's take a look at some stats here. These came from the CLP magazine State of the Laboratory Information Systems Industry Report.

Some key findings are somewhat disturbing. For instance, two-thirds of pathology labs are running on LIS systems that are over 10 years old. I mean, that's a decade of so much in technology that one year counts as three years.

So we're about 30 years behind in the laboratory industry for two-thirds of the labs. More than a quarter of the respondents stated that their lab information systems have known gaps or didn't support their testing needs, and a significant portion of these laboratories identified limitations in their LIS systems’ ability to keep up with long-term growth.

For instance, almost 70 percent of respondents using a custom laboratory information system reported significant scalability issues. And, you know, unfortunately, integration and overall interoperability still is a massive issue for laboratories. 

Approximately 45 percent of respondents were uncertain if their LIS system was on the most current LIS software version, and nearly half of them described their LIS systems as mostly unreliable. ALarmingly, 17 percent reported experiencing reliability issues with their current LIS solution. 

These findings indicate a growing dissatisfaction among labs with enterprise system-based medical LIS modules that are highly custom homegrown solutions, particularly in their ability to scale and meet future growth needs efficiently or effectively.

Now let’s focus on an overlooked aspect of laboratory information systems, and that's the unfortunate status quo that many labs find themselves in. 

First, let's look at the manual workflows and gaps that are created.

Labs rely on these manual processes and try to fill these gaps with staff within an era where technology offers streamlined solutions. These slow down operations and leave a lot of room for errors and inefficiencies.

Coupled with many laboratories, these staffing shortages and these manual processes have a significant impact on the lab and its bottom line and the impact should be considered as part of the total cost of ownership of an LIS system. So just because you might have a LIS system vendor that is quote-unquote cheap doesn't mean it's not costing a ton of money to the laboratory and having to fill up where the laboratory information systems can't provide efficient workflows leads to increased labor costs, staffing frustration, morale issues, longer processing time, and a higher potential for errors, which in turn can affect the patient care and lab revenues. 

It's crucial to understand that investing in an up-to-date LIS system isn't just about technology or keeping up with technology. It's about ensuring overall operational efficiency, financial sustainability, and success in a challenging healthcare environment.

Then there's the widespread use of Excel sheets and paper logs. People get creative here with all the technology that they try to fill these gaps with. While these tools are familiar to all of us, they're far from efficient or secure in managing complex laboratory data. This reliance on outdated methods can hinder our ability to process and analyze data effectively. 

We also see labs needing help with an outgrown LIS system and the LIS system vendors who are supposed to support them. When your laboratory information system can't keep pace with your growth, it becomes a bottleneck rather than a growth facilitator.

It limits your capabilities, affects throughput, and impacts patient care. Speaking of limited capabilities, many labs find their current LIS systems need more features to meet today's challenges. These limitations can severely impact the lab's performance with its inadequate reporting tools and lack of integration options or insufficient data analytics capabilities, allowing you to see where the bottlenecks are in the laboratory.

So another significant challenge is a non-responsive LIS system vendor. As labs come to us in a field where change is the only constant having a laboratory information system vendor that doesn't respond to your needs. or evolving needs can be frustrating and detrimental to your lab's progress and success.

Lastly, the issue of being nickel and dimed for every configuration, module, upgrade, user, you name it. The cost can quickly add up, making it difficult for labs to maintain a balance between budget, constraint, and the need for advanced technologies. These challenges paint a picture of the current state of many labs, a state that calls for urgent attention and action.

Let's explore how we can move beyond this unfortunate status quo and embrace more efficient, effective, and scalable solutions for laboratories. Unfortunately, many IT teams end up building a monster in the lab, and this is typically out of necessity, with each body part here representing different laboratory software systems and data silos in your laboratory.

This is a current challenge many labs face due to legacy LIS systems that lack the modern features required for today's operations. So let's dive into this metaphor a bit more. Each part of this monster symbolizes a distinct system or a data repository. Some might represent your technical department systems, others for financial operations, data warehouse, outreach, and tracking. You name it.

What's the problem? These body parts don't communicate effectively with each other. This is the Frankenstein scenario. They operate in isolation, create data silos and hinder your laboratory's ability to function cohesively and efficiently. And this creates lots of synchronization issues. All these systems need to be working in synchrony, and most of the time they don't. They have very simple integrations, which are having two rooms and communicating through the door keyhole, right? That's your integration from one system to another whereas in a modern LIS system that's designed from the ground up.

You should look for laboratory information systems that have all of these walls opened up, so it's all in one solution, one system, one visible source of truth. So these siloed systems lead to a labyrinth of complexities. Data transfers become cumbersome and error-prone. Reporting is delayed. Getting a comprehensive view of the lab's operation feels nearly impossible.

This fragmentation not only slows down processes but also impacts the accuracy and reliability of the data, which is critical in today's health care and laboratory field. Moreover, the effort and resources spent in managing these disparate systems are substantial. It requires more manpower to input, extract, and interpret data across multiple platforms, often leading to increased operational costs and lots of potential for human error, unfortunately.

So the irony here is that technology that is supposed to streamline our work ends up complicating it.

So with that to set up the stage here for Dennis, who has been an independent consultant for over 30 years with a lot of experience, specifically in lab informatics. He'll dive deeper into the reasons and justification for digital transformation.

With his expertise, we'll explore how unifying these disparate systems through digital transformation cannot only tame this multi-headed monster, but turn it into an ally, enabling your laboratory to function more effectively, reduce errors, and ultimately provide better patient care and revenues. So with that let’s pass it over to you, Dennis.

Dennis Winsten: Happy holidays and thank you for taking time out of your Christmas shopping to attend this webinar. As a matter of fact, after the webinar, I'm going out shopping myself.

So as Suren noted roughly two-thirds of the labs are using LIS systems that are over 10 years old. Just because they're old doesn't necessarily mean that they have to be replaced, however, there are a large number of reasons and they're not in any particular order here, that justify replacing your LIS system. One of them is not having a cloud-based operating platform. I look up to see if I can see the cloud, but I know it's there. That's an important consideration if your LIS system is not cloud-based.

