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Find the right LIS ... with EASE.

Find the rights LIS ... with EASE As a representative of health care information systems vendors for several years, I participated in system design, development, sale, selection, implementation, and support. These activities gave me opportunities to observe various techniques for choosing laboratory information systems.

Most such selection processes share certain elements: proposals by vendors, demonstrations, site visits, committee meetings. The different ways in which these common elements are organized and used will assure or limit the success of the project.

Implementation of a system selected without involving the laboratory staff is likely to meet with asistance. If those who must work with the system do not clearly understand its requirements, the chosen system might end up doing unnecessary things very well. Considering only a few vendors may lead to overlooking the best system for the job. Failing to establish reasonable criteria for eliminating systems may lead to considering more vendors than the selection committee can reasonably manage.

A return to the clinical laboratory where I had trained as a medical technology student gave me the chance to combine my experiences in industry and labs in finding, implementing, and managing an LIS. As project manager, I was efpa to design and implement an information system acquisition process that benefited from the best and avoided the pitfalls of the worst techniques I had seen. We found our acquisition process brought structure and objectivity to a task often overwhelmed by opinions, personalities, and the sheer magnitude of the job.

* Unique needs. We began our search for a replacement LIS in December 1988. The existing LIS, which computerized the general laboratories of our 700-bed tertiary-care medical center, had been in use for 10 years. A subsidiary system, dedicated to microbiology, had been implemented in 1984. Other labs reported their data on the hospital information system (HIS), in place since 1986, or on PCs.

The search for a replacement system was initiated by laboratory administration, who considered the existing systems inadequate to support current and future operations. The process I designed and implemented was intended to evaluate the labs' existing systems, to define what the replacement system should provide, and to find the most suitable system to meet those needs.

The selection process involved four major steps; namely, to:

Evaluate current environment and systems;

Assess information system needs;

State information system objectives; and

Examine alternative systems.

These steps, which led smoothly from one to the other, will be discussed sequentially here.

* Evaluate environment. The first step was intended to focus attention on our current information system. In evaluating the vendors and systems being used in the laboratory, I examined the factors liste in Figure I.

Through observation and discussion with laboratory staff and management, users of our services, and suppliers of services to the laboratory (such as our information systems department), I identified strengths and weaknesses of the current organization, including the flow of work and information. Such analysis, accompanied by careful documentation, encouraged lab staff and management to think constructively about our methods of providing services. The process led to some short-term changes that improved use of our existing systems right away. Most important, it validated our perception that the existing systems were inadequate.

* Assess needs. Interviewing managers of areas likely to become users of the new LIS helped me determine the requirements of the system for the immediate and distant future. I worked with representatives of all divisions being considered for computerization. Together we identified the organization, workflow, and information flow we wanted to achieve, emphasizing the integral part that the LIS would play. We identified the numbers and types of staff who would use the system, tasks that would be computerized, and computer hardware and interfaces needed. The result was a narrative description of laboratory operations that we ultimately included in our extensive Request for Proposal (RFP). An example is shown in Figure II (A).

As they helped identify needs, laboratory managers were able to make realistic plans for computerization or recomputerization of their areas. The documents created in the process gave vendors responding to our RFP important background material about why we wanted each attribute requested. This in turn enabled them to suggest alternative solutions to the problems we had identified.

* State objectives. While the document we were creating contained a great deal of valuable information about how we intended to use our new system, it did not lend itself well to soliciting information from LIS vendors. Therefore, we translated the documented needs into individual features, functions, or characteristics of the LIS we wanted and of the vendor that would provide it. Our preferences fell into seven major categories:

1. Functionality

2. System interfaces

The narrative description of our needs formed the basis of these two sections. We prepared a list of discrete items describing what the system should do, the programs and functionality it should provide, and what kinds of data should be transmissible to and from the LIS.

3. Technical characteristics

The third section addressed features of the computer equipment, operating system, programming languages, communications software, and utilities. We wanted these to provide an appropriate platform for the functionality and system interface applications. We also discussed the desired responsiveness, availability, integrity, and security of the system.

4. Training, implementation, and documentation

We delineated our expectations regarding four areas: the size of the vendor's staff an the extent of their experience, the vendor's past success at labs similar to ours, the amount of time and resources to be devoted to our project, and the user and technical documentation to be provided to us.

5. Maintenance and support after implementation.

We described the levels of support we expected for hardware, software, and database components of the system.

6. Cost

We identified the areas of expense that were associated with acquisition, implementation, and maintenance.

7. Vendor/Company

We stated our requirements regarding the vendors' financial status, experience in laboratory data processing, and future corporate and system plans.

These seven categories of system objectives, all prepared on a word processor, provided the basic structure for our RFP. We printed out our requirements in a document of questions for vendors to answer (Figure II, B). Their responses were fed into a spreadsheet for evaluation.

We now knew precisely what we were looking for. We had the basis for a methodical, objective, thorough search for the most suitable LIS.

* Examine alternatives. We solicited and evaluated information about commercially available systems throughout the seven-month process. This effort is clear from a comparison of dates in our LIS selection schedule (Figure III). We extended a Request for Information (RFI) and then, selectively, a Request for Proposal (RFP). Finally, we arranged for demonstrations and site visits.

Each step was followed by an objective evaluation of the information obtained. any system that failed to meet our objectives was eliminated. We proceeded from the most general information provided by a large number of vendors to the most specific details provided by those most likely to meet our needs.

The RFI was sent to 26 vendors, of which 18 responded. Five of these and our incumbent received RFP forms. Each of these six submitted written proposals and made a two-hour presentation. At that time we eliminated three and invited the three still under consideration to present two-day demonstrations at our hospital and to arrange site visits for us to laboratories that used their systems.

* Resources. I found it essential to have access to a personal computer with both word processing and spreadsheet applications and to a top-quality printer. I used the word processor to develop the RFI and the RFP and to produce all correspondence, internally and with vendors.

Using spreadsheet software, I assigned numeric values to vendors' potential responses for each question we had asked. Spreadsheets also helped me develop formulas that expressed each system's features and functionality as numeric scores. We were thus able to keep our evaluations of all RFIs, RFPs, demonstrations, and site visits uniform and objective.

During the seven-month process, I spent virtually all my time on the project. Laboratory management participated when appropriate to provide information, review materials, and attend presentations. Each director spent 30 to 40 hours on these tasks. Those who made site visits devoted an additional six days to the selection process. Representatives from other hospital departments, most notably Information Systems, contributed a substantial amount of time and information as well.

* Benefits. We found that our process identified a suitable system in a structured and well-documented way. Our laboratory derived additional benefits of identifying shortcomings, which we corrected, in our use of the existing systems; building consensus about our information system needs and the vendor we chose; and generating enthusiams for the project. Staff and management felt comfortable in knowing that everyone's needs were being considered and suggestions solicited. The resulting goodwill, as important in its way as selecting the right system, laid the foundation for its successful implementation--and we did it with EASE.

The author is laboratory systems manager at Michael Reese Hospital and Medical Center, Chicago.
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Title Annotation:four steps in the process of selecting a laboratory information system
Author:Mills, Barbara Drozd
Publication:Medical Laboratory Observer
Date:Dec 1, 1990
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