Webinars

^{Michael Kalinowski}: Hello and welcome to our LigoLab webinar. 

The topic for today's webinar is how standardization and enhanced reporting capabilities improve lab workflow and overall business operations. We are going to talk about the big picture, but we're also going to focus on Pathology Consultants and how they've leveraged modern LIS laboratory information system technology to achieve their major business goals and how other labs and other lab operations can do the same.

I'll kick off the webinar by saying my name is Michael. I am part of the communications and marketing team at LigoLab and am pleased to have Kristie and Allison with us. 

Kristie is the LIS System Administrator at Pathology Consultants. Kristie, please start by giving us a little introduction about yourself and what your role is there.

^{Kristie Becerra}: I've been with Pathology Consultants for about 22 years. Currently, I am the LIS System Administrator and my background, I have an educational background in health information technology and healthcare administration. Over the years, I've had various roles in this organization usually centered around health information, coding, laboratory billing (laboratory revenue cycle management, lab RCM), and some operational departments.

I was the project manager for our implementation of the LigoLab platform and that led me to my current role. 

^{Michael Kalinowski}: All right. Welcome. We appreciate you taking some time out of your busy schedule to join us today Allison the floor is yours. 

_{Allison Still}: I’m Allison Still. I've been working with LigoLab for about nine years and I'm the Laboratory Information System Product Manager here.

Before that, I used to work in a laboratory that underwent a project to implement LigoLab. and I helped with that, so it's nice to have that laboratory background when having these kinds of conversations. 

^{Michael Kalinowski}: Wonderful. Thanks for joining. 

So let's talk about something that anybody within the lab industry probably is already aware of.

Rising costs, falling margins, increased regulations, and personnel shortages. This makes you wonder why anybody would want to get into the laboratory industry in some ways.

Of course the folks who work in laboratories are the real heroes within the medical healthcare industry and we do appreciate what they're able to do despite these challenges, these headwinds. 

Kristie, give us a sense of what things are like and how Pathology Consultants is taking on these challenges and still able to be successful. A general overview. 

^{Kristie Becerra}: Yeah, like many organizations and especially laboratories, I think we all experience a lot of the same challenges and from rising costs to our supplies and equipment costs to even utilities have been challenging. We always are getting threats for Medicare reductions and this year, especially, it makes it difficult to maintain financial stability.

And then you always have compliance and regulations that require your time and resources and can be an administrative burden. 

^{Michael Kalinowski}: Is there any one challenge that in particular Pathology Consultants is most concerned about?

^{Kristie Becerra}: Yeah, I think staffing has been one area that we've really improved with bringing in LigoLab to our organization. We were coming out of the COVID times where staffing was really difficult. So we were not at capacity for staffing and so experiencing some of the efficiencies that we have since has really helped us.

^{Michael Kalinowski}: So success backed by technology is possible for forward thinking labs like Pathology Consultants taking matters into their own hands, and taking control and independence of their operations to enhance workflow and reporting capabilities. 

We'll get into a little bit of that next, but first, how about this…serving Western Oregon since 1932. Pathology Consultants has been around and really been a beacon of success and healthcare in that region for nearly 100 years. 

PC ran its business with a shared laboratory information system LIS for several years before making the decision to transition to the LigoLab platform and gain that independence and better control.

Kristie, give us a sense of what things were like with the shared laboratory information system and then why ultimately the change to your own LIS system. 

^{Kristie Becerra}: Yeah, I think utilizing the shared lab information system became one of our pain points because we lacked control of the LIS system.

So if we wanted to add additional testing or reconfigure the way we were reporting something, we just didn't have the ownership of the LIS software to be able to make those changes. So that was difficult for us. We had the desire to grow our organization and part of that was to expand our clinical test menu.

So that became a focus for us as well. And the LIS system that we were on didn't have the capacity to do the clinical side. Those were our two main driving forces to find something different. 

