Webinars

^Michael: So, good afternoon and good morning and welcome to this LigoLab webinar slash clinical laboratory module tour. My name is Michael Kalinowski. And we soon will also be hearing from Allison Still. Allison is a laboratory information system (LIS) product manager for LigoLab. Somebody who is well versed in the laboratory world and somebody that we really appreciate.

We know you're busy, so we really appreciate you taking the time to help us out and do this sort of demonstration with the audience that is gathered here today. Allison is going to do a demonstration that should last roughly 25 to 30 minutes, and then at that point we hope to have an interactive question and answer session.

So if you have questions, feel free to use the interactive tools on your Zoom screen to give us questions at any time, and we'll plan on answering those questions after the LIS software system presentation has finished.

For those that aren't familiar, LigoLab is an all in one laboratory informatics software solution that covers all of the diagnostic disciplines, plus lab revenue cycle management and direct to consumer lab testing. For that we have a module called TestDirectly that was very valuable during the course of the coronavirus pandemic, allowing laboratories to directly connect with patients for their direct to consumer testing needs.

So now let’s dive into the clinical laboratory module, and this is what Allison will be covering today. 

And with that, I think I will turn it over to Allison. 

_Allison: Thanks, Michael. 

Okay, our first topic today is specimen tracking. And so for that, I would like to start with the new order screen. I'm accessioning a new order here, and  I'm ready to enter the testing. Let's say today we're going to work with a panel. 

So the LIS system is telling us, you know, this is the preferred specimen type for this testing. It was added automatically by the test. Users do have the ability to add specimens manually but this is just one way that the LigoLab’s pathology lab reporting software can help guide the accessioner.

One thing that is notable about LigoLab Informatics Platform and its lab information system solution is that each specimen that's registered in the LIS system is getting its own unique identifier in the database, which we call the specimen I. D. So after this order is saved it will have its own specimen I. D. that the LIS system will know it by and usually that identifier is what is embedded in the barcode on the label for that specimen. So I'll go ahead and save the order and we'll get our label print window. 

The information that appears on the label can be whatever you would like. The accession number, the patient name, date of birth, or whatever you like. Now here we can also see it created an aliquot for us. So I have a configuration set up in the background that when this testing is ordered we're going to make a pour off tube from our sample.

Although you could print the aliquot label at accessioning, we like to advocate for what we call just-in-time printing. So we'll just print the aliquot label when we're actually making that aliquot.

So let's say we printed those labels, and then we'll be done with our order. So to print our labels, we're going to go to the specimen queue in the operations module. And here, you can search for the kind of specimen that you're going to be creating. You can look it up by the parent specimen, in this case the SST, or the specimen we're making, the aliquot.

And this is a very flexible processing queue, where basically there are up to two steps that you can register in the LIS software for processing. So when the sample begins processing which is a convenient time to print the labels. And then when it's done you don't have to do both steps for everything.

A lot of clients just skip straight to complete. But I'll show both today to show the flexibility. So we'll go ahead and open. Now from here I like to just scan in your parent specimen. So scan in your SST and then it's going to tell you to create an aliquot from that.

So you can scan them into the window. You can also select from the queue. Let's say we're just going to come in and do everything that's pending. And then when we go to begin, they'll all be in here. Or the last way that can be useful is using a rack. So let's say you had already scanned all of your SSTs into a rack.

You could just switch our lookup type to parent specimen rack, scan that whole rack, and it'll add all the specimens within it. So I'll do that for our complete step. 

Usually at this time the LIS system would print the labels associated with that. So go ahead and mark them as processed. So let's say we have our label now, and then we're going to go and mark it as complete. Now, let's say this time we're going to be scanning the aliquot itself, so we'll switch this to a specimen.

And let's say as we are creating these aliquots, we're going to be racking them. So, let's create a rack. They're very flexible. They could be like any dimension. But here I just have a pretty straightforward specimen storage rack that I've set up where you can scan specimens in. You can do a partial rack, you can fill it up however much you like, and this will be saved to track management.

And then once I save, it just immediately adds them to this window. So to show how we can refer to this information in the future, I'm going to go back to search. We're searching for this case anywhere in the LIS system where you are seeing a grid. Basically with cases or results you right click and you're going to have the option to see all the specimens for that order.

So we'll go there and we'll see our specimen and our aliquot. Since we wrapped the aliquot as part of our completion process, it is showing that location here and then it's only ever gonna show the current or most recent application location here in the search view. But you can right click and go to specimen details to see everywhere it ever was previously.

So here we can see when it was created and when it was scanned to the rack, as well as when I scanned it to end processing. And scan it into complete and you're gonna have location information. This is our facility abbreviation, so default facility, and the user, that's me, demo admin. 

