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Effective Management of Effective Management of Laboratory Information Laboratory Information

System PersonnelSystem PersonnelKathy M. Davis, BS MT(ASCP)Kathy M. Davis, BS MT(ASCP)

University of Michigan Health SystemUniversity of Michigan Health SystemDepartment of PathologyDepartment of Pathology

Division of Pathology InformaticsDivision of Pathology Informatics

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Overview Overview LIS personnel definedLIS personnel defined

Challenges facing LIS personnel and LIS managersChallenges facing LIS personnel and LIS managers

Skill set requirements of an LIS support teamSkill set requirements of an LIS support team

Hiring and retaining a strong support teamHiring and retaining a strong support team

Relationships with lab personnelRelationships with lab personnel

Relationships with other departments Relationships with other departments

Relationships with vendorsRelationships with vendors

Project management and prioritizationProject management and prioritization

Crisis managementCrisis management

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LIS Personnel DefinedLIS Personnel Defined

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Who are LIS Personnel?Who are LIS Personnel?Understand the business needs and workflow needs Understand the business needs and workflow needs of the clinical laboratoryof the clinical laboratoryResponsible for support, maintenance, and Responsible for support, maintenance, and configuration of the vendor product to promote and configuration of the vendor product to promote and enhance laboratory workflowenhance laboratory workflowResponsible for implementation and support of all Responsible for implementation and support of all value added applications and processes that enhance value added applications and processes that enhance laboratory workflowlaboratory workflowUnderstand the business of integration and Understand the business of integration and interfacesinterfacesUnderstand network infrastructure Understand network infrastructure Understand systems management and securityUnderstand systems management and security

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Overview of Pathology Informatics Overview of Pathology Informatics at University of Michigan at University of Michigan

20 FTEs divided into 5 teams20 FTEs divided into 5 teamsManage > 200 servers with numerous applicationsManage > 200 servers with numerous applicationsEngaged in >150 projects (30+ active at any given Engaged in >150 projects (30+ active at any given time)time)Support >20 laboratories and off site locationsSupport >20 laboratories and off site locationsMaintain / support interface enginesMaintain / support interface enginesManage > 80 interfacesManage > 80 interfacesOutreach program support Outreach program support Provide customer service / help desk for clinical, Provide customer service / help desk for clinical, research, and educational divisionsresearch, and educational divisions24 x 7 support team24 x 7 support team

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Pathology Informatics Pathology Informatics

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Desktop SupportDesktop Support

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Operations and Customer Operations and Customer SupportSupport

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Systems SupportSystems Support

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LIS and Interface SupportLIS and Interface Support

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Web SupportWeb Support

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10%

20%

15%25%

5%

15%

10%Help Desk / CustomerService

Routine OperationalSupport

Development andProjects

Departmental OutreachProgram Support

Departmental LeanInitiatives

Departmental LabSupport

Support for ExternalInstitutional Initiatives

Time AllocationTime Allocation

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Common Configuration of the LIS Common Configuration of the LIS Support TeamSupport Team

Pathology LIS team Pathology LIS team supports the applications supports the applications while the systems and while the systems and hardware are supported by hardware are supported by central ITcentral IT

Potential for conflict Potential for conflict exists between LIS team exists between LIS team and central IT because of and central IT because of differing priorities, differing priorities, business objectives, skill business objectives, skill sets, and educational sets, and educational backgroundbackground

Central IT

Laboratories

Outreach Program

MSIS

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Recommended Configuration of Recommended Configuration of the LIS Support Teamthe LIS Support Team

Dedicated LIS support team Dedicated LIS support team manages all lab applications, manages all lab applications, systems, and hardware systems, and hardware

Pathologist MD director Pathologist MD director provides clout and provides clout and connections within the connections within the organization organization

Manager and LIS support Manager and LIS support team have laboratory science team have laboratory science backgrounds and can speak backgrounds and can speak the language of the labthe language of the lab

LIS Support Team

Central ITTeam

OutreachProgram

MSIS

Laboratories

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Why Structured LIS Support Why Structured LIS Support Teams are ImportantTeams are Important

LIS support teams are often more focused on LIS support teams are often more focused on clinical care issues while central IT teams are often clinical care issues while central IT teams are often more focused on system management and control more focused on system management and control issuesissues

Central IT teams have their own set of priorities Central IT teams have their own set of priorities and they donand they don’’t always include the needs of the LIS t always include the needs of the LIS or laboratoryor laboratory