^{Michael Kalinowski}: Then the evaluation of the LIS system and laboratory information system vendors comes into play. Give us a sense of how that went, what the approach for Pathology Consultants was to make sure you got the best LIS system for your team and your growth goals.

^{Kristie Becerra}: We started with a slower approach.

But at one point, the other organization that we shared a system with, they had decided that they were going to move to another LIS system product. That gave us a timeline, an increased timeline. So we were very serious about what our options were. We could stay with the organization and share another lab information system, which still wasn't going to give us the clinical side of things.

And then we also looked at different laboratory information system software products that included separating our clinical (LIS medical) and AP systems (anatomic pathology LIS, anatomic pathology software), and we ended up choosing LigoLab as a great all in one pathology software product that was configurable and gave us a lot of options.

^{Michael Kalinowski}: That’s one united LIS system for anatomic pathology LIS workflow and clinical laboratory workflow management. 

Allison, tell us about your relationship with Kristie. Start with the LIS system implementation and then work your way toward where we are now today, three years later.

_{Allison Still}: I was one of the team members who worked on the Pathology Consultants LIS system implementation. So we would have several calls, almost every day of the week since they're such a large organization. We'd have specialized department calls, so molecular one day, GYN cytology one day, and so on with different teams. Kristie was usually on all of them as the lab information system Project Manager and they were really great to work with.

It was so great they had the time to work on that with us. Not all clients have the resources to be able to do that. So that was really nice. They were really receptive to learning to be able to make those customizations themselves. I think the LIS system implementation was about nine months.

Myself and Petros went out there for a few days on-site while they went live with their LIS software. Petros, while we were there, commented that it was one of the smoothest go-lives we have ever had, which I think is a testament to the Pathology Consultants team and their active involvement throughout the entire process.

After that we had ongoing support, and I think she's gonna talk about some of the new testing that was implemented after going live in just a bit.

^{Michael Kalinowski}: Kristie, 20-plus years in this industry. I'm guessing you’ve worked with multiple laboratory information systems. Were you surprised when you went through the evaluation process about what type of features and capabilities were available now? Or had you kept an eye on what was available all along and had a pretty good sense of what you needed and what was out there? 

^{Kristie Becerra}: I think it was really exciting as we were going through the process to realize we could, especially coming from where we were with very little control over manipulating some of those configurations and customizations, what was now possible.

Anytime we heard ‘yes, we can do that’, it was great. And it was really nice to have the support of the LigoLab team. They walked us through everything as we built. 

^{Michael Kalinowski}: Next let’s discuss high-level keys to business growth. Better communication, higher productivity, and simplified workflow. Kristie, I'll give you a chance to weigh in here on these big-picture statements.

^{Kristie Becerra}: We have our own laboratory as well as the professional side of the business, so sometimes you can see some silos between different departments and teams. I think this LIS system has really helped us with communicating via the LIS software, being able to tag different specimen types and identifying them utilizing the Site Manager, and then also the workflow actions have helped us to be able to communicate across teams when we're not in the same room or even in the same building.

^{Michael Kalinowski}: Allison, explain to the group here workflow actions and what that means from a LigoLab point of view. 

_{Allison Still}: Workflow actions are like a flag or a task that the lab can create on their own. The main purpose is to eliminate any manual work happening outside of the LIS system, like any Excel spreadsheets and manual notes.

So I think they definitely facilitate communication and are also useful for quality control. So let's say during grossing, they encounter an issue. Instead of having to write it down or call someone they can add a workflow action and continue doing their work and then all the grossing issues or workflow actions can be handled together. It's all documented and saved forever in the laboratory information system. 

^{Michael Kalinowski}: Kristie, do you have an example of higher productivity that you could share? 

^{Kristie Becerra}: Probably with utilizing our workflow actions, we like Allison mentioned, we're able to free up the accessioners or grossers when they do identify an issue that may be a client issue and instead of them having to stop what they're doing and unglove and get to a phone to call the client or get someone to help them with whatever the issue is, they're able to utilize those workflow actions and keep moving on their grossing or their accessioning. So that helps streamline things. 

