1. 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

2. Baylor Scott and White Health – North Texas Division
Twelve facilities on Soft converted 1/18/15
SoftLab/Mic 
SoftBank 
SoftID 
TQC 
SoftReports XXXX 
SoftMedia 
SoftUpdate 
SoftAR 
Reference Lab partnership
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Currently implementing PathDX
Implementing physician reference lab with 120 clinics, interfaced to Epic

3. 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

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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

14. 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

15. Foreign System Interfaces

16. 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

17. 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

18. 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

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

20. 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)

21. 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

22. 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

23. 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

24. 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

25. Post go live – corralling issues
Numerous issues with management reports

26. 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

27. Post go live timeline of outages

28. 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

29. 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

30. 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

31. Questions

32. Vaya con Dios, amigos