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15 May 2023

Doing the work and getting the lab paid

COVID didn’t change the lab needing to get paid for doing the work

Amanda Caudle

Amanda headshot


Amanda has worked on the Clinisys Atlas™ product line since 2005. She is passionate about helping physicians deliver the right care, to the right patient, at the right time, and making things easier for the laboratorians that give them the data to do so.

Adapted from Amanda’s presentation at Executive War College 2022

The work of a health care laboratory is complicated, but we can break down our work into just a few simple functions. Orders come in, we get the specimens onto instruments, we perform the tests, and we deliver the results. The results are what drive patient care, so it’s no surprise that 70% of medical decision-making is based on laboratory data. Lab data provides an incredible wealth of knowledge to benefit patient health and improve patient care. It can also bring value to the business of healthcare.

In 2019, we as laboratorians were delivering value to our patients and to our healthcare systems by building our laboratory businesses. We were adding scale volume through mergers, acquisitions and partnerships, and we were getting paid for the work we were doing. But we were cheating.

Behind the scenes of getting paid for lab tests

A lot of laboratory test orders have information missing. Others come in on paper requisitions. Behind the scenes, we had set up manual processes to clean up these test orders—all in an effort to get paid. In some cases, we were the ones who mistyped the order details into the laboratory information system when we had two screens going, one to manually register the patient in the health information system (HIS) or electronic health record (EHR) and the other to cross-reference their insurance details, because the physician’s office didn’t care to provide it on the electronic order from the electronic medical record (EMR). Then, we cross-referenced catalogs and re-labeled or re-accessioned the specimens.

Were we spending a lot of time on these manual processes? Sure. Were we writing off more tests than we even knew how to quantify? Absolutely. But did we capture the dollars for the good of the bottom line? Yes!

We all knew there were a few cracks in that system, but pre-pandemic, we were mostly managing. We were level. We had the pipes in place to move data where it needed to go, even if it was only partly right.

Scaling for pandemic and new testing customers

2020: pandemic time. I remember reading a news article that Los Angeles Unified School District was planning weekly COVID-19 testing for all its 1 million students. Suddenly, one school board’s decision added a million tests a week. There was brand-new business coming at us from companies, sports teams, nursing homes, prisons, ships, and more. These new customers wanted quick scaling like we had never seen, which meant we would have to perform at scale—another issue entirely. And we weren’t going to be able to cheat our way out of it.

At the same time, legislation was flying. The CDC needed data. In those early days, we were lucky to get spreadsheets via fax, with names and birthdays. Next came new order entry questions to add, which meant new data points in our databases. “Capture the new information we told you about yesterday.” “Add these new electronic lab reporting interfaces by next week.” And, “We need high quality, accurate results. By the way, we are going to partially base payment for these tests on how quickly you can churn out results. Oh. Please.”

Topping it off were the opportunists who saw the chance to get into the mobile lab ordering business. If you thought getting clean, instrument-ready HL7 orders from run-of-the-mill healthcare customers was hard, try to bring new work into your LIS from innovators and disrupters during a pandemic. These folks were ready to pay in cash, but they didn’t know what HL7 was. They expected APIs and web services up and functioning in a few days, even though they didn’t know which label, what tube, what data the CDC required, or how to capture the data for an order, transmit an order, or even report results on an order.

There was never any question that we would do what was necessary to serve our communities. So, the one thing we as laboratorians learned in the pandemic is that we had many, many processes and systems that were only mostly good enough. They were impossible at scale.

Automation is the answer to getting paid for the work

Now that the pandemic has shifted to endemic, we are still not in control. Daily nuisances happen, like an instrument goes down or a reagent is unavailable. Labor market pressures persist, global supply chain issues have eased little, and inflation is the latest concern. So, how do we do the work and get paid from here?

We must automate, where before we threw people and money at the problems. We must have the means to accept new business. We need to have the flexibility to change processes. And perhaps most importantly, we have to take control of our own lab data, because the results we generate through the laboratory information system comprise more than half the diagnostic data in the electronic medical record system.

Clinical laboratories looking for long-term solutions to replace manual work with automation should consider Clinisys Atlas™.

Clinisys Atlas™ automates laboratory workflows

Clinisys Atlas is flexible, scalable laboratory data management middleware your laboratory can use to automate the otherwise manual workflows that validate test orders, check patient eligibility, fill in missing data, generate instrument-ready barcodes, route orders between multiple locations, report back results, and ultimately deliver the data you need to improve patient care.

Focus on what you do best, doing work to help patients get the care they need, with the confidence you will get paid for it. See how Clinisys helped three Maryland hospitals automate their test sharing and routing. Get the Clinisys Atlas multi-lab networking case study.

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