Journal:Laboratory information system requirements to manage the COVID-19 pandemic: A report from the Belgian national reference testing center

Full article title	Laboratory information system requirements to manage the COVID-19 pandemic: A report from the Belgian national reference testing center
Journal	Journal of the American Medical Informatics Association
Author(s)	Weemaes, Matthias; Martens, Steven; Cuypers, Lize; Van Elslande, Jan; Hoet, Katrien; Welkenhuysen, Joris; Goossens, Ria; Wouters, Stijn; Houben, Els; Jeuris, Kirsten; Laenen, Lies; Bruyninckx, Katrien; Beuselinck, Kurt; André, Emmanuel; Depypere, Melissa; Desmet, Stefanie; Lagrou, Katrien; Van Ranst, Marc; Verdonck, Ann K.L.C.; Goveia, Jermaine
Author affiliation(s)	University Hospitals Leuven, Katholieke Universiteit Leuven
Primary contact	Email: jermaine dot goveia at uzleuven dot be
Year published	2020
Volume and issue	Ahead of print
Article #	ocaa081
DOI	10.1093/jamia/ocaa081
ISSN	1527-974X
Distribution license	Creative Commons Attribution Non-Commercial 4.0 International
Website	https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa081/5827002
Download	https://academic.oup.com/jamia/advance-article-pdf/doi/10.1093/jamia/ocaa081/33421026/ocaa081.pdf (PDF)

Abstract

Objective: The study sought to describe the development, implementation, and requirements of laboratory information system (LIS) functionality to manage test ordering, registration, specimen flow, and result reporting during the coronavirus disease 2019 (COVID-19) pandemic.

Materials and methods: Our large (more than 12,000,000 tests/year) academic hospital laboratory is the Belgian National Reference Center for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We have performed a moving total of more than 25,000 SARS-CoV-2 polymerase chain reaction tests in parallel to standard routine testing since the start of the outbreak. A LIS implementation team dedicated to developing tools to remove workflow bottlenecks—primarily situated in the pre- and post-analytical phases—was established early in the crisis.

Results: We outline the design, implementation, and requirements of LIS functionality related to managing increased test demand during the COVID-19 crisis, including tools for test ordering, standardized order sets integrated into a computerized physician order entry module, notifications on shipping requirements, automated triaging based on digital metadata forms, and the establishment of databases with contact details of other laboratories and primary care physicians to enable automated reporting. We also describe our approach to data mining and reporting of actionable daily summary statistics to governing bodies and other policymakers.

Conclusions: Rapidly developed, agile extendable LIS functionality and its meaningful use alleviates the administrative burden on laboratory personnel and improves turnaround time of SARS-CoV-2 testing. It will be important to maintain an environment that is conducive for the rapid adoption of meaningful LIS tools after the COVID-19 crisis.

Keywords: COVID-19, laboratory information system, health information technology implementation, computerized provider order entry, change management

Introduction

Background and significance

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has caused a pandemic with unprecedented medical and socioeconomic adversity. Second- and third-wave outbreaks are becoming a reality in several countries, at least partially, due to low herd immunity. Laboratory testing to rapidly detect SARS-CoV-2 using polymerase chain reaction (PCR) is essential to guide proper patient management, while serological assays will soon be required to assess population immunity (e.g., antibody tests) and guide national coronavirus disease 2019 (COVID-19) pandemic policies.

The increased demand for round-the-clock laboratory testing during the COVID-19 pandemic has surpassed surge capacity in many clinical laboratories, resulting in significant strain on laboratory personnel and infrastructure. These developments are especially undesirable when laboratories already have to process a large numbers of potentially biohazardous specimens every day. Additional delays in testing directly translate into delayed clinical decision making and consequently congest emergency departments and isolation units. Therefore, leveraging the capabilities of laboratory information systems (LIS) to streamline all phases of laboratory testing workflow (preanalytical, analytical, and postanalytical) has proven essential.