Sometimes the LIS systems that you have aren't sufficient and they don't provide the opportunities for your lab volume growth, or they limit your ability to add new clients, which is going to limit and affect the growth potential in revenue for your lab. Another factor to consider for replacement is the LIS system is very expensive.

It's expensive to operate. It's expensive to maintain. And the pricing model. How you're paying for your LIS system. Are you paying for it on a per-seat basis? Are you paying for it with a fixed license? Or are you paying for it on a transaction basis? Whatever it is, the LIS system pricing model doesn't fit your current lab's cash flow or your financial situation.

Another factor for replacement is whether the LIS system is well integrated with your laboratory billing and lab revenue cycle management systems or other institutional systems. If you're in a hospital, how does it interact with your EMR, for example? The LIS system might be based on LIS software that's not mainstream or consistent with the national or industry standards or incompatible with other existing laboratory software systems.

So those are four, and there are more reasons.

Support services for your LIS system are poor. I did a survey several years ago, and asked various people around the lab, the lab director, the pathologist, the lab techs, and the LIS manager. What are the things that are most important to you about your LIS system and your LIS system supplier? And you’d think that function and functionality would be number one, but you know, it wasn't. The number one factor that people thought was important to them was the support they get in maintaining and keeping their LIS system operating and fixing problems quickly, or ideally avoiding problems, preventing problems from happening,

Functionality and functions are important. A lot of LIS systems today, going back historically, don't have the current applications that are prevalent and necessary in today's laboratory. Molecular diagnostics, digital pathology, very flexible reporting, providing portals to the consumer, and more importantly, the application of artificial intelligence to the entire laboratory LIS system operation.

Not having these functions clearly will place your lab at a competitive disadvantage. Another criterion for replacement is a slowdown. You know, you can have the greatest functionality in the world in your LIS system, but if your response time on your LIS system is taking multiple seconds, obviously the throughput is going to be significantly affected by that, and your lab turnaround times are going to deteriorate.

The lab needs to have in-house experience, and very often this is not provided and supported by LIS system vendors. Also, federal and state regulations are constantly changing. Your laboratory information system needs to be constantly updated and quickly updated to maintain compatibility with various regulations.

Security. As you know, security has become a tremendously important issue these days. You need to ensure that your LIS system, your existing LIS system (and many older ones are not set up for that and are subject to penetration) is compliant with HIPAA. I think most of the LIS systems today, if they're operating, obviously are, but they need to be constantly upgraded to maintain security and to maintain consistency with HIPAA.

This is not true so much anymore that your LIS company is no longer in business. However, as you know, many LIS companies have been bought out by larger LIS companies. Smaller LIS companies have been bought by larger companies, and the extent to which the larger company is going to support the company that's acquired is very questionable and historically has not been a good sign for LIS companies that have been successful, that have been acquired by a larger entity.

The original LIS company that you bought, we see some of this today as well, has been replaced with a more modern version, and is discontinuing the LIS system version that you have, so you will not be getting enhancements and support for your LIS system going forward in time.

Another factor to consider for replacement is your original LIS company has been acquired by a larger company with a competing LIS system, which is very similar to the LIS company replacing your system. So now you've got a competing LIS software product and you don't have contractual assurances that you're going to get continuing support.

Although even if you do have assurances that you're going to get continuing support, if there's a competing product, which is the main focus of the LIS company, the new company, you can be assured that the kind of support you're going to be getting isn't what you expected in the past.

So if you're thinking about replacing your laboratory information system, it's not an easy thing to do. Budgets are very tight. There's a lot of competition for the available funds, either within your independent lab or in a hospital setting, and how do you go about justifying a new LIS system to get budget approval?

You have to develop a very rigorous financial spreadsheet analysis, which shows the benefits, the financial benefits, and the operational benefits that you will acquire and you will achieve by going to a new lab information system. For example, going to a pathology lab software as a service model, particularly when your capital budgets are limited, and you want to avoid upfront costs for the LIS system and replace it with monthly costs that vary with your workload. So to the extent that you've done a rigorous and definitive analysis and a cost-benefit projection, I usually like to look at five years. What's the total cost of ownership of the LIS system over five years? If you do a rigorous analysis and present it to your management that says Here's a good financial, a good operational, and a good regulatory rationale for replacing the LIS system,” the chances are a lot stronger that you'll be given the go-ahead for a much-needed replacement LIS system.

Suren Avunjian: Thank you, Dennis. By the way, with Dennis, we also bring him on as a consultant to help understand The ROI and the benefits you've gained as a customer and also he can help get the metrics that are in place today and potentially do estimates on how you could benefit in the future from the LIS system too.

So I think this is also another important exercise that could be done to justify a replacement LIS system.

Dennis Winsten: that's very important. It's, it's surprising how many labs don't look at the metrics. When they put in a new LIS system to see how and be able to measure the benefits of the system throughout using it for six months or a year and all the key performance indicators can be measured before and after. That’s tremendous, tremendous feedback to your administration that you did the right thing. 

Suren Avunjian: And a lot of it could be due to that monster we saw earlier because of all the silos, it becomes really hard to get this information. And so let's explore what the benefits are of a digital transformation for your organization. 

So these advantages are not just about keeping up with the latest trends, right? They're about fundamentally enhancing the way our laboratories are operating and how we serve our communities. Firstly, digital transformation allows us to standardize and reduce complexity, right? How do we do that?

By having a unified LIS system, we can ensure consistency across all operations, making it easier to manage, maintain, and train staff. Standardization also plays a crucial role in error reduction and turnaround times.

Next, we could streamline and automate processes. These automations transform time-consuming manual tasks into efficient technology-driven processes. This not only speeds up our overall operations but also frees up staff to focus on more critical and value-added tasks. We see many laboratories scale with us, and they're able to scale two, three, or four times more volume with the same amount of staff or maybe 10 percent more that's added, so it's much more important to, especially with these limited staff people, allow them to be doing more relevant tasks in the laboratory and let the LIS system do a lot of the redundant and boring tasks. For example, optimizing compliance, right?

To reduce the risk is another significant benefit. Digital transformation and advanced tools help us stay compliant. With the ever-changing regulations and healthcare automation compliance can be done by automating compliance-related tasks. We minimize the risk of errors, and penalties, and ensure we adhere to industry standards and best practices.