Now for my next topic, I'm going to go on to worklists and batching. In our laboratory software system, you can configure any number of worklists and a worklist is basically going to be a group of tests that you want to run together. It could even be one test, right? You see, we have COVID, probably just one test. And there can be overlap, like maybe some of your tests are on chemistry and ancillary. It just depends on whatever works for your lab.

A good way to see what is pending for your worklist is to go to the clinical overview report.

And in this column, we'll see everything that is pending for the various worklists. So we have two main types of worklists here. We see exclusive and continuous. I'll just explain those really quickly. Exclusive worklists mean that any specific instance of a lab test result can only be assigned to one specific worklist at a time.

So let's say your first shift tech comes in, pulls the worklist, and there's 30 tests pending. Then throughout the day more samples come in and then when your night shift pulls a worklist, they will only see what has come in since this morning. Nothing that was on the worklist for this morning will be on the one in the afternoon, unless you already have repeats or something like that, or unless you unassign the worklist.

And then continuous is kind of the opposite of that. So with our same scenario, the first shift assigns the test to the worklist. And more tests come in throughout the day. At night shift when they pull a worklist, it will contain everything that's pending, regardless of if it was on the worklist at the beginning of the day.

Of course, both types of worklists will only ever have pending or in processing results on them. So if they've been completed, they're not going to show up there, right? So usually our chemical or clinical worklists are configured as continuous. So we see our chemistry here, collusive or more common like molecular, for example.

So here I can see there are 120 tests pending for chemistry, and I can click on the details icon or just double click on this line to be redirected to the clinical queue, or we'll see the list of all these results pending. So if you want to look more specifically, you know what comprises those 120 pending tests. 

Then coming here is a good way to do it. So we can go back for a second and we'll just generate a worklist on these right click actions here that will also bring up the worksheet associated with that. So this template is 100 percent customizable. This is just a pretty basic one.

You can see I have a column for accession, and receive date, patient name, and the test ordered. So you could take that out. Also, if you choose not to print it, it will be saved in the laboratory information system in case you just want to come back and reference that later. So once your testing is run, then you can come to the pending review to review results.

And here's our chemistry worklist that we just generated. Another useful thing you can do here is if you right click, you can view the manifest. This is going to be a list of the specimens and their locations which are associated with the tests on this worklist. And the list is separated by the specific specimen vessel type.

So here it defaulted to SST. And so these are all the SSTs associated with the test on this worklist, including where I scanned them in storage previously. And we know I also made an aliquot so we can see where that is as well. If we would like, we can see the status. 

You can print this, of course. So this will lead us right into results entry and verification. So to review the results for this worklist, we're going to go ahead and edit it and that will open the worklist for us. So here we're seeing the batch view of the worklist where the patients are the rows and the tests are the columns.

And we can pretend these results came in from the instrument and that we're gonna manually enter the bottom two lines. A few notes about this. So when your cursor is focused in the sum, then you're going to get a pop up with additional information at the top - it will be like an extra mini table for each time results have been entered for this test or run on an instrument either imported or manually entered, so we can see that the result of one was first entered on this date and time and the result 10 was entered on this date and time. Let's skip down to current values where we'll see it has value 10, which is considered a normal result, but by units and our reference range, it's not a repeat and there's no comment.

Now let's say I need to manually correct the value of this result for whatever reason. So if I type in a thousand, for example, now we're getting information in this preview section, so it's showing value. A thousand is considered abnormal, right? And then that would get the flag.

Oh, and you see the info panel section, which doesn't have anything here, but this is like an extra section for you to configure anything else you would like to see specific to this test when reviewing results. So to click out for a second we see the same columns of patient information here that we did on the worksheet.

So accession was received in the patient name. We could easily add anything else that's associated with the case or the patient. Maybe the date of birth or if they're fasting or not, something like that. 

So it's good for historical data, maybe like the last time this patient came in for this test. Maybe other details about this result or ask a question about values that you're interested in. They can even have images if that is useful for you. Now some other actions while my cursor is focused in this cell, you can go into the detail screen of this result using the built in keyboard shortcut control space, and open the detail screen.

We're going to see much of the same information here as we did on the previous screen. But this is the ideal way to enter a comment on the fly. So I can go to the comments for this result and enter comments like that. This is a macro enabled field. I don't have my macros memorized, but we can see them all by using control space again.

Let’s empty our macros and do received as an example. This doesn't necessarily pertain to this specific case, but you can kind of understand how that would work. And then if we click OK, we'll be returned, and the comment is immediately visible in that dropdown now.

And if we navigate away, then we'll see the blue circle with the white eye, which indicates that there's a comment. The other keyboard shortcut that we might make use of here is to mark something for rerun. So that's going to just be Ctrl R. You can see the change here in the drop down and again if we navigate away from the cell, then it will be highlighted red with a flag.

