Baylor Scott and White Health, NTD Melinda Doherty, Director LIS Blazing Trails from 4.0 to 4.5 Baylor Scott and White Health, NTD Melinda Doherty, Director LIS

Baylor Scott and White Health – North Texas Division Twelve facilities on Soft converted 1/18/15 SoftLab/Mic 4.0.4.8  4.5.4.3 SoftBank 25.1 25.3.0.4 SoftID 2.0.0.25. 2.6.2.3 TQC 1.0.2.3  1.0.3.9 SoftReports XXXX  1.1.9.1 SoftMedia 2.0.8.8  3.2.7.1 SoftUpdate 3.0.2.0  3.0.2.0.25 SoftAR 4.0.6.1  4.5.4.3 Reference Lab partnership _________________________________________________________________ Currently implementing PathDX Implementing physician reference lab with 120 clinics, interfaced to Epic

Why did we go down this trail? Good reasons Lab had a MU2 requirement for ELR Anatomic Pathology department chose PathDX Bad reasons Bad timing – everyone else had a MU2 requirement We would be the second client to convert

Our approach Training System setup ! Gap analysis Build Super User training Foreign interfaces ! Validation End user training Go live steps

System setup New hardware System not available before training ! Must set up a bridge to 4.0 Lab Soft Update – impact to 4.0 New additional database – WebLogic TQC SoftID Technical calls were set up with SCC every week the first two months

System setup continued Baylor chose to not cap Oracle and did not add the recommended amount of memory

Training Baylor LIS - 12 staff Micro specialist Blood Bank specialist SoftID/hardware specialist SoftReports specialist HIS specialist TQC specialist General Lab/cross-trained in special areas 5 staff attended training at SCC – 4.5 Upgrade We developed a detailed Project Plan and managed to it weekly Was not a typical implementation

Gap analysis Order entry Keypad for order entry Specimen tracking moved to different tab Specimen barcode ID Venip displays Resulting worklist Added specimen barcode ID Expected date/time does not show up Reference lab manifest Non interfaced results – new functionality Orders submit in realtime Tasklist and manifest combined to one step Security SoftReports and TQC could be domain authenticated Can import users from excel Test Setup – functions behave differently Add up volume Values tab

Gap analysis continued Specimen tracking Autotracking stops can be hidden from users Can set up autoredirection Remote receiving automatically activated Instrument interface setup – nothing converted well ! ? Can be added to keep internal comments from going to HIS Specimen Barcode ID Comments box Result entry – internal comment tab reformatted Instrument menu – has legacy format Downtime recovery Soft generated labels Printers Conversion of printers with multiple trays Settings and Definitions UCUM settings (find info) Some hosparams have been moved to this location and can be modified

Gap analysis continued Micro Antibiotic suppressions (converted rules did not work) ! OSM More options to format the look/layout Lab OSM – add display for last time updated Had to add specimen barcode ID STATs do not display in red across the screen Font size smaller in the new layout Reports Instant reports Supervisor Review Report Exceptions Report Pending Test Report Verified Test Report Cannot add specimen barcode ID

Gap analysis continued Look at the other modules that are being upgraded SoftBank SQLs had to be rewritten as SoftReports TQC SoftReports Schemas changed SoftID SoftUpdate SoftMedia SoftAR Release notes were reviewed with implementers Developed tutorials and scripts for testing

Gap analysis continued Preventative gap analysis Doctors Wards Changes for print setup for autoreporting Cleaned up specimen tracking table (specimen setup – removed inactive terminals) Rebuilt all calculations to standardized format Print scheduler Did a side by side 4.0 vs 4.5 Label printing setup moved from OEHIS interface translation to label printing table under multisite Rebuilt security to use domain user ID rather than initials (did not carry over inactive users) Rebuilt users in SoftID roles and SoftBank worksheets