Gaining a competitive advantage is crucial in today's healthcare landscape, especially in our local markets, right? These advanced digital tools allow labs to make their offer, and bring their offer to a wider community with better services, and innovative testing options that set the lab apart from others.

Typically, the LIS system is a really important differentiator for laboratories. It allows you to serve the community, the doctors and the ordering providers, exactly the way they want to be served. And you can build all of this into the back end of the LIS system and let the system take care of this. So by improving our efficiency and capabilities, we can attract new business, and retain the current ones we have. And provide them with superior service.

Digital transformation also makes it easier to scale your operation, whether it's by increasing the testing capacity, directory of services, or expanding our services and offerings to the customers. So unifying and gaining operational visibility is about having a clear, comprehensive view of the entire operation.

This visibility allows us to make more informed decisions, identify areas for improvement, and monitor the impact of changes we implement. Lastly, solving for today and the future means the digital transformation is not just a one-time upgrade, it's an ongoing process that prepares us for future challenges and opportunities.

As technology evolves, so do our capabilities, enabling us to continuously adapt and stay ahead of our field. So in conclusion, digital transformation is an essential step in modernizing the laboratory. It's about more than just technology. It's about improving our services, efficiently and with the ability to adapt in a rapidly evolving healthcare environment.

With that, I will ask Michael to go over a case study that recently implemented laboratory gains by moving to more modern systems. 

Michael Kalinowski: Thanks for that, Suren. A very compelling argument from both of you. 

Suren brought this term up just the other day. I think it's pretty fitting here. If there is another software partner that you're contemplating working with, look at that LIS company not necessarily as a software company, but as a lab scaling company. I think that's a really good mindset because, as we all know, no two laboratories are alike. And as we all know, laboratory environments are constantly changing. So having a LIS laboratory information system and a laboratory software partner that is there and interested not only in where you are today, but where you're going to get and how quickly you're going to get there in the future, I think are two very important considerations.

Everybody likes to hear about success stories. Here's a a laboratory that was doing what a lot of laboratories do, using outdated manual processes and fragmented software solutions, running into common problems of inefficiency errors, and delayed reporting. This was turning into bottlenecks and hurting the business.

So the lab recognized the bottlenecks, recognized that it was time to make a change, and then partnered with  LigoLab for modernization. This resulted in a 31 percent increase in lab productivity, a reduction in errors, improved turnaround times, and better relations with your clients.

All of these things are offshoots of this increased efficiency and productivity within the lab, and then most importantly, revenue was boosted by 18 percent in the subsequent year thanks to the enhanced LIS laboratory information system that was operating within this laboratory. Really impressive numbers in just one case study. An increase in productivity and efficiency will ultimately mean more in net collections. And less time in accounts receivable for your laboratory. 

Suren Avunjian: Thank you, Michael. We've also prepared some self-assessment questions that you could be asking internally.

These will help determine if your laboratory has outgrown its informatics platform, and assess whether consideration to switch or upgrade the LIS system might be needed.

If your laboratory information system LIS can't integrate well with other equipment, EHRs, or laboratory software systems, it might force you to use multiple platforms.

And this approach leads to data silos and synchronization issues impacting efficiency and accuracy. For example, if you're workload has grown and the current LIS system is struggling with data processing, slow response times, or frequent crashes, it might be time to upgrade the LIS system.

The laboratory information system should provide in-depth reporting and analytics. If your current system falls short of generating reports or adhering to regulatory requirements, it may no longer be adequate. Assess if your LIS model can adapt to future growth or technological advancements. A medical LIS system that isn't flexible or easily upgradable can hinder your lab's potential to evolve and stay competitive and relevant. 

Dennis Winsten: I think the issue of silos is a very significant one because in many cases you don't know for sure which is the source of truth. If you have different systems that are not well integrated, interfacing can be done, but there are several issues associated with interfacing in terms of keeping the data coordinated and consistent with each other.

Suren Avunjian: Thank you, Dennis. Some more things to consider, right? If the LIS medical is not user-friendly, this leads to inefficiencies, errors, frustrations, and major drawbacks. The user needs to evolve and LIS systems that once seemed adequate can become outdated. Medical LIS should meet an evolving need. 

Dennis Winsten: I want to comment again on support maintenance. Very often overlooked. I think people sometimes look at the function and feature and they say, wow, look at this, isn't this great? And maybe it is, but the important thing is are they a good partner with their pathology LIS systems?

Does your LIS company understand your particular laboratory operation and what's unique about it? Because as Suren said, labs are different. I used to have a saying that labs are all the same. And then people go, Oh, and then I go on and say, except for the differences. Labs are all the same, except for the differences, and you folks out there in the lab, you know that that's the case.

Suren Avunjian: Thank you, Dennis. It's a really good key point there. And we need to also consider compliance, right? Should they keep up with the regulatory requirements and securities, function, features, and maintenance? If the laboratory information system software vendor charges excessively for every small change and cannot deliver the robust functionality needed to stay competitive in your market, that's a significant red flag. Frequent disruption and maintenance or slow support responses also indicate it's time for a change. So operational costs and efficiencies. Consider the total cost of operating your lab information system, including indirect costs like downtime, staffing, and efficiencies. You know, a LIS system that requires additional software or staff to fill the gaps can lead to increased operational costs.

So in summary, when evaluating your laboratory information system LIS in terms of scalability, integration, capabilities, reporting and analytics, user interface, compliance, and vendor support, so much to consider here, right? It's become financially burdensome for the laboratory without delivering these necessary functions.

If you're answering even up to half of the questions it's time to look for a more suitable and advanced lab organization software solution. 

So with that, I want to bring us toward our final slide and discuss, for example, how a LIS company like LigoLab can can be a transformative step for your laboratory to position itself for success in a competitive environment.

LigoLab stands out with this best-in-class white glove service, ensuring that your experience is seamless. and supported at every stage. We offer a unified platform that includes not just an LIS software solution, but really all the supporting modules the laboratory needs to be successful, paired with a lab revenue cycle management system that has full visibility into the operational and technical operations and can help with coding.