Central IT team are often quite large which often Central IT team are often quite large which often makes progress more difficult makes progress more difficult

Extra coordination is required to deploy software Extra coordination is required to deploy software changes when system processes are required for changes when system processes are required for implementing the changeimplementing the change

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Maintaining the Proximity of LIS Maintaining the Proximity of LIS Support Team, the LIS Server Support Team, the LIS Server

Room, and the Laboratories Room, and the Laboratories Immediate response to problems Immediate response to problems –– able to observe the able to observe the problemproblem

Direct communication with the end users Direct communication with the end users –– core labscore labs

Instrument and robotics troubleshootingInstrument and robotics troubleshooting

Desktop support troubleshootingDesktop support troubleshooting

Workflow observation Workflow observation –– in the Gembain the Gemba

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Organizational PoliticsOrganizational PoliticsEducate institutional leadership of the merits of Educate institutional leadership of the merits of having an Informatics Division or an LIS support team having an Informatics Division or an LIS support team within the Department of Pathology that is separate within the Department of Pathology that is separate from Central ITfrom Central ITLIS support teams are unique from traditional IT LIS support teams are unique from traditional IT support teams support teams There are inherent risks when LIS support teams There are inherent risks when LIS support teams have offhave off--site configurations of servers and support site configurations of servers and support staffstaffPeriodic struggles with Central IT who believe Periodic struggles with Central IT who believe consolidation of the data centers and IT staff consolidation of the data centers and IT staff represent the best technical and economic strategy represent the best technical and economic strategy and we manage these struggles to protect and and we manage these struggles to protect and preserve our dedicated LIS support teampreserve our dedicated LIS support team

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Understanding the Understanding the Management Challenges of an Management Challenges of an

LIS support teamLIS support team

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LIS Management ChallengesLIS Management ChallengesInformation management with regard to Information management with regard to laboratory medicine is in constant demandlaboratory medicine is in constant demandDemand typically exceeds available resourcesDemand typically exceeds available resourcesRapidly changing environment Rapidly changing environment Demands are imposed from many sourcesDemands are imposed from many sourcesInternal LIS unit demandsInternal LIS unit demandsPathology departmental support / clinical lab Pathology departmental support / clinical lab demandsdemandsMandates from external sources at the Mandates from external sources at the institutioninstitution

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LIS Support Team

Departmental Demands

LIS Internal Demands

ExternalDemands

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Internal LIS Unit DemandsInternal LIS Unit Demands

Politics

Trouble-shooting

Maintenance

Security24 x 7

Support

Help Desk

Data Integrity

CAPFDA

HireTrain

HR

LIS Team

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Pathology Departmental DemandsPathology Departmental DemandsRarely a departmental project that doesnRarely a departmental project that doesn’’t require IT t require IT resourcesresources

Support for LEAN initiatives and other process Support for LEAN initiatives and other process improvement activitiesimprovement activities

Support for laboratory outreach programsSupport for laboratory outreach programs

Support for creation of and implementation solution Support for creation of and implementation solution to complex laboratory workflow processesto complex laboratory workflow processes

Manage LIS replacement projectsManage LIS replacement projects

Support for construction and remodeling projectsSupport for construction and remodeling projects

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External Demands from Other External Demands from Other Institutional DepartmentsInstitutional Departments

Testing and validation of existing interfaces when Testing and validation of existing interfaces when interfaced systems are upgradedinterfaced systems are upgraded

Implementation of new interfaces to support Implementation of new interfaces to support institutional initiatives such as CPOE and ambulatory institutional initiatives such as CPOE and ambulatory care information systemscare information systems

Participation in institutional initiatives such as Participation in institutional initiatives such as external lab result reporting and blood product usageexternal lab result reporting and blood product usage

Interface engine managementInterface engine management

Majority of demands are unfundedMajority of demands are unfunded

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How do we manage all these How do we manage all these demands?demands?