^{Michael Kalinowski}: Allison, one LIS software database. Is that something that really contributes to this? 

_{Allison Still}: Yeah, absolutely. It's a real asset to have those in the same application, not toggling back and forth. Easier for all the users and of course the patient history. Pathology Consultants has hematology cases where they have a CBC going through the clinical lab and then slides going to the pathologist. So having those lab workflows all together is really helpful.

^{Michael Kalinowski}: Let's dive a little deeper into the Pathology Consultants workflow in particular. Kristie, please discuss customization and how that opens up multiple options for you in your team. 

^{Kristie Becerra}: This was an area we found really exciting because we were able to see a lot of the benefits of utilizing these things in the laboratory information system. We initially focused our templating efforts on our derm path work because it was a high-volume department and we were seeing a lot of repetitive diagnoses and microscopic descriptions and thought that would be a good area to start in.

So we have connected microscopic diagnoses to the final diagnoses and added the diagnostic codes with the CPT codes, and we've seen big-time efficiencies in our coding group and our audit group where we were struggling with staffing. We were able to start meeting our productivity goals by utilizing the efficiencies and our dermatopathologists noticed pretty quickly that they were saving some time in their day.

They were having some really long days before we implemented LigoLab, and they were finding that they were getting done with their workload a couple of hours earlier in the day, which was great for them. 

^{Michael Kalinowski}: Automated coding. Sounds great. 

^{Kristie Becerra}: We've been able to utilize some of the automation and rules configurations to make our coding a little bit easier. One that comes to mind is we have automation set up for our flow reporting, so we have some calculations working in the background that count the markers, check for duplicate markers, and add all that information up.

If you've ever done coding on flow reports, it can be a little tricky to do that manually. You have to look at the documentation to see what was done and make sure you're capturing all the charges. We have our flow reporting almost completely automated, so it saves our coding staff a lot of time on the back end.

^{Michael Kalinowski}: Fantastic. Synoptic reporting support. Kristie, maybe you can talk a little bit about that. And then I know Allison is prepared to show the LIS software and give everybody a look at how it works within the LIS system. 

^{Kristie Becerra}: We have found a lot of benefits using the synoptic reporting feature and we're meeting CAP compliance in our reporting.

We’ve been able to utilize those data elements to meet other compliance standards. We can export that data easily to produce reports and extract data for our MIPS reporting. So we've been able to utilize it in a lot of different ways.

And then, of course, you can still attach your CPT codes and ICD 10 codes to make that all a little bit more efficient as well. 

^{Michael Kalinowski}: Allison, if you are prepared, I’ll let you take over.

_{Allison Still}: So this is our LIS system demo environment. On the left is the Result Manager where pathologists can enter their results and various tabs of other things. And this is a floating report preview. So to use the synoptic reports in our LIS system they'll be tied to a macro, which I'm going to pick from the pick list here.

Just enter the abbreviation which you configure or dictate, which I think Pathology Consultants does a lot, but when we choose the macro linked to the CAP synoptic report, then what I call the wizard will open and in this will be an imported template from CAP. 

When you fill it in, it gets the green checkmark letting you know that you've filled it in sufficiently and the yellow plus signs are optional. When you're done, you can just click OK, and it'll all be added into the Result Window. 

^{Michael Kalinowski}: So this is great. What happens if you don't have this option? Is it done manually on an Excel document? 

_{Allison Still}: They would probably just type it in directly like they would maybe pull it up on CAP’s website and reference it and then you have to type it in manually. They do make changes quarterly so you just have to make sure to keep up to date on all of their latest recommendations. 

^{Michael Kalinowski}: Thank you for sharing. 

The next topic is data standardization and consistency. Consistent data flow across all departments and providers for better documentation and enhanced lab billing accuracy. So that's something that should catch everybody's attention. Better lab billing accuracy, which translates into more consistent cash flow.

Kristie, what is the impact in terms of standardization and your customers? Can you describe how those improvements have impacted your relationships with the customers that you work with? 