And all the compliance that comes with a direct-to-consumer lab testing solution called TestDirectly. This unified approach eliminates the need for multiple disjointed systems, thereby reducing data silos and synchronization issues. One of the key reasons why  LigoLab was founded is the desire to take full ownership of all of your informatic needs. That way if there is an issue you only have one laboratory information system vendor that takes full responsibility for all the informatics needs rather than the finger-pointing that is commonplace, unfortunately.

We align with the laboratory and its growth. Our LIS system is designed to grow with your laboratory. It understands that as your laboratory expands, your needs evolve, and the LIS system is built to adapt and scale, providing flexibility, and functionality requirements to support your lab's growth along with changes in the industry.

We're continuously improving the lab information system. Every day we roll out new features. With LigoLab, you're not just getting a static LIS system, you're investing in a LIS software solution that's continuously improving. LigoLab stays ahead of the industry trends and technological advancements, ensuring that your laboratory has access to the latest features, modules, and tools to be successful.

Dennis Winsten: Well, in addition to helping you win Suren, I believe I'm correct that the LIS system will help you justify if you have situations which we described, where it makes sense to replace your system, but you have to convince someone to do it. And you know, the biggest factor is always money.

So, I believe that if you look at The cost of ownership over several years that will help you look at the financial trade-offs and the financial difference between, for example, upgrading versus continuing to operate your existing LIS system in terms of what your current cost model is.

Suren Avunjian: Thank you, Dennis. And, you know, it's not just about LIS software. It's really about the service. It provides best-in-class, unparalleled support and assistance to the lab. So this includes personalized training, responsive customer service, and expert guidance to ensure maximum benefit out of the system.

We're continuously helping the laboratory evolve and implement new features to keep up with the dynamic nature of this industry. In a competitive market, having a robust, efficient, forward-thinking LIS company as a partner can be a game changer.

You're partnering with a team of dedicated laboratorians, software engineers, and people who will continuously help and improve your lab workflow and provide the best processes that we've learned from different organizations so that the laboratory can have a lot of different choices in how the laboratory information system LIS is working for them.

Because as Dennis mentioned, every lab is quite different, even though, you know, it sounds like it should be the same. Every lab loves to do things a little bit differently, and that's why it's important to build an LIS laboratory information system that has this level of flexibility to tailor to your needs without necessarily needing to go and write new software for it.

It's more on the back end, super configurable, and in your hands to be able to make this change without ever being nickel and dimed for all these configuration needs. You know, that's what laboratories that are customers with us love to have, this kind of capability at their fingertips. Not only does it not cost them a couple of thousand dollars every time they need to make a change, it only costs them a few minutes to go and make that change themselves.

So with this unified platform, we align with your growth. That's our pricing model, our licensing model, and just in general, our philosophy. That's why we provide best-in-class service. We commit to continuous improvements and make it an invaluable asset in achieving and maintaining a leading edge in your field.

So I want to thank you all for your time and attention and wish you all happy holidays. Michael, I'll turn it over to you. 

Michael Kalinowski: Perfect. I think the summary you gave was fantastic. We bet on the lab's future success which is a big part of our success. too.

And so that is one of the core beliefs with is. We want to have a partnership and we believe in your lab's growth, be it anatomic pathology, molecular diagnostics, or reference laboratory work. We have the tools to help you. 

Now we still have a minute or two, so we can slip in a question or two from the audience. Go ahead and use the chat option at the bottom of your Zoom screen to ask your questions.

Also, one thing that came out of this discussion for me, and Dennis, I'll let you weigh in here first, how many lab managers and lab directors out there are familiar with today's innovative laboratory information system solutions?

Dennis Winsten: It's very interesting because if you're a user of a certain LIS system software, your mindset is sort of related to that particular system. Sometimes it's very hard for someone to understand that they can leapfrog ahead because their experience has been limited to one particular healthcare LIS. Very often it's that they are sort of constrained by the system they're using and sometimes it's really difficult to to have them understand, for example, what does it mean if you're on the cloud? Or what does it mean if you have this type of flexibility in your laboratory report software? And what does it mean if you're integrated versus interfaced? So I think there's a lot of educational needs out there, and that's why I'm pleased to see that LIS companies like LigoLab are offering informational webinars like this one.

Michael Kalinowski: Anything that you’d like to add, Suren? 

Suren Avunjian: Yeah, we're seeing more and more prospects coming to us that are well-educated on the exact issues that are having, and that's been enlightening. I think there's a lot more awareness of what to look out for and where the constraints are. A lot of new customers do their homework and do massive due diligence.

The sales cycles are long and they should be because this is a really important decision. It’s mission-critical software, and we're seeing people pay a lot more attention and make the right decisions.

Michael Kalinowski: I do have a question from the audience. What size lab is your LIS system designed to scale and support with a transition? Are you looking at a lab with 30 clients hoping to grow to 100 for instance? Are you trying to disrupt the real big national laboratories that exist within our country?

Suren Avunjian: That's a great question. The LIS system software is designed for laboratories of all sizes, but our real target audience is medium-to-large-sized laboratories already having hundreds of clients and scaling to thousands of clients. If not tens of thousands of clients. We have a lot of laboratories like this that we support. So we're covering enabling over 200 different laboratory facilities to scale currently.

A lot of these labs can vary because we cover lots of different disciplines. So, for example, for pathology labs, I'd say a good level where the pain point is high enough to need an advanced LIS software system like the labs with over four or five pathologists.

A lot of the groups that we serve are the ones with 20-plus pathologists. That's a typical customer. But then we have groups that have almost 100 pathologists in them, so really on the pathology side, it varies. On the molecular or clinical side, it's typically a couple of 100 tests per day, but more often a couple of 1000 tests per day and they're looking to scale two, three, four, or five times more. We have laboratories that have grown 10 times more, but obviously, this takes much longer periods because it doesn't happen overnight unless it's COVID. And even in those instances during COVID, we had many laboratories that we're processing around a thousand or a few thousand cases per day.

Some of the fastest-growing laboratories in the country were our customers, and I don't think it was a coincidence. Typically these customers use the entire platform. We call it the trifecta, and that is the direct-to-consumer lab testing solution in the front, the laboratory information system solution in the middle running all the technical operations, and then the lab revenue cycle management solution in the back, automating all of the laboratory billing on the back end. 