Identify the necessary skill setsIdentify the necessary skill sets

Hire and retain great peopleHire and retain great people

Anticipate future staffing needsAnticipate future staffing needs

Build strong work teamsBuild strong work teams

Project management toolsProject management tools

Customer support toolsCustomer support tools

Communicate, communicate, communicateCommunicate, communicate, communicate

Constantly prioritizeConstantly prioritize

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Practically SpeakingPractically SpeakingDonDon’’t attempt to micromanage team memberst attempt to micromanage team members

Encourage and enable staff to attend training classesEncourage and enable staff to attend training classes

Enable staff to work on projects that excite them in Enable staff to work on projects that excite them in addition to the daily operational support tasksaddition to the daily operational support tasks

-- Happy workers are productive workersHappy workers are productive workers

All projects will take longer than expected due to All projects will take longer than expected due to competing project priorities and mandates or issues competing project priorities and mandates or issues for which you have no controlfor which you have no control

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PrioritizationPrioritizationMust prioritize patient safety issues firstMust prioritize patient safety issues firstConstant struggle as patient safety issues always Constant struggle as patient safety issues always compete with project timecompete with project timeImportant for the LIS team to manage expectationsImportant for the LIS team to manage expectationsTransparency is best solution to help others Transparency is best solution to help others understand reasons for project delays understand reasons for project delays Everyone has their own agenda and typically donEveryone has their own agenda and typically don’’t t care about your concernscare about your concernsDevelop executive steering committee to assist with Develop executive steering committee to assist with prioritizationprioritization

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Skill Set Requirements of Skill Set Requirements of an LIS Teaman LIS Team

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Desirable Character TraitsDesirable Character TraitsSolid interpersonal and communication skillsSolid interpersonal and communication skills

Chemistry that fits with other members of the teamChemistry that fits with other members of the team

Connects well with peersConnects well with peers

Respected by othersRespected by others

Transparent Transparent –– open, truthful, and honestopen, truthful, and honest

ServiceService--orientedoriented

Team playerTeam player

Demonstrates integrityDemonstrates integrity

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Skills RequiredSkills Required

Medical Technology or clinical lab science backgroundMedical Technology or clinical lab science background

Application and system programming Application and system programming

Database management and query skillsDatabase management and query skills

HL7 interface programmingHL7 interface programming

Desktop support skillsDesktop support skills

Systems, networking, and security knowledgeSystems, networking, and security knowledge

Web programming skillsWeb programming skills

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Hiring and Retaining StaffHiring and Retaining Staff

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Finding the ResourcesFinding the Resources

Medical technologists with aptitude for information Medical technologists with aptitude for information management often interested in new career pathmanagement often interested in new career path

Central IT staff with desire to change job rolesCentral IT staff with desire to change job roles

Internal vs. external candidatesInternal vs. external candidates

Experienced vs. inexperiencedExperienced vs. inexperienced

ConsultantsConsultants

Horizontal integration into the laboratories Horizontal integration into the laboratories

-- Laboratory Med Tech IT specialistsLaboratory Med Tech IT specialists

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Medical TechnologistsMedical Technologists

Understand the business of the clinical labs Understand the business of the clinical labs and speak the languageand speak the language

Tend to have excellent troubleshooting skills Tend to have excellent troubleshooting skills and analytical skillsand analytical skills

Are respected and trusted by fellow Are respected and trusted by fellow laboratory stafflaboratory staff

Are readily available in the laboratoriesAre readily available in the laboratories

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ConsultantsConsultants

Consultants are excellent team members for Consultants are excellent team members for urgent closedurgent closed--ended projectsended projects

Consultant salaries often exceed the salaries Consultant salaries often exceed the salaries of existing IT staff which can cause rancor of existing IT staff which can cause rancor among regular employeesamong regular employees

Knowledge about how to support the Knowledge about how to support the application or service often leaves with the application or service often leaves with the consultantconsultant

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Job Competition with Central IT Job Competition with Central IT StaffStaff

Important to work with HR departments to Important to work with HR departments to ensure LIS personnel and Central IT staff have ensure LIS personnel and Central IT staff have similar pay scalessimilar pay scales

Use similar job classes and job titles to prevent Use similar job classes and job titles to prevent loosing valuable trained team members to the loosing valuable trained team members to the Central IT divisionCentral IT division

Job satisfaction is often greater in smaller Job satisfaction is often greater in smaller divisions where individual team members tend to divisions where individual team members tend to learn more skill sets and are less likely to be learn more skill sets and are less likely to be limited to one or two skill setslimited to one or two skill sets

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Retaining the ResourcesRetaining the ResourcesExciting and challenging Exciting and challenging workworkDiverse work Diverse work assignmentsassignmentsChoice of projects and Choice of projects and responsibilitiesresponsibilitiesAbility to learn on the Ability to learn on the jobjobOpportunities for Opportunities for career growthcareer growth

