LIS “Pros” Leverage Orchard Products to Promote Patient Care Improvements
A valued longtime Orchard Software customer, Mary Lanning Healthcare, uses multiple Orchard products to effectively boost lab efficiency, speed test reporting, improve patient safety, and increase their lab’s overall contribution to patient care. Mary Lanning is focused on efficiency and finding better ways to take care of its patients, and the laboratory has leveraged the many tools in Orchard’s products to support their goals.
“Dedicated to Excellence, Offering Hope, Health, and Healing”
Mary Lanning Healthcare is a forward-thinking, independently owned, 170-bed hospital in central Nebraska that is dedicated to excellence, hope, health, and healing. With a Level 3 trauma center, Level 2 NICU, two cancer centers, and multiple clinics, Mary Lanning is constantly growing. As an employer, Mary Lanning focuses on teamwork and employee engagement—as six-time Gallup Great Workplace Award recipient, their success is recognized worldwide.
Stellar Lab Staff with Lean Six Sigma Training
The laboratory at Mary Lanning performs more than 96% of requested testing on campus. The laboratory also services nearby critical access hospitals, outreach clinics, and private practices across south-central Nebraska and north-central Kansas.
The talented laboratory staff—more than 50 people with a combined 300 years of experience—includes three pathologists who are certified in clinical and anatomic pathology, as well as cancer diagnostics. The clinical and pathology laboratory performed more than 350,000 billable tests in 2021.
Mary Lanning invests in staff training, specifically quality initiatives such as Lean Six Sigma Green Belt training. The Lean concept relies on teamwork to improve performance by reducing waste and variation. Several of their laboratory staff completed this training and implemented efficiencies by using Orchard Software products. Medical Laboratory Observer (MLO) magazine named Mary Lanning Healthcare Laboratory as “2020 Lab of the Year, Runner-up,” largely due to the team’s ability to drive performance, quality, efficiency, and safety through these Greenbelt projects, which were complimented through the use of Orchard’s products.
Mutually Beneficial, Long-term Partnership with Orchard Software
Mary Lanning and Orchard Software teamed up in 2009 when the laboratory installed Orchard® Pathology and Orchard® Outreach™. Since then, Mary Lanning Healthcare Laboratory Services has expanded their Orchard product suite to include Orchard® Harvest™ Microbiology module, Orchard® Point-of-Care™, and Orchard® Collect™.
The laboratory has numerous interfaces: electronic medical records (EPIC), reference labs, blood bank (Haemonetics SafeTrace), and state reportable diseases. Their expertise in utilizing their laboratory information system (LIS) combined with Orchard’s consistent support and overall system configurability has allowed Mary Lanning Laboratory to maximize Orchard’s products to support the focus on efficiency and dedication to patient care.
Positive Patient ID Elevates Patient Safety
One of the initial projects undertaken by Mary Lanning’s laboratory involved specimen bar coding for block slide verification. Specimen bar codes are used for pathology to enable specimen tracking and patient ID verification across the entire process—from the specimen container, to the cassette, to the slide, and ultimately, to the pathologist. This block slide verification process ensures that the correctly identified patient specimens move through the system without errors. Compared to the previous process that involved handwriting on the slides, the bar code system has greatly improved the lab’s confidence in their processing accuracy and patient safety.
“With Orchard’s block slide verification, the lab can simply scan the cassette and the system will automatically print the slide and close that loop to ensure positive patient identity.” — Dr. Adam Horn, Chief Medical Officer and Laboratory Medical Director
With bar code scanning, there is an audit trail across the process, with time stamping at every point along the way. These efforts were recognized and accepted for presentation at the College of American Pathologists in 2019. (add footnote here to reference publication from Horn, et al.)
User Expertise & System Flexibility Enhance Communication
Orchard’s systems are highly configurable, so experienced lab staff at Mary Lanning continue to find ways to use the system to meet their specific needs and support their providers and patients. For example, the lab orders stains in the LIS and the orders display on a monitor in Histology. The Mary Lanning laboratory professionals and pathologists appreciate the flexibility of Orchard’s product suite because the software allows users to make individual modifications to support their workflows.
“One of the great things about Orchard is the system flexibility that allows us to improve our overall processes, rather than trying to replicate an inefficient paper system.” — Dr. Adam Horn, Chief Medical Officer and Laboratory Medical Director
Innovative Report Setup Speeds Result Delivery
With a significant amount of ancillary data and send out tests that do not flow through the interfaces, the lab was able to design a real-time data aggregation solution using a novel report type. The laboratory presented a poster presentation at the College of American Pathologists in 2021 defining this process. (again, add footnote?)