The main job of LIS systems is to remove the bottleneck of growth and the artificial ceilings that the laboratory ends up kind of being trapped in. This is what the LIS system and the laboratory information system vendor's job is, to remove this.

So if it's a small customer growing from 30 clients to 100, it has completely different problems that need to be solved. But then from a hundred to 500, 500 to a few thousand, and then to processing on average between 20 to 30,000 orders per day and then some of them reaching 50, 000 per day. So these are completely different scaling problems, but the beauty is you don't need to keep changing LIS systems to be able to solve these. The laboratory information system has been built foundationally from the ground up to be able to solve all of these different artificial barriers as the lab breaches them.

So that's why with our aligned pricing model, we're very much in line with the growth appetite of the laboratory. So whether you're just the startup lab trying to take over a little bit of a marketplace or trying to disrupt Quest or Labcorp, we're there to support you.

Sonic Healthcare has been a customer for over 10 years, so I think they're on their way to making some disruptions on a larger scale as well. So thank you for that question. 

Michael Kalinowski: Another question. Can you give me an example of automation and how it would turn a complex process into a simple one? 

Suren Avunjian: So typically automation and the rule engine can help bring all of this standardization into the lab workflow to make sure nothing is dropped through the cracks. For example, with women's health where you might have different testing platforms like a Panther or a Roche for your molecular needs, you might have some customers that have a preference for these testing platforms.

So based on the combination of the specimen, the preference of the customer, and the availability of the instrument, the LIS system can help make these routing decisions on where the specimen should go and put human readable data on the specimen level. Of course, the platform has all this information in it.

So when you scan the specimen, it tells you where it's been, what kind of derivatives it might have, and where it's going. So this is just a very small, simple automation that could be built to help with these kinds of preferences. Another example is if you're not carrying a certain type of insurance the lab information system can route to a different laboratory for testing.

And all of this, instead of, you know, Betsy in the laboratory remembering all these preferences, these are programmed by your team with our team's help in the beginning, but once you do the same thing a few times, it becomes pretty simple for someone to replicate and maintain these rules and automation.

The laboratory can build as many of these as they wish. We've seen some laboratories build 30-plus different nodes of decision-making like a decision support tree. To model the realities and the needs of customers or the laboratory into the LIS system so that the LIS system can help you improve these and make sure nothing slips through the cracks.

Dennis Winsten: I'd like to underscore what Suren said. In a complex situation, there are a lot of decisions that have to be made, and if the decisions are being presented to the user all the time, you can simplify the process by building in rules or AI that says, “I understand where you need to go with this,” and not require someone to do all the manual entries in a complex process.

Michael Kalinowski: All right, well, we'll respect everybody's time and go to final thoughts from Dennis and Suren

Dennis Winsten: There are a lot of people out there who probably are operating LIS systems that should be replaced. And I think it falls very often on the laboratory information system vendors to be able to provide the tools and the information to these people so that they get the needed help. And I think it behooves any LIS vendor who's looking at helping a lab to be able to say, “Hey, we can give you some tools to help you do what you need to do to convince the people to release the money to let you do what you need to do.”

Suren Avunjian: I would add this. Today with with all of the different pressures from reimbursement rates being cut, staffing shortages, and more expensive labor costs, it's really important to make the right investment into the laboratory's future and ensure growth, efficiency, and success.

Tour LigoLab’s Clinical Laboratory Module!

Watch on-demand as Laboratory Information Systems Specialist Allison Still provides a guided tour of LigoLab’s Clinical Laboratory solution. During the tour, Still demonstrates how a modern and flexible LIS system removes common laboratory limitations and makes clinical operations more efficient, interoperable, compliant, and profitable.

During the tour, Still expertly highlights Specimen Tracking, Worklists and Batching, Results Entry and Verification, plus Quality Assurance and Statistical Reporting. She also hosts a Q&A session after wrapping up the tour.

WATCH

Michael: So, good afternoon and good morning and welcome to this LigoLab webinar slash clinical laboratory module tour. My name is Michael Kalinowski. And we soon will also be hearing from Allison Still. Allison is a laboratory information system (LIS) product manager for LigoLab. Somebody who is well versed in the laboratory world and somebody that we really appreciate.

We know you're busy, so we really appreciate you taking the time to help us out and do this sort of demonstration with the audience that is gathered here today. Allison is going to do a demonstration that should last roughly 25 to 30 minutes, and then at that point we hope to have an interactive question and answer session.

So if you have questions, feel free to use the interactive tools on your Zoom screen to give us questions at any time, and we'll plan on answering those questions after the LIS software system presentation has finished.

For those that aren't familiar, LigoLab is an all in one laboratory informatics software solution that covers all of the diagnostic disciplines, plus lab revenue cycle management and direct to consumer lab testing. For that we have a module called TestDirectly that was very valuable during the course of the coronavirus pandemic, allowing laboratories to directly connect with patients for their direct to consumer testing needs.

So now let’s dive into the clinical laboratory module, and this is what Allison will be covering today. 

And with that, I think I will turn it over to Allison. 

Allison: Thanks, Michael. 

Okay, our first topic today is specimen tracking. And so for that, I would like to start with the new order screen. I'm accessioning a new order here, and  I'm ready to enter the testing. Let's say today we're going to work with a panel. 

So the LIS system is telling us, you know, this is the preferred specimen type for this testing. It was added automatically by the test. Users do have the ability to add specimens manually but this is just one way that the LigoLab’s pathology lab reporting software can help guide the accessioner.

One thing that is notable about LigoLab Informatics Platform and its lab information system solution is that each specimen that's registered in the LIS system is getting its own unique identifier in the database, which we call the specimen I. D. So after this order is saved it will have its own specimen I. D. that the LIS system will know it by and usually that identifier is what is embedded in the barcode on the label for that specimen. So I'll go ahead and save the order and we'll get our label print window. 

The information that appears on the label can be whatever you would like. The accession number, the patient name, date of birth, or whatever you like. Now here we can also see it created an aliquot for us. So I have a configuration set up in the background that when this testing is ordered we're going to make a pour off tube from our sample.

