Tuesday, December 3, 2013

"Lab Man" Is Too Vague

We recently were asked to fix a specific instance of a general Lab Man issue. Again.

The specific instance was providing phlebotomists with collection information.

The general issue is trying to make a "Lab Man" that is all things to all people.

I say that "Lab Man" is too vague because according to my observation, it refers to any of these options:

A Test Menu, from which clinicians select clinical tests to be done. This is all about ordering, so it includes helping a clinician figure out which tests to order, in addition to simply what code to use.
A Collection Manual, which gives the phelbotomist or nurse or lab tech information about how to collect, store and transport the specimen.
A Processing Manual, which gives a bench tech guidance about how to prepare and processing the specimen.
A Result Interpretation Reference to which clinicians can turn for help in understanding the clinical significance of a given result.
Sadly, many of our clients feel that this model "makes things too complicated" and that a single format will somehow handle all these functions. "Why do you make things complicated by having different formats and different documents?" we often hear from the Lab Man Committee. But to the Medical Director, "Lab Man" means one thing, to the Lab Manager "Lab Man" means another thing and to Outreach Coordinator "Lab Man" means yet another thing.

Strangely, few members of the committee dispute that clinicians don't want to wade through collection instructions when trying to figure out the significance of a result. Drawers don't want to browse a catalogue, they just want to go straight to the pre-selected assay on the order. Bench techs only rarely care about the clinical research supporting the use of a particular assay for a particular medical history; instead, they want the preparation and processing instructions as quickly as possible.

One of our clients has a fab new HIS (Epic) which they want to use as much as possible outside the lab. They did not want to complicate things, so their Lab Man is a Test Menu/Result Interpretation Reference hybrid. This hybrid format works for doctors. But it does not work for drawers (nurses and PAs and phlebotomists) who are also "outside the lab." No Collection Manual for them.

Collecting without a Collection Manual is not working out very well, so I proposed the following: let the web site choose the format based on the incoming user ID. Or based on the IP (we can tell internal from external and we can tell which external IPs are actually draw stations.)

Context is everything, and these days context-sensitivity is often pretty easy to provide, so why not take advantage?

Update Thursday, December 5, 2013
Client has decided to go with a hard-to-find second link on their HIS, in the hope that (a) drawers can find the Collection Manual link and (b) clinicians cannot find the Collection Manual link. Good luck to them, say I.

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