1. Soft Web – Our Journey from Accessioning to Electronic Orders
Michael Huppenthal – Pathology Administration
Greg Rex – I.T. Project Leader

2. Presentation Focus Soft Web Overview Outpatient Phlebotomy at J.H.H.
Soft Web Workflow
Hands on Workshop
Measures / Outcomes / Improvements
Implementation Hurdles

3. SCC’s Marketing of Soft Web
Improve profitability by providing outreach services to the community.
Low cost, efficient tool for managing and growing outreach programs.
Fast, efficient, and user friendly.
Increase Laboratory Revenue.
Optimize Workflow in the Lab.

4. Johns Hopkins Pathology: Business Model
Our outreach business model is targeted to strategically located Health Centers affiliated with the Johns Hopkins Medical Institutions.
The majority of these sites use the JHMI EMR’s for result query.
November 7, 2018November 7, 2018

5. Soft Web at Johns Hopkins
We use Soft Web Plus as a web based extension of the Lab Information System:
Web based Order Entry from Paper Orders.
Collection of Electronic Order from the Epic HIS.
Printing of barcodes specimen labels.
Advance Beneficiary Notice Compliance.
Management of specimens at each collection site.
Shipping reports, manifests, and specimen receipt.

6. J.H. @ Baltimore Metro Phlebotomy Locations

7. Johns Hopkins at Sites (21):
East Baltimore (2 mi)
Wyman Park (5 mi)
White Marsh (11 mi)
Riverside (28 mi)
Odenton (20 mi)
Annapolis (36 mi)
Hager Park (78 mi)
Frederick (46 mi)

8. Outpatient Phlebotomy Reception

9. Typical Phlebotomy Booth

10. Typical Workflow
Soft Web is used at most Outpatient Phlebotomy Stations.
Sites process 15 to 350 patients/day.
Average day – 2600 Outpatient Phlebotomy Encounters.
Encounters vary from 1 to 28 test orders with an average of 6.8 test orders per encounter.
Sites perform Phlebotomy Collection and also Label all Clinic Collect Specimens before shipment to the testing laboratory.

11. WORKFLOW
November 7, 2018November 7, 2018

12. Patient Orders Three Workflows Soft Web Order Entry
Soft Lab Order Entry
Electronic Interface from the HIS (Epic)
Phlebotomist releases orders from Epic to Soft
Clinic Collect labeling after Collection in Epic

13. Login – Site Location
You must correctly identify your Phlebotomy site to Manage specimen collections at each station.

14. Patient Order Entry 1. The entered Phlebotomy Site name displays here.
2. Search for the Patient by entering the MRN or Patient Name.
3. Click Find to begin the Search.

15. Entering Patient Information for a New Entry
The screen is divided into four tabs.
Patient
Payor/Insurance
Emergency Contact
Policy Holder/Insured.
Mandatory fields are in Pink.
In our workflow, we only enter the mandatory patient and payor/insurance information.

16. Enter the Requisition Details
Enter the Billing Method:
Commercial
Medicare
Self Pay
Client
Enter the Diagnosis Codes supplied by the Provider
Quick select tests from the available templates
Low frequency tests can be added through the Test Lookup Tab

17. Medicare – Check Compliance (Only applicable to Medicare Patients)
Tests that fail the Compliance checking are clearly displayed.
ABN’s can be printed in English or Spanish. Two copies are printed. The patient copy and the retained signed copy.

18. System Printed (ABN) Advance Beneficiary Notice
A Media Label is applied to the ABN. When scanned, the document will be stored with the orders.
Patient signs and dates one copy of the ABN form
Failed test(s) and the estimated price(s) are printed on the ABN

19. Print the Labels Local attached Printer
Select the printer and label layout and click OK.

20. Specimen Barcodes Specimen Labels print to the selected printer.
Labels contain the patient name, MRN, birthdate, age, sex, barcode number, order number, collection container, date and time of label print, the ordered tests, and test specific instructional comments.
The required number of media labels are also ordered and applied to all paper(s) associated with the patient lab encounter.

