Webinars

^{Michael Kalinowski}: Hello, and welcome to this LigoLab webinar. Thanks for taking time out of your busy day to attend and hopefully learn a little bit about LIS laboratory information system solutions, modern anatomic pathology LIS solutions, with our expert in the field, Allison Still. 

Welcome again to the audience and also my two colleagues Allison and Olga.

We all know what the challenges with legacy LIS systems are. We'll talk about that in just a minute, but I wanted to make sure that we had a chance for each of you to introduce yourself to the audience before we get into the nitty gritty.

Allison, we'll start with you. 

_{Allison Still}: I'm Allison Still. I am the LIS system product manager here at LigoLab. I've been working with the application for about nine years now. Before that, I worked in a laboratory that used LigoLab, so it's nice to have that background. I'm excited to show everyone the application today.

^{Olga Solodukhina}: Hello everyone my name is Olga. I'm the head of sales and marketing at LigoLab. I've been with the company for more than two years. I'm here to answer any questions if you have them regarding the deal structure, how it goes, the LIS system software pricing questions, like how we implement the product, how much time it could take, things like that. If you're interested in any of that, I'm here to answer.

^{Michael Kalinowski}: Perfect. My name, Michael. I'm on the communications and marketing side of LigoLab. I've been with LigoLab for five plus years. 

So let's get things underway. If you’re attending this webinar, chances are you've run into these types of challenges that we have listed here on the screen. Legacy LIS systems are clunky, time consuming, require manual workarounds, and lack data integrity.

These are things that come about often when we talk about legacy LIS systems. Now, that's the bad news. The good news is there are other options out there. There are modern options out there that we hope to showcase for you today.

Olga what do you generally hear from lab operators, lab directors, and managers that have reached out to you wondering about what LigoLab can offer?

^{Olga Solodukhina}: We have different sizes of the labs reaching out to us, small ones, mid size and large size. As we always explain in our discoveries, the LigoLab platform has been built for mid size and large size labs primarily. But even in those cases, we still can see a lot of manual workflows, right? A lot of paperwork being used and a lot of gaps in the workflows that they want to fill in.

And even when they use some modern LIS systems, they still have those problems. That's why they would come to us to figure out how we can help them with that.

I think one of the main things also that we hear is that if the lab has both anatomic pathology and clinical lab workflow, that's something that causes issues because not all LIS systems are able to support both of them at once on the same level of quality.

^{Michael Kalinowski}: Allison, what may they be missing out on in terms of automation and advanced functions and features if it’s been a while since they shopped for a lab information system? 

_{Allison Still}: Every time we go to visit any prospects they always have a binder of rules that they're keeping at their workstation for things that they have to remember, especially accessioners.

So automation can really help with that. All those little things, little rules for special scenarios that you are trying to keep track of manually. That's really one of the main assets of automations, in my opinion. 

^{Michael Kalinowski}: Here are a few things that we'll touch upon during the course of this webinar.

The best LIS system does truly have the power to transform your lab operations, be it technical or financial. The key, especially with all the challenges that those in the laboratory industry face on a daily basis, is becoming super efficient while still being very precise and accurate, and then just boosting productivity.

These are things that you look for in a LIS system and in an LIS company to help you not only survive, but thrive, and that is the goal for all of us here. 

So Allison, if you're ready to go, I can stop sharing. You can dive into your presentation and into the LIS software and enlighten us with these three topics in particular.

_{Allison Still}: Yeah, I'm ready. I am showing our LIS software demo environment and let's go ahead and get started with ordering. We do accept what we call remote orders. These are going to be any orders sent to the lab electronically, most commonly from your clients EMRs, EHRs, and outreach. All of these things we call remote orders.

They will appear in this queue for the accessioning team. Here, if the specimen and or the paperwork that is received at the lab has a barcode with an identifier that has also been sent to us, the user can scan it up here and it will automatically open the corresponding order with everything pre filled.