To our knowledge, only a single report has been published that discusses the implementation of health informatics to support clinical management of the COVID-19 pandemic through novel electronic health record (EHR) functionality. COVID-19 is a laboratory diagnosis with immediate consequences in the health sector (hospitalization, patient isolation, postponing surgery, etc.). Therefore, clinical laboratories face specific challenges that require dedicated LIS functionality to ensure safe, reliable testing and acceptable turnaround times. However, no literature exists on tools that leverage the LIS in order to alleviate the burden on laboratory personnel, streamline laboratory testing, improve test reporting, facilitate epidemiological and translational research, and enable data-driven policy making.

Objectives

Here, we describe the challenges faced by the Belgian National Reference Center for COVID-19 testing when demand passed allocated surge capacity during the initial phases of the COVID-19 pandemic. We used Kotter’s principles as a framework to rapidly develop and implement additional LIS functionality (Table 1). We implemented tools to manage specimen and data streams, and detail functionality to improve (1) the prelaboratory phase (test ordering, specimen packaging, and shipping), (2) the preanalytical phase (specimen registration, tracking, and test prioritization [triaging]), and (3) the postanalytical phase (automated reporting and facilitating data-driven policymaking). We also briefly discuss unexpected opportunities in which the COVID-19 crisis accelerated the adoption of practices that promote the meaningful use of LIS systems.

Table 1. Kotter’s principles applied to laboratory informatics change management during the COVID-19 crisis Kotter’s principles Change management in response to the COVID-19 crisis Phase 1. Creating a climate for change Step 1. Establing a sense of urgency ▪ Comfortability with the known and fearfulness of the unknown hampers innovation. ▪ Convey why the change is needed and why does it need to occur now. ▪ The COVID-19 pandemic put a tremendous burden on the medical administration staff. ▪ Manual registration of order forms into the LIS system from external laboratories was highly labor intensive. ▪ Sample reception, triage, and patient registration at the laboratory were overwhelming. ▪ Only one-third of results is automatically reported. ▪ Together, these issues clearly conveyed the necessity to implement IT tools. Step 2. Building a powerful guiding coalition ▪ Identify key staff members. ▪ Attract eager, people-oriented, and real leaders. ▪ Establish a crisis management team (CMT). ▪ The CMT should consist of a goal-oriented group of expert staff. ▪ Include IT managers in CMT, as well as analytical and human resource personnel. Step 3. Creating a clear vision ▪ Define what the future state should look like. ▪ Capitalize on pre-existing and newly developed health IT platforms to:    ▪ decrease the burden on clinical, administrative, and scientific staff;    ▪ reallocate technical staff to the tasks related to the analytical phase; and    ▪ support COVID-19 crisis management. ▪ Focus on innovation and scientific advances. Phase 2. Communication and empowering others Step 4. Communicating the proposed vision ▪ Communicate how this change will affect everyone. ▪ Provide much-needed emotional support.   Step 5. Empowering others to act on the vision ▪ Delegate leadership roles (workflow redesign). ▪ Schedule weekly meetings to brief staff on:    ▪ emerging problems and bottlenecks; and    ▪ proposed solutions and expected benefits. ▪ Invite staff to propose alternative and additional solutions, and include IT professionals in their discussion. ▪ Delegate responsibilities to staff beyond the CMT to proactively solve problems in-line with the vision, including:    ▪ IT professionals;    ▪ lab technicians; and    ▪ clinical pathology residents. Step 6. Planning and creating short-term gains ▪ Promote good ideas. ▪ Celebrate successes as often as possible. ▪ Communicate success regarding the following achievements:    ▪ improved efficiency in ordering COVID-19 laboratory testing;    ▪ reduction in workload (improved work schedules);    ▪ automatic reporting of >98% of analytical results;    ▪ reduction in the number of phone calls to the COVID-19 call center;    ▪ implementation of a lean and easily adaptable database for fully automated reporting; and    ▪ automatic summary statistics reporting, with attractive data visualizations to all stakeholders. Phase 3. Implementation and sustaining the changes Step 7. Consolidating improvements ▪ Continue problem solving and promoting solutions. ▪ The successful implementation of COVID-19 solutions results in a gain in workflow efficiency, and … Step 8. Institutionalizing new approaches ▪ Focus on changing interpersonal work dynamics to organizational culture. ▪ … a reduction in the administrative burden causes increased engagement of all laboratory staff to remedy problems through novel IT solutions.

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added.