21. Label Examples

22. STEP 2: COLLECTION
This tab is used for the collection of accessioned orders (Lab and Web).
For sites using electronic orders, users start at the Soft Web Collection Tab.
As of July 1, 2013; 90% of our Web orders now originate from Epic (except those that fail to transmit).

23. Main Screen – Collections Draw List Tab
1. Enter your Phlebotomy Site ID.
2. Enter your patient to display all the available orders for collection on the patient. Click FIND.

24. Collection Details
3. Click OK to submit the entered Collection Times or other action.
1. Highlighting one order from the patient and Click on Collect Specimen, which launches the Collection Details Screen.
2. The Phlebotomist can enter the collection date and time for each specimen in the list. Options include collection, not collecting (difficult stick) or skipping the specific specimen.

25. Step 3: Shipping a Batch of Specimens
1. Click on the Shipping tab to display all of the collected specimens at the Phlebotomy Site that have been collected and are ready for shipping.
3. Close the process by clicking on “Create Shipping Manifest”.
2. Specimens can be scanned into the list and should be loaded into the shipping container (Bag or Carrier).

26. Manifest Generation Menu: Collection / Shipping Tab
The shipping manifest could be one specimen or hundreds. Each manifest is uniquely identified and can be associated with all the collected specimens that were entered within the batch.
Click Close to move to the next step.

27. Transport Documentation
Enter the transportation details in the pop-up box.
Examples:
(Courier Driver 21 - Joe H.)
Click OK to enter the comment

28. Reports Menu Specimen Status Report
Enter the desired criteria for the report. Enter a date range, draw location, or ordering location.
You can also search by multiple specimen statuses: Not Collected, Collected, Not Shipped, Picked-up, and Received.

29. Phlebotomy Sites: Activity Management
Use Soft Web Management Reports to ensure that 100% of label prints and collections are completed each day at each Phlebotomy site.
Next working day, print the Management report to screen for A.W.O.L. specimens.
Call J.H.H. Customer Service to report issues.

30. Specimen Status Report

31. Specimen Status Report Missed Scan

32. Manifest Status Report

33. Shipping Manifest Individual Package

34. Outcome: ABN Compliance
Prior to Soft Web, ABN compliance averaged 72% with paper ABN’s.
With Soft Web accessioning, ABN compliance for Outpatient collections increased to an average of 96%.
With Epic electronic orders, ABN compliance is “not good”.

35. Outreach Phlebotomy Cancellation Q.A.
Lab cancellations are monitored for a variety of reason.
Incorrect Collection Container
Incorrect Specimen Transport Condition
Specimen Quantity not Sufficient
Specimen Clotted
Specimen Not Received
Specimen Unlabeled /Mislabeled
Duplicate Orders

36. Soft Web Test Cancellation Structured Comments

37. Outcome: Cancellation Rates – AWOL specimens
Prior to Soft Web, core cancellation rates averaged 2.3% monthly.
QNS, Incorrect Container, Lab Issue, Not Received, Clotted, Labeling Issue, Patient ID
With Soft Web, overall cancellation rates average 0.26% monthly. (119/45,525)
The greatest cancel category reductions were lost specimens and incorrect collections.

38. Epic Electronic Orders Challenges
Epic ABN compliance with P.O.E.
Releasing Future Orders

39. Implementation Challenges The Bad and the Ugly
Printing of Specimen Labels.
Database: Lab vs Web.
Security set-up – Rotating Staff.
Laboratory Cancellation Statistics.

40. Printing Specimen Labels
Soft printer recommendations
What printer?
Direct connect or network
Active X
Speed of Label Printing
Quality of printed Barcodes
No printerc file

41. Soft Lab vs. Soft Web
Lab accessioning where there are network/citrix connections
Utilize Soft Web
Outreach sites
Non-lab users
Hybrid Model

42. Security Set-Up/Staffing and Stats
SoftSecurity first
Edit Assessable Location in SWP Admin
Then reset security in SoftSecurity
Good statistics for supervisors by draw and order location
Specimen Tracking
Manifest Reports

43. 1889 to 2012

44. New Automated Core Lab Open April 2012

45. Questions