Although you could print the aliquot label at accessioning, we like to advocate for what we call just-in-time printing. So we'll just print the aliquot label when we're actually making that aliquot.

So let's say we printed those labels, and then we'll be done with our order. So to print our labels, we're going to go to the specimen queue in the operations module. And here, you can search for the kind of specimen that you're going to be creating. You can look it up by the parent specimen, in this case the SST, or the specimen we're making, the aliquot.

And this is a very flexible processing queue, where basically there are up to two steps that you can register in the LIS software for processing. So when the sample begins processing which is a convenient time to print the labels. And then when it's done you don't have to do both steps for everything.

A lot of clients just skip straight to complete. But I'll show both today to show the flexibility. So we'll go ahead and open. Now from here I like to just scan in your parent specimen. So scan in your SST and then it's going to tell you to create an aliquot from that.

So you can scan them into the window. You can also select from the queue. Let's say we're just going to come in and do everything that's pending. And then when we go to begin, they'll all be in here. Or the last way that can be useful is using a rack. So let's say you had already scanned all of your SSTs into a rack.

You could just switch our lookup type to parent specimen rack, scan that whole rack, and it'll add all the specimens within it. So I'll do that for our complete step. 

Usually at this time the LIS system would print the labels associated with that. So go ahead and mark them as processed. So let's say we have our label now, and then we're going to go and mark it as complete. Now, let's say this time we're going to be scanning the aliquot itself, so we'll switch this to a specimen.

And let's say as we are creating these aliquots, we're going to be racking them. So, let's create a rack. They're very flexible. They could be like any dimension. But here I just have a pretty straightforward specimen storage rack that I've set up where you can scan specimens in. You can do a partial rack, you can fill it up however much you like, and this will be saved to track management.

And then once I save, it just immediately adds them to this window. So to show how we can refer to this information in the future, I'm going to go back to search. We're searching for this case anywhere in the LIS system where you are seeing a grid. Basically with cases or results you right click and you're going to have the option to see all the specimens for that order.

So we'll go there and we'll see our specimen and our aliquot. Since we wrapped the aliquot as part of our completion process, it is showing that location here and then it's only ever gonna show the current or most recent application location here in the search view. But you can right click and go to specimen details to see everywhere it ever was previously.

So here we can see when it was created and when it was scanned to the rack, as well as when I scanned it to end processing. And scan it into complete and you're gonna have location information. This is our facility abbreviation, so default facility, and the user, that's me, demo admin. 

Now for my next topic, I'm going to go on to worklists and batching. In our laboratory software system, you can configure any number of worklists and a worklist is basically going to be a group of tests that you want to run together. It could even be one test, right? You see, we have COVID, probably just one test. And there can be overlap, like maybe some of your tests are on chemistry and ancillary. It just depends on whatever works for your lab.

A good way to see what is pending for your worklist is to go to the clinical overview report.

And in this column, we'll see everything that is pending for the various worklists. So we have two main types of worklists here. We see exclusive and continuous. I'll just explain those really quickly. Exclusive worklists mean that any specific instance of a lab test result can only be assigned to one specific worklist at a time.

So let's say your first shift tech comes in, pulls the worklist, and there's 30 tests pending. Then throughout the day more samples come in and then when your night shift pulls a worklist, they will only see what has come in since this morning. Nothing that was on the worklist for this morning will be on the one in the afternoon, unless you already have repeats or something like that, or unless you unassign the worklist.

And then continuous is kind of the opposite of that. So with our same scenario, the first shift assigns the test to the worklist. And more tests come in throughout the day. At night shift when they pull a worklist, it will contain everything that's pending, regardless of if it was on the worklist at the beginning of the day.

Of course, both types of worklists will only ever have pending or in processing results on them. So if they've been completed, they're not going to show up there, right? So usually our chemical or clinical worklists are configured as continuous. So we see our chemistry here, collusive or more common like molecular, for example.

So here I can see there are 120 tests pending for chemistry, and I can click on the details icon or just double click on this line to be redirected to the clinical queue, or we'll see the list of all these results pending. So if you want to look more specifically, you know what comprises those 120 pending tests. 

Then coming here is a good way to do it. So we can go back for a second and we'll just generate a worklist on these right click actions here that will also bring up the worksheet associated with that. So this template is 100 percent customizable. This is just a pretty basic one.

You can see I have a column for accession, and receive date, patient name, and the test ordered. So you could take that out. Also, if you choose not to print it, it will be saved in the laboratory information system in case you just want to come back and reference that later. So once your testing is run, then you can come to the pending review to review results.

And here's our chemistry worklist that we just generated. Another useful thing you can do here is if you right click, you can view the manifest. This is going to be a list of the specimens and their locations which are associated with the tests on this worklist. And the list is separated by the specific specimen vessel type.

So here it defaulted to SST. And so these are all the SSTs associated with the test on this worklist, including where I scanned them in storage previously. And we know I also made an aliquot so we can see where that is as well. If we would like, we can see the status. 

You can print this, of course. So this will lead us right into results entry and verification. So to review the results for this worklist, we're going to go ahead and edit it and that will open the worklist for us. So here we're seeing the batch view of the worklist where the patients are the rows and the tests are the columns.

And we can pretend these results came in from the instrument and that we're gonna manually enter the bottom two lines. A few notes about this. So when your cursor is focused in the sum, then you're going to get a pop up with additional information at the top - it will be like an extra mini table for each time results have been entered for this test or run on an instrument either imported or manually entered, so we can see that the result of one was first entered on this date and time and the result 10 was entered on this date and time. Let's skip down to current values where we'll see it has value 10, which is considered a normal result, but by units and our reference range, it's not a repeat and there's no comment.

Now let's say I need to manually correct the value of this result for whatever reason. So if I type in a thousand, for example, now we're getting information in this preview section, so it's showing value. A thousand is considered abnormal, right? And then that would get the flag.

Oh, and you see the info panel section, which doesn't have anything here, but this is like an extra section for you to configure anything else you would like to see specific to this test when reviewing results. So to click out for a second we see the same columns of patient information here that we did on the worksheet.

So accession was received in the patient name. We could easily add anything else that's associated with the case or the patient. Maybe the date of birth or if they're fasting or not, something like that. 