Being part of a good Being part of a good teamteamSupportive managementSupportive managementRecognition, value, Recognition, value, respect, and trustrespect, and trustFlexibilityFlexibilityBeing fairly treated Being fairly treated with fair paywith fair payGoodies on FridayGoodies on Friday

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Friday TreatsFriday Treats

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Work Groups or TeamsWork Groups or TeamsSmall teams or work groups ensure redundancy Small teams or work groups ensure redundancy of required skills to support the system or of required skills to support the system or applicationapplication

Always avoid single threaded models of Always avoid single threaded models of supportsupport

Progress is threatened when bottlenecks occurProgress is threatened when bottlenecks occur

Team leader roles for each team provide Team leader roles for each team provide stratification and upward mobility for team stratification and upward mobility for team membersmembers

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TeamworkTeamwork

Teamwork is the ability to work together Teamwork is the ability to work together toward a common vision. The ability to toward a common vision. The ability to direct individual accomplishments direct individual accomplishments toward organizational objectives. It is toward organizational objectives. It is the tool that allows common people to the tool that allows common people to attain uncommon results.attain uncommon results.

-- unknownunknown

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A Winning Team!A Winning Team!

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More team work!More team work!

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DiversityDiversityCultivate an atmosphere that recognizes, values, Cultivate an atmosphere that recognizes, values, respects, and appreciates the strengths and respects, and appreciates the strengths and differences that exist among peopledifferences that exist among people

Average age of population and workforce is rising Average age of population and workforce is rising

Two thirds of new entrants into the workforce are Two thirds of new entrants into the workforce are womenwomen

Minorities comprise 29% of new entrants into the Minorities comprise 29% of new entrants into the workforceworkforce

Research shows that building diverse work teams take Research shows that building diverse work teams take longer, but that innovation and productivity improve longer, but that innovation and productivity improve over timeover time

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Managing Across the Managing Across the GenerationsGenerations

TraditionalistsTraditionalists19001900--19451945

Loyal, selfLoyal, self--sacrifice, likes respect for sacrifice, likes respect for authority, dislikes wasteauthority, dislikes waste

Baby BoomersBaby Boomers1946 1946 -- 19641964

Optimistic, workaholics, likes Optimistic, workaholics, likes responsibility, dislikes lazinessresponsibility, dislikes laziness

Generation XsGeneration Xs1965 1965 –– 19801980

Independent, suspicious of authority, Independent, suspicious of authority, likes freedom, dislikes micromanagerslikes freedom, dislikes micromanagers

MillennialsMillennials1981 1981 -- 20002000

Hopeful, determined, likes latest Hopeful, determined, likes latest technology, dislikes anything slowtechnology, dislikes anything slow

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HR IssuesHR IssuesAnger and hostilities in Anger and hostilities in the workplacethe workplace

DeceitfulnessDeceitfulness

InsubordinationInsubordination

Instigators and Instigators and troublemakerstroublemakers

FaultFault--finders and finders and complainerscomplainers

SlothfulnessSlothfulness

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Relationships with Lab Relationships with Lab PersonnelPersonnel

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Importance of LIS Liaison in Importance of LIS Liaison in Each Laboratory SectionEach Laboratory Section

The LIS team must stay connected with the The LIS team must stay connected with the laboratorieslaboratories

Horizontal integration into the labs achieved by Horizontal integration into the labs achieved by tagging a bench technologist in the laboratory as tagging a bench technologist in the laboratory as an IT specialist that works directly with the LIS an IT specialist that works directly with the LIS support team support team

Ensure that front line workers have ownership of Ensure that front line workers have ownership of LIS workflow processesLIS workflow processes

Must stay in touch with laboratory initiatives; Must stay in touch with laboratory initiatives; each lab has their own agenda and prioritieseach lab has their own agenda and priorities

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Relationships with Other Relationships with Other DepartmentsDepartments

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Relationships with Central ITRelationships with Central ITBuild strong relationships with Central IT and Build strong relationships with Central IT and utilize the infrastructure; it enables LIS teams utilize the infrastructure; it enables LIS teams to address the business needs of Pathologyto address the business needs of Pathology

Desktop clinical images, email management, Desktop clinical images, email management, paging systems, security policies are well paging systems, security policies are well managed by Central IT teamsmanaged by Central IT teams