Interfaces – There is a new MOM in town Interfaces – converted to HL7 2.5.1 HIS – orders/results MedHost – orders/results Physician portal (myBaylorEMR) MedMined HIM Transplant Research RIS POC Billing Reference Lab - converted to HL7 2.5.1 Mayo Med fusion - with discrete micro Histotrac – orders/results MFN ELR – HL7 2.5.1

Foreign system interfaces ESB Still have RCV, SFS, ADTP MOM Set of data collectors HISOE Hisparams are in HISOE config file Engine configuration Managing orders between environments pre go live Results to file back to appropriate system

Foreign System Interfaces

Build Continuous process, began after Gap analysis Test setup Instruments Calculations Antibiotic suppressions Security Reports MU2 TQC Set up weekly staff meetings Set up weekly calls with implementers

Super User training Lab section workgroups Preanalytic (SoftID) Chemistry Hematology Microbiology Blood Bank Referrals TQC – integrated into departments Respiratory Created testing scripts for validation Created tutorials for new workflow for end user training LIS performed WebEx training for each section

Validation Application SoftLab/Mic Keypads Default results Resulting templates Interpretive data Labels SoftBank Upgrade – Korcheck SCR Mock conversion patient records TQC upgrade Referrals Non interfaced Blood Bank – ran scripts that compared patient records on 4.0 to 4.5

Validation continued SoftID Upgrade SCR OSM Referrals Non interfaced results Reports Instant reports Cumulative reports SQL SoftReports Epi reports

Validation continued Instrument interfaces RBS Query Specimen tracking Autoposting/Autoverification Partial posting Full validation, normal, abnormal, critical, AMR RBS Query Specimen tracking Workstation redirection (enter order number manually) Print scheduler (discharge, new results after discharge, flagging runs) Faxing (licenses)

Validation continued Foreign system interfaces ADT Full ADT message testing Patient merging Order Order merging Automatic cancellation of orders (HISOE, RBS, Newshift - Cleanup Rules) Results Reflex tests Results to all downstream systems POC Reference Lab Billing Connectivity/Unit/Functional Validation used for CAP

End user training End users got on the system late ! Used tutorials that were developed with SU Created a signoff sheet to comply with CAP

Go live steps Failover Stress test Mock go lives – Blood Bank and TQC TEST 4.0 to TEST2 4.5 Interfaces Orders/results LIVE 4.0 to TEST2 4.5 Can estimate amount of downtime from the LIVE to TEST2 mock go live

Go live steps Go live planning Initialize system Started ADT, MFN 4.0 up except for Blood Bank Take down interface between Lab and Blood Bank Inactivated Blood Bank orders TQC Print DT labels Initialize system Started ADT, MFN Validated instrument interfaces Be sure to set interface active = N

Post go live – corralling issues Numerous issues with management reports

Post go live – corralling issues Significant issues included: Result posting slowness Bottleneck of IN AM orders Autoreporting – couldn’t print reports, had to add 4 more autoreporting servers Orders not merging correctly – ORCFG_split_tests now OECFG_isolate_tests Interfaces and autoposting not on MONIT TQC slowness SoftBank hanging when orders being added

Post go live timeline of outages

Lessons learned Develop a reasonable timeline – give yourself time System set up before you go to training, start your gap analysis Set the system up according to SCC recommendation Make sure you attend the right training Begin discussions early about go live Bridging to 4.0 Lab/Mic Interfaces in TEST and TEST2 Blood Bank conversion System config Populating 4.5 with patients Conversion of TQC When to create TEST2 When to cutover to LIVE2

Lessons learned End user validation of workflow Reports Change control Do not make system config changes after failover testing After LIVE2 system initialization and set up validate and check settings Instrument interfaces Printers

Lessons learned Config downtime labels differently between LIVE2 and TEST2 Review processes on MONIT Review HIS throughput and make sure you have enough instances of HISOE Ask SCC for system performance review before conversion Ask SCC to review system configuration before conversion Rotate on call staff daily for two weeks post go live

Questions

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