Orchard Pathology was used “to create a novel report type, Ancillary Testing Aggregate Report Information (ATARI), which can be accessioned for each cancer diagnosis either at the time of appointment registration or at the time additional tests are ordered. Outside results are aggregated at the time of presentation and entered through the [LIS] text menus to include the specimen identification number, where the test was performed, and the test results. Internally generated test requests also include the date the tissue was sent for testing, which allows for real-time status updates on expected turnaround time. The ATARI is electronically delivered to the pathology section of the hospital electronic medical record, and the report is amended as new data are generated, ensuring only one updated version is available.”1
The lab’s ingenuity and knowledge of the vast functionality within their Orchard products allowed them to use this clever reporting tool to aggregate the information and speed result delivery.
“It’s nice to know that we can depend on Orchard and on our own internal staff to make changes. The power of having the ability to configure the system internally is greatly appreciated.” — Dr. Adam Horn, Chief Medical Officer and Laboratory Medical Director
Automated Pathology Billing Aligns with Efficiency Goals
For the lab billing process, Mary Lanning’s goal is efficiency and automation. With Orchard’s solutions, Mary Lanning replaced their manual pathology billing process with automated professional billing, which reduced errors, increased claim payments, and vastly decreased hours spent by professional staff manually entering charges into the billing system.
Interfaced Analyzers Reduce Chemotherapy Wait Times
To address long wait times for patients needing chemotherapy treatment, Mary Lanning Laboratory Services used their Lean Six Sigma Green Belt training to uncover root causes and find solutions using Orchard’s integration expertise.
Patients who needed chemotherapy sometimes waited for necessary lab results on their treatment day—priority lab values weren’t reported efficiently which delayed the start to their chemotherapy regimen. To remedy the problem, the Cancer Center installed two new instrument interfaces that allowed results to transmit directly to the EMR. This rapid test delivery allowed providers to see results immediately and start a patient’s treatment.
By integrating the new analyzers with the existing LIS and EMR, Mary Lanning significantly reduced wait times for its cancer patients, and increased patient and provider satisfaction.
Provider-specific Rules Improve Communication
The Mary Lanning laboratory also tackled a project to address provider-specific requests regarding result delivery and automatic notifications. The team designed alerts within the system to meet specific provider requests and improve overall communication.
“With Orchard’s solutions, we have been able to get down to the provider level, the result level, and the test order level and create pop-ups so that our technologists are reminded to call when they need to, even if it’s not critical.” — Terri Brown, Director of Laboratory and Pathology Services
Alert for Blood Cultures Improves Patient Care & Staff Satisfaction
Using the flexibility in Orchard’s suite of products, Mary Lanning Lab staff were able to creatively solve a problem that had been unresolved for quite some time. Because positive blood cultures need to be addressed quickly and their microbiology lab was not staffed for third shift, they needed an efficient way to notify core third shift lab staff when there was a positive blood culture alarm.
Lab staff had tried several workarounds, such as setting timers and running over to the microbiology lab every hour to check if an alarm was sounding. The team was able to solve this problem with their integrated Orchard software. They created pop-up alerts in the LIS that would trigger a message on computer monitors in the core lab when a blood culture test needed attention.
This solution improved staff satisfaction and enabled the lab to address the positive blood cultures promptly.
Auto-validation Boosts Efficiency & Speeds Turnaround Time
With targeted focus on efficiency, auto-validation is a major strategic endeavor the Mary Lanning lab. “Efficiency is key in the lab and so any time we don’t have to stop what we’re doing to click a button to approve a result, that’s a big win for us. Our goal is to auto validate 75% of our interfaced lab test results, making those results available in the chart without the need for us to intervene.” — Terri Brown, Director of Laboratory and Pathology Services
State Reportable Interface Saves Techs Time
Mary Lanning Laboratory Services also has an interface with the Nebraska Public Health Laboratory that fully automates the process for mandatory communication of reportable diseases to the state lab. Result evaluation rules and scheduled browsers are used to designate results that need to be reported to the state. The automated reporting process saves technologists four hours per week and ensures that the state receives accurate and timely information. “One of the interfaces that we are the proudest of is our state reportable interface. Our state epidemiologist recognized our laboratory and Orchard Software as one of the best that they’ve ever worked with on a project.” — Lisa McCormick, Laboratory Information Systems Analyst
Summary of improvements
- Positive Patient ID Elevates Patient Safety
- User Expertise & System Flexibility Enhance Communication
- Innovative Report Setup Speeds Result Delivery
- Automated Pathology Billing Aligns with Efficiency Goals
- Interfaced Analyzers Reduce Chemotherapy Wait Times
- Provider-specific Rules Improve Communication
- Alert for Blood Cultures Improves Patient Care & Staff Satisfaction
- Auto-validation Boosts Efficiency & Speeds Turnaround Time
- State Reportable Interface Saves Techs Time
Reference List
Horn, A, et al. Consolidating molecular pathology data: a low-cost composite report prototype. CAP Abstract Poster No. 136; 2021.