Enhancing the financial performance of a health system laboratory network using an information system

Indicadores de desempenho e decisão sobre terceirização em rede pública de laboratórios

OBJETIVO: Elaborar indicadores de desempenho e terceirização em rede de laboratórios clínicos, baseados em sistemas de informações e registros administrativos públicos. MÉTODOS: A rede tinha 33 laboratórios com equipamentos automatizados, mas sem informatização, 90 postos de coleta e 983 funcionários, no município de Rio de Janeiro, RJ. As informações foram obtidas de registros administrativos do Sistema de Informações de Orçamentos Públicos para a Saúde e do Sistema de Informações Ambulatoriais e Hospitalares do Sistema Único de Saúde. Os indicadores (produção, produtividade, utilização e custos) foram elaborados com dados colhidos como rotina de 2006 a 2008. As variações da produção, custos e preços unitários dos testes no período foram analisadas por índices de Laspeyres e de Paasche, específicos para medir a atividade dos laboratórios, e pelo Índice de Preços ao Consumidor Amplo do Instituto Brasileiro de Geografia e Estatística. RESULTADOS: A produção foi de 10.359.111 testes em 2008 (aumento de 10,6% em relação a 2006) e a relação testes/funcionário cresceu 8,6%. As despesas com insumos, salários e prestador conveniado aumentaram, respectivamente 2,3%, 45,4% e 18,3%. Os testes laboratoriais por consulta e internação cresceram 10% e 20%. Os custos diretos totalizaram R$ 63,2 milhões em 2008, com aumento de 22,2% em valores correntes no período. Os custos diretos deflacionados pelo Índice de Preços ao Consumidor Amplo (9,5% para o período) mostram aumento do volume da produção de 11,6%. O índice de volume específico para a atividade, que considera as variações do mix de testes, mostrou aumento de 18,5% no preço unitário do teste e de 3,1% no volume da produção. CONCLUSÕES: Os indicadores, em especial os índices específicos de volume e preços da atividade, constituem uma linha de base de desempenho potencial para acompanhar laboratórios próprios e terceirizados. Os indicadores de desempenho econômicos elaborados mostram a necessidade de informatização da rede, antecedendo a decisão de terceirização.

Clinical laboratory as an economic model for business performance analysis

Aim

To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths.

Methods

Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory.

Results

Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465.

Conclusion

The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by implementing changes in the next fiscal period.

Association between the implementation of a laboratory information system and the revenue of a general hospital

CONTEXT

A laboratory information system (LIS) is a useful tool for the management of laboratory processes and data, as well as for improving quality.

OBJECTIVE

To examine the association between the implementation of a LIS with the outpatient and inpatient revenues of a general hospital.

DESIGN

This study analyzed the outpatient and inpatient revenue data of all 212 general hospitals in South Korea; data were obtained from the Korean National Health Insurance Corporation during the period from 1996 through 1999. The mixed model was used for the repeated measure data. The following listed variables were used in the analysis: LIS implementation status, the population size, the state of competition, average local income, the hospital location, the hospital size, whether or not the hospital was a teaching hospital, whether the hospital was private or public, and the effect of the implementation time.

RESULTS

The revenues from both the outpatient and inpatient departments were significantly higher 1 year after implementing a LIS, even after controlling for confounding variables.

CONCLUSIONS

Although the causality needs to be clarified, the implementation of a LIS was found to be significantly associated with higher outpatient and inpatient revenues.

The Total Laboratory Solution: A New Laboratory E-Business Model Based on a Vertical Laboratory Meta-Network

Major forces are now reshaping all businesses on a global basis, including the healthcare and clinical laboratory industries. One of the major forces at work is information technology (IT), which now provides the opportunity to create a new economic and business model for the clinical laboratory industry based on the creation of an integrated vertical meta-network, referred to here as the “total laboratory solution” (TLS). Participants at the most basic level of such a network would include a hospital-based laboratory, a reference laboratory, a laboratory information system/application service provider/laboratory portal vendor, an in vitro diagnostic manufacturer, and a pharmaceutical/biotechnology manufacturer. It is suggested that each of these participants would add value to the network primarily in its area of core competency. Subvariants of such a network have evolved over recent years, but a TLS comprising all or most of these participants does not exist at this time. Although the TLS, enabled by IT and closely akin to the various e-businesses that are now taking shape, offers many advantages from a theoretical perspective over the current laboratory business model, its success will depend largely on (a) market forces, (b) how the collaborative networks are organized and managed, and (c) whether the network can offer healthcare organizations higher quality testing services at lower cost. If the concept is successful, new demands will be placed on hospital-based laboratory professionals to shift the range of professional services that they offer toward clinical consulting, integration of laboratory information from multiple sources, and laboratory information management. These information management and integration tasks can only increase in complexity in the future as new genomic and proteomics testing modalities are developed and come on-line in clinical laboratories.