^{Kristie Becerra}: Yeah, we've actually heard from some of our clients that they do appreciate the standardization that they're seeing and some of our results because it helps them easily identify the information that they're looking for.

I mentioned that our coding and audit teams have benefited. But how that kind of has translated into dollars is that they're able to identify the technical work that has been performed and documented more easily when it's not scattered about in different areas of the report. By standardizing your documentation, you're able to more accurately identify all the stains that you performed and all the additional work up that you may have done on the case so that you can capture those charges.

And then we always like pleasing our clients by providing them with any improvements that we can.

^{Michael Kalinowski}: This was referenced earlier. The next area to highlight is expanded test offerings, taking previously sent out tests, keeping them in house, and how that has positively affected the bottom line, strengthened client relationships, and sped up turnaround times. 

^{Kristie Becerra}: Right away we identified tests that were a high priority for us to bring in house and that made sense for us to bring them in house. We were motivated by the oncology group here in Oregon that we work with. We're close partners with them and they were vocal to us about tests that they would like to see improved turnaround times on and that they would like an all in one facility to send their material to get their results.

So we had some tests in mind and worked on some of those during our initial implementation and then quickly got up to speed adding some of those PCR tests, the EGFR, the MSI and the BRAF, pretty quickly afterwards. 

^{Michael Kalinowski}: How was the staff affected by this? Was more staff needed to bring on this testing or were current staff members repositioned? Give us a sense of the work behind the scenes to make this a reality.

^{Kristie Becerra}: Our state of staffing was a little bit pained because of the kind of COVID times that we were coming out of. It was difficult to recruit and retain qualified staff. So for our send out department, we saw a pretty big impact because we had about four FTE working just in send out with the pulling of the blocks, the packaging, and keeping track of return materials and return results.

We immediately saw a quick reduction in our staffing there. So we were able to redirect the staff to doing other things, which really helped us a lot. 

^{Michael Kalinowski}: That's really good. So you've accomplished a lot over the course of three years.

You and your team deserve a lot of credit. In fact, I believe in a previous discussion, you mentioned that there were some that resisted change and you were able to overcome that. 

What are the leaders of your team thinking about as the next steps as far as improving particular departments and improving client relations?

^{Kristie Becerra}: We're continuing to focus on quality improvements and process improvements.

Of course, we do want to continue to expand our test menu. So there are always exciting tests on the horizon that we're looking out for. We still have some high volume tests that we send out, so we keep an eye on those as well and see if those are feasible to bring in. We've looked at a couple of different tests that we might want to bring in, some FISH and additional PCR testing.

But we really want to look at our GI specimens and try to capitalize on the templates that we've utilized in our derm path work and see if we can make that site a little bit more efficient as well, and see if we can gain some of that efficiency there. 

^{Michael Kalinowski}: Allison, an LIS System Product Specialist. Part of your job is talking with the people that use the LIS system on a daily basis and garnering feedback and understanding what could help them improve their laboratory workflow management even more.

From your position, what value does that feedback have as far as our development arrangement with LigoLab is concerned? Everybody always wants something yesterday but how does customer feedback directly affect the development roadmap?

_{Allison Still}: It affects it very much. Almost all the new features we develop are because one of our clients requested it. It's crucial. One of the features we're looking at implementing right now is for peer review. It's something we've used workflow actions for in the past, but because it is such a dedicated special workflow that more and more clients are wanting to implement, we want to develop a devoted feature for it. 

^{Michael Kalinowski}: Let's segue into questions from the audience. If you've been on these webinars before you know you can submit your questions via the Zoom application at the bottom of your screen.

This one is for Kristie. What did the pathologists think about the new laboratory information system?

^{Kristie Becerra}: We were pretty lucky with our group. I think our pathologists were ready for the change. They were ready for something different and something that would improve their organization. So they've been pretty good about the changes and the differences that they're seeing in their workflow.