Utilize server room space for redundancy of Utilize server room space for redundancy of hardware and disaster recovery solutionshardware and disaster recovery solutions

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Relationships with Other Relationships with Other AncillariesAncillaries

Important to establish working relationships Important to establish working relationships with other ancillary departmentswith other ancillary departments

May be able to share expertise when May be able to share expertise when troubleshooting problemstroubleshooting problems

May be able to provide mutual space for May be able to provide mutual space for hardware that provides server redundancies hardware that provides server redundancies between the two ancillaries between the two ancillaries –– partnershipspartnerships

Maintenance contract consolidationMaintenance contract consolidation

Shared hardware resources to reduce cost of Shared hardware resources to reduce cost of ownership and duplication of effortownership and duplication of effort

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Relationships with VendorsRelationships with Vendors

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Relationships with VendorsRelationships with VendorsMust work towards a partnership relationship with Must work towards a partnership relationship with your LIS vendor to create value for both parties your LIS vendor to create value for both parties

Kindle a culture of coKindle a culture of co--development and trustdevelopment and trust

LIS personnel are responsible for helping LIS LIS personnel are responsible for helping LIS vendors understand the workflow needs of the vendors understand the workflow needs of the laboratory laboratory

Stay involved and participate in user groupsStay involved and participate in user groups

Pursue participation on vendor steering committeesPursue participation on vendor steering committees

No undelivered communicationsNo undelivered communications

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Project Management and Project Management and PrioritizationPrioritization

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Project ManagementProject ManagementKeep it simple Keep it simple

Formal project management can consume Formal project management can consume available time and resources to complete the available time and resources to complete the projectproject

Web based forms for user requests and Web based forms for user requests and status updatesstatus updates

Manage expectations Manage expectations -- COMMUNICATECOMMUNICATE

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Project Management Project Management DocumentsDocuments

Project Scope DocumentProject Scope Document

Project Technical DocumentProject Technical Document

Project End User DocumentProject End User Document

Project Validation and Testing DocumentationProject Validation and Testing Documentation

Project Sign OffProject Sign Off

Project Status ReportProject Status Report

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Project PrioritizationProject PrioritizationIT staff must be able to multiIT staff must be able to multi--task task

Very difficult to prioritize projects as Very difficult to prioritize projects as everyone has their own agendas and prioritieseveryone has their own agendas and priorities

The organization is a pyramid with LIS support The organization is a pyramid with LIS support team the base of the pyramidteam the base of the pyramid

Steering committee is beneficial to remove IT Steering committee is beneficial to remove IT staff from front line decision making regarding staff from front line decision making regarding a projecta project

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Project DashboardProject DashboardDepartmental Projects

Team Name Notes

APP HLA Project

LISMlabs Integrated Report

APP Transcription replacement project

LIS AP Inbound Orders

LIS/Balis Cytology Printers

LIS/BalisAP Custom Labels

LISMlabs Connect

LIS LEAN data collection for Micro and Cytology

LISAntibiogram revisions

LISESR Analyzer Interface

LIS Chemistry Interface

LIS Cytogenetics State Reporting

LIS Hematology Paperless Workflow

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Crisis ManagementCrisis Management

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Support DocumentationSupport DocumentationMust have adequate support and Must have adequate support and troubleshooting procedures for all supported troubleshooting procedures for all supported applicationsapplications

Make these procedures available on lineMake these procedures available on line

Ensure complete information is on file Ensure complete information is on file regarding vendor contact information and regarding vendor contact information and escalation proceduresescalation procedures

Conduct drills and post mortem analysesConduct drills and post mortem analyses

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On Call Support StaffOn Call Support StaffEnsure a team member is on call for all Ensure a team member is on call for all technical or end user issues 24 x 7 technical or end user issues 24 x 7

Cross train individuals for on call rotationsCross train individuals for on call rotations

Cultivate an expectation that team Cultivate an expectation that team members may be called upon during off members may be called upon during off shifts and weekends even if they are not shifts and weekends even if they are not ““on callon call”” if they are the expert for the if they are the expert for the issueissue

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SummarySummaryCommunicate, communicate, Communicate, communicate, communicatecommunicate

Hire and retain good peopleHire and retain good people

Provide ample training Provide ample training opportunitiesopportunities

Build strong teamsBuild strong teams

Build strong relationships with Build strong relationships with labs staff, other departments, labs staff, other departments, and vendorsand vendors

Stay organizedStay organized

Be Be NICENICE!!