It's just a quick quality control step and they will save the order and be on their way. But for today I'm going to do a manual order as if the laboratory had received a paper requisition. First, we will enter the client and the provider. We can enter any additional CC providers that should get a copy of this patient's report.

I'm tabbing through, adjusting our collected time and date, our received date and time. And then we'll tap down to the patient.

Here once the user enters the first line of the patient demographics, that's going to be MRN, patient first and last, date of birth, social. The lab information system will do a check to see if this potentially matches an existing patient in the system. If there is a potential match, the user will get this pop up on the top.

In this case, there's only one, but you might imagine there would be multiple and we can scroll through them. So at this time we can compare what we see to any physical documentation we received. If we determine that this is the same patient, go ahead and apply it to this order. Or if it's not, then we'll just go back and continue creating a new one.

Let's go ahead and apply this patient profile to the order. We'll see if their demographics got populated, as well as the insurance that they had the last time they came through. If they didn't have lab billing connected to the patient profile or you're entering the patient from scratch, then you could enter the payment source here from this drop down and adjust multiple payment sources.

Here there is some light lab billing functionality available as well, which is real time eligibility checking as well as insurance discovery. Going on to the second tab at the top, we will have our ICD codes and then we can tap down to add our tests. So this quick add drop down is always going to have the complete and comprehensive list of all the tests and panels that the laboratory performs here.

Now for labs that have larger test menus they sometimes like to take advantage of these what we call frequently ordered test menus. These can be configured by the lab with the things the accessioners are most commonly going to be ordering. You could customize these however is most useful to you, or also for smaller labs they usually turn these off.

I went ahead and added a searchable test for our demo today. Any “Ask at Order Entry” questions or additional data that you want to capture about this patient's date of service can be configured to appear here. Here we most commonly have a free text clinical history appearing here.

You can customize these however you like. Lastly we'll have the specimen section. There are a lot of customization options available for the default specimens that can be added in here.

It's going to create this tree, the first level of which is the name of our test. And then it's going to start with the defaults that are configured, most commonly it's going to be one site which is contained within one bottle. And then here I have it set up to always order one cassette and one H&E for every bottle, so that's defaulted in for us.

Here on the site description line, we're going to type the free text description as received from the clinic.

Entering the specimens like this, you can always enter more on the fly but I'm going to show more at grossing for a more traditional time in which that is done. So once we're done entering specimens, we can go ahead and save our order. First we have the option to print labels. The main two kinds of labels we're getting are specimen labels and lab order labels.

One unique thing about the LigoLab LIS system is each specimen gets its own unique identifier in the database, which we call specimen ID. And that is most commonly the identifier that will be embedded on the barcode that prints on the label for your specimens. And our lab order labels typically have the accession in them.

They're a little bit more basic. And an important note is the labels and their default configuration can be configured to what we call silently print in which case the default configuration will automatically print. This window wouldn't even come up and they would print without any user interaction.

I just like to have them to have the window shown for the demonstration. So normally we would print selected. And then we have the opportunity to scan the paperwork. For anatomic pathology, we do recommend this one piece flow, where the users can scan in the paperwork, any documentation, billing, anything that's received with the case.

It'll immediately be attached to the case. We do recommend this because the first step this is going to go to in the lab is grossing, where we've built an interface for the grossers that shows these attachments side by side with this workflow. The paperwork doesn't need to physically follow the specimen to the lab, where it could get damaged or damaged.

If that doesn't work for your lab what is more common with clinical specimens is batch scanning, which can happen downstream at any time. Just when you're doing the batch scanning, you want to make sure to sticker each piece of paperwork with the barcode I mentioned on the previous screen so that when you upload those documents, the laboratory information system will read that barcode.

And know which case to match each piece of paperwork up with. I'm just going to go ahead and attach a random PDF I have saved on my computer so we can get an idea of what this looks like. They're automatically saved. And that will be the end of the accession network flow. 

Next we can go to grossing.

So once the specimen goes to the lab, the first department it will be delivered to is grossing. The grossing tech will open the grossing queue. This is their real time list of all the cases that need to be grossed. If you are a lab that handles multiple specimen types, you'll see it all is grouped in this queue together.

