Tuesday, March 19, 2013

Ordering Off The Menu

Today we start implementing our solution for a universal lab problem: ordering off the menu. In other words, supporting orders for tests which your lab can either do, or send out, but which are not common enough to merit a test definition and/or an entry in your Lab Manual.

(In the trenches, we know that the explosion of possible assays will likely always outstrip the ability of labs to define tests and to maintain their Lab Manual, but the "not common enough" party line is so much more palatable to management that we use it as a courtesy to our clients.)

A truly useful test definition has the following aspects:
  1. an LIS definition to facilitate processing
  2. documentation, ideally in the external Lab Man
    1. what the test is called
    2. how to order it
    3. why order it
    4. when it is done
  3. documentation, hopefully in an internal Lab Man
    1. collection instructions
    2. handling & preparation instructions
    3. processing instructions 
  4. a billing definition to facilitate billing
An uncommon or new test might have to do without item 1 above for a while, because LIS test definitions are often complicated to do, difficult to validate and scarey to release.

More awkwardly, it is usually difficult to collaborate on test definitions in an LIS, although the ordering information make come from a Medical Director, the collection & handling instruction from the Front Bench and the processing instructions from the Lab Supervisor. Usually the LIS only provides good tools for the processing instructions since those are near and dear to LIS developers' hearts.

But when the lab falls too far behind in documenting new or uncommon assays, they make work for themselves when orders for these tests arrive. And this work is at every stop along the way: Customer Service to answer questions about ordering, the Front Bench to deal with miscollected or mishandled specimens, the Processing Bench to try to do the assay on whatever was collected, etc.

So we are providing a technological stepping-stone: what we call a pre-LIS test definition. We created a system to do the following:
  • attach different names to the MISC code
    • these looks like different tests to the users for ordering & processing
    • but these look like a MISC to the LIS for reporting
  • allow different users to enter different parts of the pre-LIS
    • include that information in the internal Lab Man
    • include that information in the external Lab Man
  • when the pre-LIS test definition is ready
    • automatically create an internal Lab task to build the test definition
    • automatically send information to Billing to request billing codes, etc
We feel that this is the best of both worlds: a rapid, easy-to-edit visible test definition that supports, rather than usurps, building LIS test definitions.