And when, if we were to release the worklist right now, then things marked for rerun will not be released, and then the lab information system will ask you to pull a manifest of just those reruns to help you repeat them. And that rerun status is just a toggle. If I do the ctrl R again, then it goes away. 

Another thing worth noting. Here you can see some of the results have a darker gray shading on the left and others don't. This is an indication of which results are editable. So in this case an uneditable result is calculated so I can't edit these like ratios. So for example, my bun creatinine ratio, it's getting this calculation directly from these tests.

And if I were to update this, then we'd see that value update in real time. And I mentioned this is the whole batch view of this worklist, right? There's one alternate view of the worklist, which is that instead of seeing all patients at one time, you can see just one patient at a time. So anywhere on your patient columns, right click and go to edit the result.

And then you'll be switched to a view where we're just looking at this one patient right now. And here now our tests are the rows, and we see some additional information in our columns here, information that would be available here but it's a little bit more visible. It just depends on your preference for how you like to review results.

And this can be set as the default view of the worklist if you prefer, instead of the batch view. So when you open it, it will default to this. So I'll switch back to the other view and release our results here. If I click release right now, everything has a value, so not the last two rows but the first four rows will be released.

Now, if instead you only want to release a few results for whatever reason with your cursor in that cell you can press enter and you'll see I get a green gradient on the right side. So, this indicates that soft approval. So right now, if I were to click release, then only those marked green will be released.

So that's a flexible way without any configuration or LIS software system changes or anything, you have the option if you want to release everything at once, or just a few. At this time, I would also like you to know we do have the capability to do autoverification based on criteria such as inconsistency rules, critical values, quality controls, and Delta checks.

In fact, you can see the Quality Control here. For example, we can view all the control rules from here, go into our statistics and see things like our Levy Jennings. We won't go into QC in detail today but can do so in a future webinar dedicated to Quality Control and Quality Assurance.

So my last topic is QA and statistical reporting. So let's say that I guess for QA and statistical reporting, we are going to leverage our tags and workflow action feature. So tags and workflow actions recorded in the LIS system are sually like the order, individual results, reports, or specimens. The way I like to describe them is that a tag is just like an indicator. It's kind of like a sticky note you put on something like you know pending hpv or high risk. Done, scanned, or something like that.

And a workflow action is similar but more, so it'll come with a comment. And then when a workflow action is applied, it's going to go to a queue for someone to do something with it. So it's good for things like “call the client about this”, or “this needs to be reprepped”, something like that.

It could be when this was received, when you were doing the processing here at results entry, or at any time. Let's say you are working with this specimen, but you realize you won't be able to run the testing because the specimen is hemolyzed. So I'm going to go to the order and scroll down to my specimens here.

I'm gonna go to my SST and I have these tags created for such issues. So I'm gonna add the hemolysis tag to this specimen to indicate that it is hemolyzed. And if we just peek over to the result data real quick we'll see a list of our tests and you can see that the LIS system has awareness of which specimen is associated with these tests and which one it should be run off of, which in this case is the SST, which is the sample.

I'm pretending it is hemolyzed. So what's gonna happen is when we save based on that tag, then it will reject all of the corresponding tests as “test not performed”, which because I did it from the screen, you can see very nicely in real time. And if we go over we can view our report. So here we can see the result of tests not performed for all of these and out of the common sample not sample hemolyzed.

So of course, this is just an example of how these could work. You could make the comment, whatever you want, or if you want to say rejected instead of “test not performed”. Totally flexible. And this was just done by a pretty simple automation that I created in the background. So then once we have done that, then of course we will be able to pull some statistics based on that information.

Let's go to operations. Here I have a template set up showing me my hemolyzed specimens from within the last 30 days. So I'm just searching for that tag and the default date range, and it brings them up. 

So it can be like show me these four specimens that were hemolyzed. We click on them, and that'll take us to a specimen search view, where we can find out more details about these cases and these specimens. 

Now, for a few more statistical reports. We are going to go to our test results tab in the reporting module. So, this is even more robust than the specimen stats that we just saw. These are the pre-built report types that we have in here. Turnaround based on lots of different start dates. Tags and workflow actions.

So I already saved a template for percent of positivity received in the last 30 days. And here we can see I'm doing a summary by department and then test. So we have clinical and molecular levels. If we expand the clinical, then we'll see the six instances of this test that were run in the time period, zero were abnormal and six were innate.

And A is going to be the test not performed, rejected, indeterminate, invalid, anything like that is usual. So these can be good for state reporting or even just general awareness. And you can adjust the summary however you like. Another common one for this report is about the client.