When a case is marked as grossing completed then it will not be visible in this queue, but it will be visible in the next queue for the next step in the workflow. Here, in the grossing queue, the tech could manually browse this queue, double click on a case they're interested in, or scan the bottom up here to open the more detailed view of the result.

But as mentioned, we built a specialized interface just for grossers, which we call the touch screen. The screen is optimized for a touch screen monitor, which grossers often have. And as such, everything here is a little bit bigger for optimization. With that, we'll scan our bottle and the case will populate into the window.

We can go ahead and select skin, or a more specific area as needed, and then our operation. The operation is going to be the key piece that is tied to some more automation. You can see it brought in a link to a grossing description, it added the CPT code, and it can also apply those histology protocols for you.

Here in the grossing description we use this triple question mark character as a placeholder for values that need to be filled in by the grosser. In this case here, there's some dimensions. We can use the on screen keyboard, or your regular keyboard, of course, to fill those in.

You can use the on screen keyboard to move between the question marks using the arrows. You can also use just your regular keyboard with the control and arrows keys. Grossing techs don't always have real keyboards, but again, this convention is used throughout the application, so pathologists and transcriptionists, all sorts, can make use of them.

Entering the description is the main thing we're trying to accomplish here. We can go back to specimens and see the default specimens that were added at order entry. If we want to apply the protocol or order additional stains, we can open those as appropriate. A PIP here indicates there's some patient history we could take a look at if we would like, and if the grossers are taking images, then we will have a light integration with their camera, and any images they take will actually light here and be visible to the pathologist when they are reading the case.

We do support pre printing of cassettes, in which case a verification screen could come up when this was first brought into the window. Otherwise, this is the screen from which cassettes are most commonly printed when you're entering the gross. So normally I would recommend clicking print block and save, but since I don't have a block printer, I'll just save it the normal way.

After grossing the next workflow step will be the block queue. This is the real time queue of all the cassette blocks that need to be processed and embedded. In the block queue, there is a particularly flexible workflow. From this queue, we can record up to three workflow steps. When cassettes are loaded into the processor, when they come out of the processor and when they are embedded and when I say it's flexible, you are by no means required to record all three of these steps.

These steps are just here for you to record as much information about the cassette processing and embedding as you would like, and is practical for your organization. Some labs might only record two of these steps, only one, or they might skip the block queue altogether. All of those are totally fine.

Let me find the blocks from our test case.

I'm just going to record the histo tech that's doing this. We can indicate what processor we're loading these blocks into, and then go ahead and scan all the blocks that you are loading into the processor.

Each block that's scanned will get added to the window like this, and you'll be able to modify or customize the amount of information that appears about each block here. You can scan as many blocks as you would like, and then we'll click begin. And then when those blocks come out of the processor, you can switch to processing.

If you are tracking a processor, you could filter by those specific processors. Maybe here we'll just check our numbers. We know we then click the checkboxes. and then indicate these are coming out of the processor. All these steps are flexible, but you could use the checkboxes or a scan, just depending on what you prefer.

Indicating to the LIS laboratory information system we're taking these blocks out of the processor. And then lastly when it's at embedding, you can also record a specific workstation associated with that. Like I said, you don't have to perform all of these block processing and embedding steps.

In particular, if you track the beginning and processing steps, we have a dedicated stats report for calculating the processing turnaround time. Or just in general, it's nice to have a chain of custody of what instrument it was on, who did this and when. 

So embedding is the last step for the block queue.

Once it's embedded, it will come off the queue. And then we can go to the slide queue. The slide queue is similar. It is a real time queue of all the slides that need to be cut.

From here my recommended workflow is to open the assign window. You would have print slide labels checked, and then scan a cassette, and all the slides that need to be cut from that cassette will be added to the window. So this is the most common time to print the slide labels, as I said, and then the LIS system will know that this histo tech cut these slides.

