Manual processes – scaling up is hard

The COVID-19 pandemic has sounded the alarm again on how laboratories are under-IT resourced, still relying on manual processes in the pre-analytical, analytical, and post analytical phases of laboratory result processing. This author has seen an explosion of articles mid-pandemic in industry publications that call the laboratory to arms to replace outdated and antiquated manual activities.

The pandemic has further exposed the outdated IT infrastructure of some laboratories to meet the current COVID-19 testing challenge,  as well as laboratories without adequate IT support, depending on outdated manual processes. A recent MLO article indicated that labs with robust IT systems can quickly adapt to new testing by adding to their existing platforms whereas under-resourced labs are caught flat footed, missing the moment (Wilson, 2020). The reliance on manual processes is telling in a pandemic – the inefficiency of tedious and error prone activities directly impacts patient care. When labs cannot meet the market turnaround time needs, they are ineffective, and this seriously impacts consumer confidence. Linda Wilson says it best,- manual processes do not scale well when testing is needed fast and cheaply (Wilson, 2020).

Why do we Chase Paper?

The use of paper-based systems is not preferable or desired but exists nonetheless because, quite frankly, it’s easier. Paper is something we can see and touch. Migrating these processes to an electronic system can feel like we are losing control, even though the opposite is true.

The reasons for maintaining paper-based systems can range from indifference, a lack of awareness of the negative impact paper processes have on productivity to support a fear of change. We often hear lab managers complain: ‘I don’t have the budget to replace paper processing with IT or ‘my lab is not big enough to support an IT-based solution’ or ‘why fix what is not broken.’ The fight to keep paper-based and manual processes is steeped in the beliefs 1. paper-based systems are good enough, 2. that maintaining IT-based systems is more than it’s worth and 3. losing paper-based processes is equivalent to losing control.

Yet we know that paper binds data, it sequesters and hides it from all but a selected group of people. Paper-based processes prevent a wider user-base from gaining access to it, these processes bar data from real-time access and prevents that data from being used and analyzed, along with other data, to improve other processes. In short, paper-based systems suppress data that could be used to improve lab productivity and protect patient care.

What is the impact of paper-based systems?

Labs that continue to maintain paper-dependent processes will struggle to keep pace with the changing COVID-19 environment. Paper and manual based processes set up un-intended and unforeseen bottlenecks in the laboratory and across the organization that can impact the following operational aspects of your laboratory business.

• Delays in patient reporting

  Few industries incorporate the high use of paper and manual processes as a clinical laboratory. Unfortunately, these  manual processes add additional, usually non-added value steps to a time-sensitive patient result reporting process. Result data that is dependent on multiple steps invites errors and obstacles to life-saving patient care.

• Data is unavailable to others and not accessible on demand

  Information that is tied up on paper, is not accessible by other people and processes to leverage. Every specimen order has specific elements that should be shared with other users and cross department teams. Sequestering data on paper renders it static and not reusable to support crucial steps in the patient care continuum.

• Productivity and efficiency are sacrificed and cannot scale as volumes grow

  The use of manual based systems impedes lab growth and prevents the lab’s ability to adapt during high volume periods. There is no economy of scale when employing manual processes - you will eventually hit a wall where even the best forms and logs cannot make a difference in being able to operate efficiently.  

• Complex data manipulation or correlation is not possible

  Meaningful laboratory results depend on making correlations between analytes and their respective values. Lab results can also be expressed as part of a calculation of one or more results or as ratios or the formation of an additional result. Performed as manual computations without electronic data checks, these results are fraught with the possibility of error, even when performed by the most highly trained personnel. Electronic data integrity logic that ensures accuracy and clinical applicability is unavailable to labs that rely on manual processes.

• Data can be lost or mis-filed due to human errors

  Paper gets lost. Important result, QC or logs can ‘go walking’ and even disappear in a lab. These important documents fall behind instruments, get inadvertently stapled to other documents, or accidentally discarded to the trash. Reliance on human attention to keeping up with and keeping track of paper-based systems is impossible in today’s short-handed lab where techs multi-tasking more than ever.