So it's good for historical data, maybe like the last time this patient came in for this test. Maybe other details about this result or ask a question about values that you're interested in. They can even have images if that is useful for you. Now some other actions while my cursor is focused in this cell, you can go into the detail screen of this result using the built in keyboard shortcut control space, and open the detail screen.

We're going to see much of the same information here as we did on the previous screen. But this is the ideal way to enter a comment on the fly. So I can go to the comments for this result and enter comments like that. This is a macro enabled field. I don't have my macros memorized, but we can see them all by using control space again.

Let’s empty our macros and do received as an example. This doesn't necessarily pertain to this specific case, but you can kind of understand how that would work. And then if we click OK, we'll be returned, and the comment is immediately visible in that dropdown now.

And if we navigate away, then we'll see the blue circle with the white eye, which indicates that there's a comment. The other keyboard shortcut that we might make use of here is to mark something for rerun. So that's going to just be Ctrl R. You can see the change here in the drop down and again if we navigate away from the cell, then it will be highlighted red with a flag.

And when, if we were to release the worklist right now, then things marked for rerun will not be released, and then the lab information system will ask you to pull a manifest of just those reruns to help you repeat them. And that rerun status is just a toggle. If I do the ctrl R again, then it goes away. 

Another thing worth noting. Here you can see some of the results have a darker gray shading on the left and others don't. This is an indication of which results are editable. So in this case an uneditable result is calculated so I can't edit these like ratios. So for example, my bun creatinine ratio, it's getting this calculation directly from these tests.

And if I were to update this, then we'd see that value update in real time. And I mentioned this is the whole batch view of this worklist, right? There's one alternate view of the worklist, which is that instead of seeing all patients at one time, you can see just one patient at a time. So anywhere on your patient columns, right click and go to edit the result.

And then you'll be switched to a view where we're just looking at this one patient right now. And here now our tests are the rows, and we see some additional information in our columns here, information that would be available here but it's a little bit more visible. It just depends on your preference for how you like to review results.

And this can be set as the default view of the worklist if you prefer, instead of the batch view. So when you open it, it will default to this. So I'll switch back to the other view and release our results here. If I click release right now, everything has a value, so not the last two rows but the first four rows will be released.

Now, if instead you only want to release a few results for whatever reason with your cursor in that cell you can press enter and you'll see I get a green gradient on the right side. So, this indicates that soft approval. So right now, if I were to click release, then only those marked green will be released.

So that's a flexible way without any configuration or LIS software system changes or anything, you have the option if you want to release everything at once, or just a few. At this time, I would also like you to know we do have the capability to do autoverification based on criteria such as inconsistency rules, critical values, quality controls, and Delta checks.

In fact, you can see the Quality Control here. For example, we can view all the control rules from here, go into our statistics and see things like our Levy Jennings. We won't go into QC in detail today but can do so in a future webinar dedicated to Quality Control and Quality Assurance.

So my last topic is QA and statistical reporting. So let's say that I guess for QA and statistical reporting, we are going to leverage our tags and workflow action feature. So tags and workflow actions recorded in the LIS system are sually like the order, individual results, reports, or specimens. The way I like to describe them is that a tag is just like an indicator. It's kind of like a sticky note you put on something like you know pending hpv or high risk. Done, scanned, or something like that.

And a workflow action is similar but more, so it'll come with a comment. And then when a workflow action is applied, it's going to go to a queue for someone to do something with it. So it's good for things like “call the client about this”, or “this needs to be reprepped”, something like that.

It could be when this was received, when you were doing the processing here at results entry, or at any time. Let's say you are working with this specimen, but you realize you won't be able to run the testing because the specimen is hemolyzed. So I'm going to go to the order and scroll down to my specimens here.

I'm gonna go to my SST and I have these tags created for such issues. So I'm gonna add the hemolysis tag to this specimen to indicate that it is hemolyzed. And if we just peek over to the result data real quick we'll see a list of our tests and you can see that the LIS system has awareness of which specimen is associated with these tests and which one it should be run off of, which in this case is the SST, which is the sample.

I'm pretending it is hemolyzed. So what's gonna happen is when we save based on that tag, then it will reject all of the corresponding tests as “test not performed”, which because I did it from the screen, you can see very nicely in real time. And if we go over we can view our report. So here we can see the result of tests not performed for all of these and out of the common sample not sample hemolyzed.

So of course, this is just an example of how these could work. You could make the comment, whatever you want, or if you want to say rejected instead of “test not performed”. Totally flexible. And this was just done by a pretty simple automation that I created in the background. So then once we have done that, then of course we will be able to pull some statistics based on that information.

Let's go to operations. Here I have a template set up showing me my hemolyzed specimens from within the last 30 days. So I'm just searching for that tag and the default date range, and it brings them up. 

So it can be like show me these four specimens that were hemolyzed. We click on them, and that'll take us to a specimen search view, where we can find out more details about these cases and these specimens. 

Now, for a few more statistical reports. We are going to go to our test results tab in the reporting module. So, this is even more robust than the specimen stats that we just saw. These are the pre-built report types that we have in here. Turnaround based on lots of different start dates. Tags and workflow actions.

So I already saved a template for percent of positivity received in the last 30 days. And here we can see I'm doing a summary by department and then test. So we have clinical and molecular levels. If we expand the clinical, then we'll see the six instances of this test that were run in the time period, zero were abnormal and six were innate.

And A is going to be the test not performed, rejected, indeterminate, invalid, anything like that is usual. So these can be good for state reporting or even just general awareness. And you can adjust the summary however you like. Another common one for this report is about the client.

See if you have higher positivity coming from certain clients. And maybe that needs attention. And here, I'm just searching by my result ID, prefix of clinical, but you can see there's a lot of different filters available here so you can always adjust the criteria and then save your own template and then it'll be here in the future whenever you want to pull it.

So the last report I have to show is the turnaround time. Here is a turnaround time report. I selected some specific tests to show in this report. Again, just last 30 days by test. So, for example, the alkaline phosphatase that was received in the last 30 days, there were 10 tests received and they took an average of 33 hours to complete.