There is an optional intermediate step that can be enabled if you would also like to scan the slides when they're being loaded into the stainer. I do have it turned off in this environment as it's not the most common workflow. And then once the slides are done you could do this at the time of cover slipping or whenever the slides are being prepared or bundled to leave the department.

We will come and tell the LIS system that the slides are completed.

We can open the complete window and then we'll scan all of our slides into this window to tell the LIS system software that they're completed. At this time you could print a working draft for the pathologists if your pathologists like to have a physical hard copy in front of them while they're reviewing the case.

Otherwise we'll just tell them that they're complete. We do have a case distribution workflow, which can be helpful for larger labs. The more pathologists you have, the more likely you are to want to take advantage of the pathology lab management system assigning the cases to the pathologists for you. 

Our LIS system has a rules engine that can help assign these cases based on these criteria up here. Case type specialty, state licensure, result ID prefix, maybe a client preference or a payer preference. Those are just the main criteria. Really, we can use anything that's associated with the case to assign it. Those are just the most common ones.

And here we can see there are some weights that can be configured. If they are configured, they will show here, and you can use that to limit the weight of cases that's assigned to any given pathologist. Maybe if you have pathologists that are only working part time, something like that.

And then we'll move on to pathologists reading the cases. So when a pathologist logs into the application, usually the LIS system will open directly to the pathologist queue. Any filters they would like, most commonly what's assigned to them, will be preset on their profile, so they don't need to mess with these filters, unless they want to, of course, but it'll already be exactly where they need to be ready for sending out cases.

So this is the Microscopic Surgical Test Result Details window. This is where everything for the case can be processed. We could have also done grossing from here if we hadn't used the touchscreen I briefly mentioned. When this case opens, the cursor will be right in Final Diagnosis, ready for the pathologist to enter their diagnosis.

To enter their diagnosis, they could just type the old fashioned way, they could dictate, they could type in a macro, Select a macro from this drop down up here. They even dictate a macro. It's a lot of options there. I'll go ahead and select one. This one came with a linked microscopic description.

There could also be a linked comment macro. We see a report review here on the right updating in real time with any changes. For example, if we add a comment here the section will update in real time. We can see CPTs and ICDs at a glance. If images have been added, they will be visible here.

If no additional stains are needed or anything we can just straight go to release. This can also be triggered by the keyboard shortcut F7, which you can see in the hover text there. And then the case will be on its way to be released.

If you don't want to scan the slides every time, that can be a nice way to work this queue. And for your more complex cases there's obviously a lot more tabs of information that can be used for more complex cases here. For example, images, right? So if you are a pathologist that likes to include micro photographs on your report we can talk to your camera, your microscopic camera, to bring in images.

I don't have a microscopic camera, so I'll just pick up an image I have saved locally. Those accumulate here and can be included on the report. If you take numerous pictures, you can hide them and also change the layout the multiple images appear in. You can go to the specimens tab and see all the specimens that were performed.

We could go into the slide and see the tracking information that I touched on earlier. If we want to order any additional items, we could open a stain table and drag and drop these or double click on them. Red indicates pending. As soon as this is saved with additional slide orders, these slides will appear back in the slide queue that we saw previously for the lab.

That slide queue can be set to auto refresh. Again, for larger labs, it can be nice to set up a monitor in the lab that always uses the slide queue and it's set to auto refresh frequently. All these additional orders will be viewed in a timely manner and the lab can start working on them as soon as possible.

We made a lab billing entry and adjusted our CPTs and ICDs as needed. These ones were added from the macros that were selected, right? A305 was applied because I chose this biopsy operation. And this ICD was chosen as associated with the final diagnosis marker I chose. We could go to consultations. This is ideal for internal consultations. For example, let's say I want to know what my colleague Petros has to say about this. We can put a note in here.

This user logs into the application. They will also see this case now in their queue with the note next to it, so the notes for the consult. We can go over to clinical history and we'll see those asked order entry questions from that order. Once this case is signed out, if it needs to be amended or corrected, we consider all those revisions.