• Hides analytical or processing trends or insights

  Data locked on paper is data that cannot be found to identify important trends or highlight a critical result value or an important time-sensitive data point because paper-based data cannot be recaptured.  What’s more, lab data is dependent on timeliness – meaning if it is not available when the physician needs it, the data becomes less useful. For example, critical lab results that are logged on paper to be called or followed up on are examples of data that is not available to be reported to medical professional or other reporting agencies in a timely manner. This could impact the patient treatment or the evaluation of emerging trends in real-time. Lab data that is locked onto paper in a permanent or delayed state cannot be transmitted to clinical repositories for data aggregation and analysis. Hidden data skews and distorts not only the holistic view of the patient medical history, but data on a bigger scale including epidemiology and population healthcare insights.

•  Manual processes are highly dependent on good personnel

  Reliance on too many paper-based systems especially in the laboratory creates inequities. Labs have to be constantly training and following up on those that forget to comply or are not trained adequately. This reliance creates friction in the lab when there are new employees, rotating technologists and those who intermittently cover different work areas.

IT Innovations are plentiful in the era of COVID-19

The rush to address the elimination of these paper-based and manual processes in labs in the era of COVID-19 is happening now, in real-time. The sheer volume of new lab testing dedicated to COVID-19 has again highlighted the problem of dependence on manual processes that degrade turnaround time and result reporting velocity with volume surges. Laboratories need to quickly replace paper dependent processes with applications that support connectivity, instrument interfacing, process automation, data transformation and reporting. As laboratories try to thread the needle with peaks and valleys of testing, they need to shed the practices that bog their processes down into the quicksand of manual activities.

New processes, methodologies and partnerships are being introduced into the laboratory every day, especially for molecular testing. Labs now maintain multiple platforms for the same test and must be able to transmit this data to more points of connectivity. Workflows are changing and are becoming more complex. For instance,  the implementation of pooled testing workflow requires IT and data logic that can aggregate and de-aggregate patient data to isolate positives and quickly report negatives. This type of IT and workflow assistance can ensure there is data integrity throughout the testing and reporting process, virtually eliminating any need for paper pushing.

There is an abundance of electronic and automated solutions that can eliminate paper and manual processes for all phases of analytical data processing and reporting.  Many well-known and emerging health IT companies have taken the opportunity to step in and help labs migrate their manual processes to provide faster and higher through-put testing. Labs can no longer delay the inevitable. The recent survey by MedicalLab Management released in November 2020, indicated that 45% of laboratories are increasing their technology acquisitions during the pandemic (McCormick, 2020). This is a directional indication that laboratories are taking advantage of the moment to start the justification process to add more IT and technology to automate more processes in the laboratory.

IT solutions are also needed for connectivity with providers, third-parties and point-of-care testing directly serving the consumer wherever they are. A study conducted by  KLAS/Chime in October 2020 indicates that interoperability, especially for third party applications for patient facing and clinical decision tools are some of the top needs for laboratories (Burda, 2021).  This same study proclaims that interoperability is going to make significant changes in the future. If we are to make this type of lasting change, manual processes have to be reviewed and eliminated where necessary using interoperability and software logic to reduce the human burden of managing and analyzing large amounts data.

Embracing connectivity with new software solutions and along with replacing manual processing through automation is how labs will meet the current crisis in testing and will be able to survive, prosper and ready to tackle the next challenge.

Inspire you.

Auto-verification is one of those electronic processes that eliminates manual review of results with paper backups. Any lab – small to large can implement with its current LIS, middleware, or instrument vendor. It is one of the IT tools that once implemented makes an immediate and dramatic change in your ability to scale up to larger testing volumes with the same resources. Check out our blogs for more in-depth analysis of auto-verification and how this tool can help you stop the paper chase and improve your laboratory operations.

References:

1. Wilson, L, (2019). Deleting paper processes improved covid-19 testing throughput. MLO, November, 19, 2020. Retrieved from Deleting paper processes improves COVID-19 testing throughput | Medical Laboratory Observer (mlo-online.com)

2. McCormick, D. (2020). Striving for laboratory equilibrium. Medical Lab Management. November 2020, Vol. 9, No. Page #4. Retreived from Wilson, L (2019). Deleting paper processes improved covid-19 testing throughput. MLO, November, 19, 2020. Retrieved from Deleting paper processes improves COVID-19 testing throughput | Medical Laboratory Observer (mlo-online.com).

3. Burda, D. (2021. Interoperability is in the eye of the patient information blocker. 4sight Health, February 1, 2021. Retrieved from https://www.4sighthealth.com/interoperability-is-in-the-eye-of-the-patient-information-blocker/