But they've also enjoyed that they're able to ask for some things in the lab information system that we can accommodate by customization. The LigoLab staff has been great at getting back to us in a timely way and continuing to work with us when our pathologists do want to see something a little bit different in their view or workflow.

So I wouldn't say that we've had any outstanding issues there. I think they've all been pretty happy with how it works, especially with our dermatopathologists and some of our other areas that have seen some efficiencies. They have been able to reduce their time at the scope by some of the efficiencies of the LIS system just getting them through their workday a little bit faster.

^{Michael Kalinowski}: Here's a question for Allison: How much, if at all, does LigoLab help clients with templating and report customization, the two elements that were mentioned a little bit earlier? 

_{Allison Still}: A lot. Usually the first reports that are built during LIS system implementation are built by us, and then we will show the client how we did it so that they can customize it themselves in the future.

Typically when there are new assays, the EGFR that Kristie mentioned, we will do those as well.

^{Michael Kalinowski}: Kristie, can you compare the current LIS system software with some of the other LIS systems that you've worked with in the past?

^{Kristie Becerra}: Oh, it really does not compare. I think it’s a robust LIS system and that you can take it as far as you want to take it. 

Allison had said they can be very involved in helping with templates. That's one thing that we really appreciated about their LIS model. I can get one of them on the phone or on a virtual share and they'll walk me through how to do something maybe once, twice, or 10 times if I need it.

They have helped me to be able to own some of the configuration myself so that we're not reliant on it. You can reach out to their support desk and get help with what you need help with. 

^{Michael Kalinowski}: That's interesting. So would you call yourself a LigoLab super user at this point?

_{Allison Still}: I think she is. I hereby designate you!

^{Michael Kalinowski}: The key is, I guess you don't have to be necessarily a super user because there is the support that's available.

Here's a question. What LIS system improvements are out there? What's the next step? The buzzwords really are machine learning and AI. How would a laboratory information system like the LigoLab product take on these new tools?

_{Allison Still}: We do have some projects related to AI going on at the moment. Our CEO, Suren, is very passionate about that, and however we can leverage that. So the engineers are working on how they could read the free text diagnosis and then, based on that, recommend an ICD and similar CPT code.

Other features we're looking at are related to peer review and inventory enhancements for clients that want to track their supplies within the medical LIS. 

^{Michael Kalinowski}: Last question. I'll give it to Kristie.

It's that time of year where we're looking back and looking forward to 2025. From your seat at Pathology Consultants, what do you see as being a big issue in 2025?  

^{Kristie Becerra}: We've looked at the Medicare cuts for laboratory services and we're concerned about that. So we want to continue to be efficient and streamline our workloads and processes and try to be mindful about where we're going in the future. Our organization specifically, we are continuing to look to expand our services. So we'll continue to look at what tests are needed in our community and what makes sense for us to bring in house to add to our test menu. 

We have recently added the client portal that LigoLab offers and many of our clients are benefiting from that. So we will probably see some growth there too.

^{Michael Kalinowski}: Okay, I'll let Allison weigh in on the provider portal. I know you've had a lot of involvement with development and improvements there. 

_{Allison Still}: We are definitely working hard on enhancing our physician portal, but also related to the web, we are working towards allowing pathologists to sign out from the web. That's a request we get pretty frequently. To allow pathologists to sign out from a tablet to be more remote, more on the move. So yeah, that's something we hope to do very soon. Next year. 

^{Michael Kalinowski}: All right. We have reached the end.

Thank you very much for you both for the folks that attended. We will in a couple of days have this webinar available on demand on our website. And as always, if there is a particular topic that interests you that you'd like to see turned into a webinar. Here's your opportunity.

In fact, I'll volunteer Allison. We've got Allison's email address up here. Directly ping Allison with an email and say ‘this is what I would like to see for a webinar next time coming from LigoLab. 

With that, thank you again for everything that Allison and Kristie have contributed here and for the audience for taking the time to listen and learn.

And until next time, I'm Michael. That's goodbye from LigoLab.