You can see five took less than 12 hours, one took less than 48, and four are incomplete. Those are going to be ones that aren't done yet. Now, one note, you can customize these brackets. So let's say for clinical you really want to add less than four hours or something, you could easily do that in the global settings.

And we can right click on the cell to go to those specific cases, right? So show me these alkaline phosphatases that were done so quickly, and it will redirect you to a search view. And so you can look at that.

That is all I have to present for this time. Any questions?

Michael: The statistical reporting. I think we got a good sense there of how versatile and robust the LIS system is. The amount of filters that are being utilized. You’ve got pre-built reports in there. And obviously, if you want to make an ad hoc report, that's possible to, correct?

Allison: Yeah, so additional tools we have for stats are going to be dynamic reports. We have lots of these pre-built stats screens but anything more niche that you might need, we can build in the dynamic report section.

Michael: All right, thank you very much for that tour. Now we'll open it up for questions. Utilize the Q&A option at the bottom of your screen. I will start things off. One area that I think is interesting and maybe you can shed some light on this, you mentioned batch testing during the course of your presentation. Are there any limits on the amount of batching that can be done within the LIS system at one time?

Allison: No, no limits. We can make a worklist for any size or any number of tests. For example, PCR. We support 384 well plates, which could be 384 results or even more if they're multiplexed, right? So yeah, any number that you need, this laboratory information system can support it.

Michael: One area of importance certainly is specimen tracking, and you went into pretty good detail about how this LIS system handles specimen tracking. From the hardware point of view and barcode printers, what have you found to be the best fit for LigoLab’s software solution? 

Allison: The preferred label printers are zebra, or any printer that communicates in the zebra language, which is ZPL. 

Michael: Next question. Are there visual indicators for stat, delta, and critical? 

Allison: Yes, there are. I didn't have them turned on but we can highlight critical results however you like. Let me go to the clinical queue real quick so you can and see this highlighting in the accession queue is a priority indicator. 

So I know in the LIS system that means their stat, You can configure as many priorities as you would like, just the defaults in the pathology software are going to be routine, expedite, and stat, and again, just in this LIS system, the highlighting for stat is red, but if you want to make it more nuanced priorities you can.

Michael: So Allison, in this pathology lab reporting software system built on rules, and then with those rules, you're able to create automation in the clinical laboratory?

Allison: Yeah, the rules and automations are pretty important for clinical labs, especially if you want to do any autoverification, that's going to be handled with the rules. 

But any more, like robust flagging, for example, are possible. I mentioned the workflow actions being used to call the clients. So that's something we frequently implement for clinical use. There are a lot of different possibilities there. 

Michael: Another point that was touched upon, maybe we can dive into it a little bit deeper, is the customization aspect. I think you mentioned the customization with the worklists and then you can take that out to the level of customization on reports, too?

Allison: Yeah, the reports are highly customizable. That's always a dedicated part of implementation where we'll design the reports with you. We'll have some templates pre-built that you can choose from but also, if you have an existing report that you really like, we can recreate it in our pathology lab software system. We can even work together to create something totally new. Everything's flexible. The layout. The colors. One of the frequent client customizations is putting their logo on the report. Basically you can have a unique report template for each client. 

A common example would be an HPV combined with a Pap, right? Maybe some of your clients want all those tests on the same report. Some of your clients may want a separate HPV from the Pap report. We can easily accommodate that. 

Michael: So let’s wrap things up here. The tour was a very good one. Well done, Allison.

For those of you that may have joined late or maybe there was something that was missed, we will have a recording of this webinar posted shortly at ligolab.com/webinars.

Also, if you have any specific question that you'd like to ask Allison, this email address, info@ligolab.com, would also be something of value for you. Allison, any last words that you'd like to share with our group before we say goodbye? 

Allison: No, I don't think so. Thanks everyone for joining. And I guess if there's any topics you'd be interested in seeing in the future, please feel free to reach out. 

Michael: Very important. Thanks for that.

In conclusion, we look forward to doing this again in the very near future. Check out LigoLab.com and any of our social media or emailing messages for details about future webinars. Thanks for your time and attention, and goodbye until next time.

AP LIS Product Tour

Watch this on-demand webinar and AP LIS Product tour with LIS Specialist Allison Still. See how advanced anatomic pathology software can modernize pathology lab management and deliver the desired flexibility to overcome bottlenecks and common pain points that prevent efficiency and growth. 

Allison’s tour of the AP module includes looks at the Grossing Touchscreen and the Histology Work Log. She also covers Error Tracking, Case Assignment and Distribution, and Quality Assurance and Statistical Reporting before wrapping up the tour with a question and answer session.

WATCH

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.

Healthcare Disruptors & Transition Strategies for Success

Watch our on-demand webinar as laboratory expert Stan Schofield discusses the volatile and uncertain landscape that today's independent clinical labs and pathology groups face, and what can be done to be successful despite the difficulties. 

Stan covers what's causing industry disruption before offering practical tips for how to navigate the choppy waters. During the webinar, he lays out his five rules for successful laboratories and looks at new-school ways for medical labs to add clients, keep clients, create new revenue opportunities, reduce expenses, and get paid.

WATCH

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.

Emerging Technologies of the Future Lab

Clinical laboratories and pathology groups are truly the health system’s “workhorses,” serving a critical role even as the industry deals with serious issues like reimbursement cuts, increasing supply costs, and a wide-ranging shortage of qualified personnel.

So how can today’s clinical and pathology lab successfully prepare for what the future holds?

It can do so by adopting technology and innovative new tools as they become available.

Watch our on-demand webinar as industry experts discuss the current state of laboratory technology and how innovation and emerging technologies will shape the lab of the future. 

WATCH

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.

Beat Pathologist Burnout & Combat Staffing Shortages

Pathologist burnout and staffing shortages are two major issues all clinical labs are faced with today. This, unfortunately, is unsurprising as they collectively deal with all-time high caseloads, rising costs, and shrinking budgets.

At LigoLab, we believe advanced technology and automation are the keys to addressing both of these issues.

Watch our on-demand webinar to learn how several automated LIS solutions can help minimize the repetitive and redundant steps that lead to stress and a lack of job satisfaction.

WATCH

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.

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