Decision Support to Enhance Automated Laboratory Testing by Leveraging Analytical Capabilities

Digital transformation and sustainability in healthcare and clinical laboratories

Healthcare, and in particular, clinical laboratories, are major contributors to carbon emissions and waste. Sustainability in healthcare has shifted from an environmental concern towards a holistic definition that includes balancing socio-ecological and socio-technical systems, including health services effectiveness and cost efficiency. Digital transformation can reduce waste and the cost of services by enhancing effectiveness while maintaining quality. Digital health interventions can provide personalized patient-centered care on a global scale and include decision support systems that have the potential to improve the performance and quality of healthcare. The right interfaces must be used so that the advantages of going digital are felt throughout the health system: a successful and sustainable implementation of digital innovation depends on its integration into a functional health ecosystem. Telehealth has the potential to reduce carbon emissions due to the reduced daily commute of health professionals, although research is limited. Recently, economic models have changed from the linear "take-make-dispose" to circular models based on recycling and upcycling that have the goal of keeping products, components, and materials at their highest utility and value. The previous linear models threaten human health and well-being and harm natural ecosystems.

Laboratory Interventions to Eliminate Unnecessary Rapid COVID-19 Testing During a Reagent Shortage

Objectives

In the fall of 2020, US medical centers were running out of rapid coronavirus disease 2019 (COVID-19) tests. The aim of this study is to evaluate the impact of an intervention to eliminate rapid test misutilization and to quantify the effect of the countermeasures to control rapid test ordering using a test utilization dashboard.

Methods

Interventions were made to preserve a severely limited supply of rapid diagnostic tests based on real-time analysis of a COVID-19 test utilization dashboard. This study is a retrospective observational study evaluating pre- and postintervention rates of appropriate rapid test use, reporting times, and cost/savings of resources used.

Results

This study included 14,462 severe acute respiratory syndrome coronavirus 2 reverse transcriptase polymerase chain reaction tests ordered during the study period. After the intervention, there was a 27.3% decrease in nonconforming rapid tests. Rapid test reporting time from laboratory receipt decreased by 1.47 hours. The number of days of rapid test inventory on hand increased by 39 days.

Conclusions

Performing diagnostic test stewardship, informed by real-time review of a test utilization dashboard, was associated with significantly improved appropriate utilization of rapid diagnostic COVID-19 tests, improved reporting times, implied cost savings, and improved reagent inventory on hand, which facilitated the management of scarce resources during a pandemic.

Pandemic Response in the Clinical Laboratory: The Utility of Interactive Dashboards

The ability to access and analyze data is critical to manage a laboratory and respond and adapt to changes, particularly during a pandemic. Data analytic tools can not only improve laboratory operations, but also increase the visibility of the laboratory in the healthcare system and demonstrate the positive impact of the laboratory on patient care. In this article, we describe the creation and utility of laboratory dashboards. Several dashboards were designed to assist with pandemic response. For each dashboard, a stored procedure was created that performed a SQL query of our laboratory information system mirror database. We utilized the business analytics platform, Tableau, for data visualization. Users could modify the data by selecting a specific date range, time window, work shift, institution(s), specific test(s), and/or testing platform(s). Access was controlled by OKTA integration to the host server over the web, behind the hospital firewall. During the April 2020 surge, we saw an increase in blood gas testing and corresponding decrease in non-critical testing such as Vitamin D. At our institution, SARS-CoV-2 molecular testing was performed using four primary platforms, four in-house and one send-out. Weekly and hourly testing volumes as well as turnaround times fluctuated based on reagent availability, new testing requests, staffing, and operational changes. Productivity dashboards indicated that coagulation testing volumes were highest on the third shift and that all three analyzers may not be necessary. Further, specimen volumes and productivity of accessioning staff varied throughout the day. Phlebotomy venipuncture volumes and patient wait times also varied throughout the pandemic. A decrease in ambulatory draws was seen during the surge but after reopening draw volumes, particularly at offsite locations, surpassed prepandemic volumes. We demonstrate that data analytics and interactive dashboards are powerful tools, are helpful in response to a pandemic and lead to improved TAT, supply utilization, staffing and workflows. Furthermore, dashboards provide objective data to review with hospital leadership and promote collaboration.

Identifying Opportunities for Workflow Automation in Health Care: Lessons Learned from Other Industries

Background  Workflow automation, which involves identifying sequences of tasks that can be streamlined by using technology and modern computing, offers opportunities to address the United States health care system's challenges with quality, safety, and efficiency. Other industries have successfully implemented workflow automation to address these concerns, and lessons learned from those experiences may inform its application in health care.

Objective  Our aim was to identify and synthesize (1) current approaches in workflow automation across industries, (2) opportunities for applying workflow automation in health care, and (3) considerations for designing and implementing workflow automation that may be relevant to health care.

Methods  We conducted a targeted review of peer-reviewed and gray literature on automation approaches. We identified relevant databases and terms to conduct the searches across sources and reviewed abstracts to identify 123 relevant articles across 11 disciplines.

Results  Workflow automation is used across industries such as finance, manufacturing, and travel to increase efficiency, productivity, and quality. We found automation ranged from low to full automation, and this variation was associated with task and technology characteristics. The level of automation is linked to how well a task is defined, whether a task is repetitive, the degree of human intervention and decision-making required, and the sophistication of available technology. We found that identifying automation goals and assessing whether those goals were reached was critical, and ongoing monitoring and improvement would help to ensure successful automation.

Conclusion  Use of workflow automation in other industries can inform automating health care workflows by considering the critical role of people, process, and technology in design, testing, implementation, use, and ongoing monitoring of automated workflows. Insights gained from other industries will inform an interdisciplinary effort by the Office of the National Coordinator for Health Information Technology to outline priorities for advancing health care workflow automation.