So this tab will be used for those. You can have correlations. These are between concurrent or historical results for the same patient. It can be added via automation or manually and these are the fields you would fill in about that. We do have a correlation stats module that can be used to view the data on these later.

Additionally, the option to include it in the report as you like. We can go to send out, so if you want to send out for any procedures part of this case, you can track that. We do have a dedicated send out module where these records would appear.

And then any auxiliary fields or subtests you might want to configure can appear on these last tabs. So again, once we're ready to release, we'll go ahead and click that command. We have an optional screen that can appear that we call the pre release checklist. This is basically a nice way to enforce the pathologists double checking certain things about the case before they sign it out.

You can customize to some degree the type of information that appears here. For example, here we have our CPTs, our ICDs, it detected that it ordered slides that are incomplete, a consultation that's incomplete, right? 

This is just a nice way for them to check these certain elements. It's just one more click to sign out the case. Like I said, it's optional. You can turn this window off. You can even have it enabled for specific users.

Let me click OK. It’s detecting my incomplete correlation.

Let's delete it.

And then our case will be on its way out. Reports that are signed out will accumulate in this pending release report queue. Here's our test case. Here cases or reports will be held for a period of time which the laboratory controls. For AP labs, they like to configure this usually to 30 or 60 minutes.

This is a fail safe for scenarios where the pathologist signs out a case and then immediately remembers that he or she forgot something. Because the case is in this holding period, they can come here and pull the case back, make changes. But there was no revision needed because the case wasn't actually released.

But also, if that sounds like a feature you wouldn't use and you prefer them to just be released in a more timely manner, you can set that hold period to zero, in which case there will never really be cases here except for those that have an active hold. And then once the case is, it will be distributed to the client based on their settings in the application.

^{Michael Kalinowski}: Fantastic job. One question that popped up during the course of your presentation was voice dictation. Is voice dictation an option at the grossing stage?

_{Allison Still}: Yes, absolutely. The grossing window is highly dictation compatible. Really the entire application is but yeah, grossers and pathologists and transcriptionists are the most common users using that kind of dictation.

^{Michael Kalinowski}: All right. At this point, we'll start taking on more questions. Use the Zoom application at the bottom of your screen to ask a question of either Allison or Olga.

Allison, about case assignment. When would be used and how does it actually work?

_{Allison Still}: I would say it has two functions. One like what you said, to balance workload using the weight properties, right? And the other one it can be just very important to make sure pathologists read cases that they're licensed for. 

Especially if you are a larger client, you're more likely to be taking cases from out of state. Not all your pathologists might be certified in those like more niche states that most of your workload's not from. So yeah, I would say that the second component is to help enforce that the pathologists will get the right cases also for their specialty.

Derm paths, GI paths, heme paths, things like that. But yeah, the cases could be distributed either at a scheduled time of day, which you can control. Maybe you want everything that's available at 6 a. m. to be distributed appropriately according to the rules you've configured or otherwise you can just do it like ad hoc with whatever is available.

If they're coming on that day, they're just gonna distribute whenever they are available and then any cases that come in after that time of distribution or are left over will be in this queue for manual assignment. 

^{Michael Kalinowski}: Another good question that has come in. How are CAP synoptic report templates updated within the laboratory information system?

_{Allison Still}: We do the updates for you as long as you have a subscription with CAP. We will load those in for you. 

^{Michael Kalinowski}: Another one, digital pathology, how does that integration take place within the LigoLab applications? 

_{Allison Still}: Yeah, so we've integrated with several digital pathology systems.

The most common workflow is that when the case is opened from the pathologist queue, then it will send a transmission to the slide viewer and open the case in that application, side by side with LigoLab. It's ideal if you have a second monitor to view such things. But we also have a kind of the reverse of that we support, which is if the pathologist is using the viewer as their primary cue. When they open the case in that system, it can send a message to LigoLab to open the corresponding case on our side. So it can really go either direction.

^{Michael Kalinowski}: Another question that came in. Can we receive a link to the recording of this webinar? Certainly. I'll give out how you can contact either Allison or myself as we wrap things up and certainly we can send a recording your way. 

