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New TriCore IT Architecture Improves Lab Data Capture, Lab Efficiency

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NEW YORK (360Dx) – A new IT architecture implemented at TriCore Reference Laboratories is streamlining lab-related data collection and expanding the amount of lab data held in TriCore's central data repository.

The changes are intended to give lab personnel, physicians, and patients a more complete view of patient health, TriCore executives said.

"We have added more data into the data repository and we have gone from multiple sources of data reporting to a single source of data reporting out of that repository," said Steve Ayer, TriCore's chief information officer. "We have added features and standardized the data better, so we have enhanced it."

The new architecture was designed by Rhodes Group, the clinical information technology company that TriCore has worked with for approximately 10 years and acquired in 2015. While some elements of the Rhodes Group platform have been in place at TriCore for years, including the central data repository, TriCore's new architecture, dubbed C21, more fully implements the features of the platform to create an architecture in which various sources of data are more seamlessly integrated, according to Ayer.

Ayer describes the Rhodes Group platform as a "wraparound" to TriCore's lab information system that improves how the LIS communicates with various other systems and collects data into a central repository. A financial component of the Rhodes platform that TriCore has had in place for years, for example, assembles various data required by insurers to ensure that all information is properly collected before bills are sent to insurance companies.

"We know that our probability of billing goes up by 80 percent compared to what we would get without it," Ayer said.

The new enhanced architecture more seamlessly collects anatomic pathology data into TriCore's central data repository, according to Ayer. The enhancements to lab data collection have also improved the lab's ability to create antibiograms — or profiles of antimicrobial susceptibility testing results of microorganisms to antimicrobial drugs — he said.

Enhancements made with the C21 architecture also involved standardizing electronic master patient index processes across different platforms and touchpoints of the architecture to ensure that data collected about patients is more complete and reliable, Ayer said.

These and other improvements to data collection will allow TriCore to provide clinicians with a deeper longitudinal view of the health of their patients, according to Ayer.

In addition to improving clinicians' view of patient health, the new architecture will enable the creation of a patient portal to give patients a complete view of their lab testing history. The patient portal is expected to be delivered in the second quarter of next year.

"We are in the definition phase of our patient portal so that we can have direct interaction with the patient and their [lab] results," Ayer said. "Through the patient portal, patients will see all of their results no matter where they are coming from."

The new architecture involved upgrading the Rhodes Platform as well as TriCore's SunQuest LIS. It also involved moving to an interface engine from Data Innovations. These upgrades, according to Ayer, help TriCore more seamlessly interface with the three different hospital systems and more than 70 locations it serves in New Mexico, as well as the variety of lab equipment it uses. The hospitals the lab serves use different electronic health record systems.

By improving connections and data collection and creating a deeper data repository, the new architecture will also support improved analytics, which are the basis for the "Lab 2.0" model that TriCore has long advocated, according to Ayer. Lab 2.0 involves using population health analysis to develop lab programs that will drive improvements in patient care, while also supporting value-based care cost models.

"We have more data and more sources of data feeding into our analytics. We had already started on the path to analytics with Lab 2.0 but we just have a richer environment to work with now," Ayer said.

In addition to improving data collection the new architecture is helping the lab improve the efficiency of its processes, Ayer said. The upgrade improved specimen routing in the order entry and specimen routing component of the new architecture. Specimens are grouped together more efficiently for faster routing and processing in the laboratory. In addition, the new system can better track specimens throughout the life cycle, from when the draw is first taken, to the pickup by the laboratory, and the routing within the laboratory, Ayer said.

Moving forward, TriCore is working with radio frequency identification to manage lab specimens without having to touch them or use hand scanners to scan bar codes.

"We haven't implemented that yet but we are working to make it happen," he said.

Another new feature added to the new architecture has improved the efficiency with which the lab contacts physicians when the result of a lab test is in an urgent or critical range, Ayer said. Previously if a test result was in a critical range, lab personnel would manually go into the Sunquest system, look up the contact information for the physician who ordered the test, and then call the physician. In the C21 architecture, TriCore built new integration with its Salesforce customer relationship management system, so that when a test result falls in a critical range, that result and the contact information for the physician is automatically sent to the top of the queue in the call center.

"The physician callouts happen within basically a few minutes of the notification coming from the lab equipment that the particular test result is within a critical range," Ayer said. "It saves us time and it saves us labor."

The new feature resulted in a 20 percent time savings in calling physicians by eliminating the manual work of looking up the physician contact details, he estimated.

Other new enhancements were also designed to improve the patient experience. The C21 architecture's order entry component is used in draw centers, so that when patients come in, TriCore personnel know who they are and what they have come in for. In addition, analytics built into the C21 architecture enable insurance companies to do "targeted interventions" through which insurers can reach out to physicians to drive patient contact if patients have missed tests that should be performed.

"For example, if you are in a prenatal circumstance, and you miss a second trimester test, we can alert the insurance company. They can then alert the physicians to call the patient," he said.

In some places, the smoother connections of the new architecture have enabled TriCore to remove some of the architecture's components. Processors used in a data transmission technique known as "store and forward" were able to be eliminated from the laboratory information system through the new architecture. Processors used for terminal emulation, which enables terminals to emulate or appear like another terminal, were also no longer needed. Eliminating processors serving these functions have enabled TriCore achieve significant savings, Ayer said. TriCore has saved $213k so far this year and will continue to save approximately $54k/month on an ongoing basis from architecture changes, he said.

Implementing new architecture required some retraining of lab personnel, particularly lab workers who entered orders into TriCore's Sunquest LIS or its SunQuest PowerPath anatomic pathology laboratory information system. Those orders are now entered through the C21 architecture, which also helps bring more data into TriCore's data repository. However, while it requires some training to familiarize lab personnel with new formats, the new architecture also standardizes more order entry in the lab, according to Ayer.

"I think the biggest advantages are we standardized on a single platform that people interact with. We have seen a significant reduction in cost and improved efficiencies," Ayer said. "From my perspective, we have made it easier to provide better healthcare because of the fact that we can do better analytics and we can do faster identification of issues."