See if you have higher positivity coming from certain clients. And maybe that needs attention. And here, I'm just searching by my result ID, prefix of clinical, but you can see there's a lot of different filters available here so you can always adjust the criteria and then save your own template and then it'll be here in the future whenever you want to pull it.

So the last report I have to show is the turnaround time. Here is a turnaround time report. I selected some specific tests to show in this report. Again, just last 30 days by test. So, for example, the alkaline phosphatase that was received in the last 30 days, there were 10 tests received and they took an average of 33 hours to complete.

You can see five took less than 12 hours, one took less than 48, and four are incomplete. Those are going to be ones that aren't done yet. Now, one note, you can customize these brackets. So let's say for clinical you really want to add less than four hours or something, you could easily do that in the global settings.

And we can right click on the cell to go to those specific cases, right? So show me these alkaline phosphatases that were done so quickly, and it will redirect you to a search view. And so you can look at that.

That is all I have to present for this time. Any questions?

^Michael: The statistical reporting. I think we got a good sense there of how versatile and robust the LIS system is. The amount of filters that are being utilized. You’ve got pre-built reports in there. And obviously, if you want to make an ad hoc report, that's possible to, correct?

_Allison: Yeah, so additional tools we have for stats are going to be dynamic reports. We have lots of these pre-built stats screens but anything more niche that you might need, we can build in the dynamic report section.

^Michael: All right, thank you very much for that tour. Now we'll open it up for questions. Utilize the Q&A option at the bottom of your screen. I will start things off. One area that I think is interesting and maybe you can shed some light on this, you mentioned batch testing during the course of your presentation. Are there any limits on the amount of batching that can be done within the LIS system at one time?

_Allison: No, no limits. We can make a worklist for any size or any number of tests. For example, PCR. We support 384 well plates, which could be 384 results or even more if they're multiplexed, right? So yeah, any number that you need, this laboratory information system can support it.

^Michael: One area of importance certainly is specimen tracking, and you went into pretty good detail about how this LIS system handles specimen tracking. From the hardware point of view and barcode printers, what have you found to be the best fit for LigoLab’s software solution? 

_Allison: The preferred label printers are zebra, or any printer that communicates in the zebra language, which is ZPL. 

^Michael: Next question. Are there visual indicators for stat, delta, and critical? 

_Allison: Yes, there are. I didn't have them turned on but we can highlight critical results however you like. Let me go to the clinical queue real quick so you can and see this highlighting in the accession queue is a priority indicator. 

So I know in the LIS system that means their stat, You can configure as many priorities as you would like, just the defaults in the pathology software are going to be routine, expedite, and stat, and again, just in this LIS system, the highlighting for stat is red, but if you want to make it more nuanced priorities you can.

^Michael: So Allison, in this pathology lab reporting software system built on rules, and then with those rules, you're able to create automation in the clinical laboratory?

_Allison: Yeah, the rules and automations are pretty important for clinical labs, especially if you want to do any autoverification, that's going to be handled with the rules. 

But any more, like robust flagging, for example, are possible. I mentioned the workflow actions being used to call the clients. So that's something we frequently implement for clinical use. There are a lot of different possibilities there. 

^Michael: Another point that was touched upon, maybe we can dive into it a little bit deeper, is the customization aspect. I think you mentioned the customization with the worklists and then you can take that out to the level of customization on reports, too?

_Allison: Yeah, the reports are highly customizable. That's always a dedicated part of implementation where we'll design the reports with you. We'll have some templates pre-built that you can choose from but also, if you have an existing report that you really like, we can recreate it in our pathology lab software system. We can even work together to create something totally new. Everything's flexible. The layout. The colors. One of the frequent client customizations is putting their logo on the report. Basically you can have a unique report template for each client. 

A common example would be an HPV combined with a Pap, right? Maybe some of your clients want all those tests on the same report. Some of your clients may want a separate HPV from the Pap report. We can easily accommodate that. 

^Michael: So let’s wrap things up here. The tour was a very good one. Well done, Allison.

For those of you that may have joined late or maybe there was something that was missed, we will have a recording of this webinar posted shortly at ligolab.com/webinars.

Also, if you have any specific question that you'd like to ask Allison, this email address, info@ligolab.com, would also be something of value for you. Allison, any last words that you'd like to share with our group before we say goodbye? 

_Allison: No, I don't think so. Thanks everyone for joining. And I guess if there's any topics you'd be interested in seeing in the future, please feel free to reach out. 

^Michael: Very important. Thanks for that.

In conclusion, we look forward to doing this again in the very near future. Check out LigoLab.com and any of our social media or emailing messages for details about future webinars. Thanks for your time and attention, and goodbye until next time.