Another question. Is there a cloud version of the platform? And if so, does it work the same way?

_{Allison Still}: LigoLab is a Java application that is launched from your desktop with an icon like this. But the database itself can be hosted either on-prem or in the cloud. So the functionality of the application will be the same as you'll be launching it locally either way. But yeah, you can either have the server on site or be hosted in the cloud with Azure, AWS, or similar.

^{Michael Kalinowski}: Another good question. How long does it take for someone to be proficient in the LIS system and all the functions and features available? 

_{Allison Still}: Partly it'll depend on how many workflows the laboratory has, right? So for the smaller clients that are like a small DERM path, right?

You really have one workflow for your DERM path, I would say really quickly. And it depends on how much time you have to devote to being proficient in that, right? And then for your clients that have both clinical and AP maybe even, just more niche scenarios, it is going to take a lot longer.

So it really depends. For smaller labs, I don't know, maybe like a month, and then for larger labs, maybe up to a year, it just depends on how much you're working with it. 

^{Michael Kalinowski}: How about LIS system implementation. Can you give us a kind of a broad overview of how that works? 

_{Allison Still}: So once you sign with us, implementation starts usually immediately. First, we'll get the LIS software environment set up. And as soon as the environment is set up, you will be free to go in, start configuring, play around, get your feet wet, as they say.

We will have, depending on the scale and your timeline, regular meetings. Typically weekly, it could be more frequent. If your timeline is more aggressive, you'll meet with our implementation agents where they'll guide you through everything, training your LIS admin and helping you with all those configurations, rules, and reporting.

Then to go live, frequently our implementation agents will go on site. 

^{Michael Kalinowski}: Olga, I think maybe an opportunity for you to weigh in here or if there's anything else that you'd like to add.

^{Olga Solodukhina}: Yeah. Can I share my screen? So I just wanted to add a little bit about the implementation. If you can see my screen now. 

Okay. So just to outline the timeline and a little more about our sales process. Everything would start with a discovery call with the lab, and then we weigh in to the first demo and do as many demos as you will need depending on how big of a team you have or how fast you want to move forward.

Then we usually would discuss the proposal and the pricing and negotiate the conditions. Then once the decision is made, we'll go into the contracting stage, and then we'll go into the implementation. And again, depending on the size of the lab, implementation can take anywhere from three to nine months.

And yeah, the majority of the implementation is the integration. Everything will depend on the details of the integrations that we will have to build for you. And these timelines can be definitely a little different. If you need to move faster, we can go faster. And probably one more thing that I wanted to highlight today is also that we have the tiered pricing system approaching the different sizes of the lab.

What Allison has shown primarily covers the workflow for the essential tier and professional tier for the AP LIS pathology lab workflow. We do have a lot of advanced features and enterprise features that we can dive deeper into in case you're interested in that.

So the pricing will depend on the tier that your lab falls under. So I just wanted to highlight that part as well. And if there are any questions, you're definitely welcome to ask.

^{Michael Kalinowski:} Thank you very much. Tiered pricing. A little bit different. But I think it offers the laboratory the right size. LIS lab solution at the right time in their business trajectory. I certainly welcome that.

^{Olga Solodukhina}: And you can also think of the LIS system as a puzzle. Let's say you want to go with the essential tier, but you want to end up with a couple features from the upper tiers. That's also a thing we can do for you and build a custom solution.

^{Michael Kalinowski}: If anybody would appreciate a recording, please reach out to Allison. You can either scan the QR code or you can see her email address on screen.

And if you want a recording, or you have a direct question that you didn't have a chance to ask now, you’ll want to follow up with Allison. If you have a suggestion on another upcoming webinar, something that you would like to see that would be valuable for you, please, by all means, reach out.

Allison, Olga, any final comments? 

_{Allison Still}: Thanks everyone for joining. Happy Holidays. 

^{Michael Kalinowski}: That's what I was going to say. Happy Holidays and goodbye for now.