Appalachian Regional Healthcare System Full Case Study

Clinical laboratories across the U.S face a plethora of business issues, not the least of which is delivering excellent patient care under tight timelines while maximizing productivity of the existing workforce. In this often tense environment a major information technology (IT) project can be daunting, especially for a community based healthcare system with small departmental teams.

The Town of Boone, located in North Carolina’s High Country in the Appalachian Mountains is named for Daniel Boone, early America’s famed pioneer and explorer, the city has a population of just over 18,000 and is home to Appalachian State University. Based in Boone, Appalachian Regional Healthcare System (ARHS) is comprised of:

  • Charles A. Cannon, Jr. Memorial Hospital in Linville
  • Watauga Medical Center in Boone
  • Appalachian Regional Medical Associates (ARMA), a physician practice management group
  • The Foley Center at Chestnut Ridge in Blowing Rock
  • Appalachian Regional Healthcare Foundation

ARHS is the premier healthcare system in the region, with a commitment to “promoting health in the High Country, enhancing the quality of life and simply ‘making life better’”.

This community-based healthcare system installed SCC’s SoftLab® and SoftBank® in 2006, the Allscripts Sunrise™ system in 2013 and added Mosaiq® Medical Oncology in 2017. Since the lab produces information that is critical for patient care, any new clinical system as well as Lab Information System (LIS) upgrades include interface testing to validate lab result data passes correctly to those systems. ARHS’s LIS team consists of two people and requires support from departmental staff to perform all validation in the Soft LIS for large projects or upgrades. In a busy lab, this can have an immense impact on daily operations or risk project delays if testers need to work the bench.

In 2015, the ARHS lab faced a formidable task – completing a major Soft LIS upgrade while adding SoftTotalQC™, SoftID® and electronic crossmatch functionality to the system in time to complete their part in other enterprise projects. The timeline for the LIS upgrade was nine months. Three months into the upgrade, ARHS chose Software Testing Solution’s (STS) SoftBank Test Suites to help.

“Not only were we facing a compressed 9-month timeline for our upgrade, but we were immediately facing CAP inspection preparation,” states Beth Miller, ARHS Senior Director.  “With our limited staffing resources, upcoming summer staff vacations, and CAP preparation, the ROI with STS actually demonstrated significant FTE testing hour savings.  We could accomplish everything we wanted without significant additional stressors to the staff for testing and validation hours.  The testing/validation hours we saved with STS for the upgrade far outweighed the manual hours we would have invested.  We realized a quicker upgrade outcome with minimal impact to our other laboratory service needs, i.e. CAP preparation, vacation coverage, stress, etc.”  

Wendy Williams, ARHS Laboratory Operations Manager, states “the STS product is extremely user friendly and provided the extent of validation testing we needed to support the documentation of a full version validation.  In addition, we continue to use the product for validation of version upgrades and additional needs throughout the year.”

Because STS’s staff works closely with customers who are undertaking major validation projects, things moved quickly! Within two weeks of receiving ARHS’s order, STS staff had remotely loaded the software, worked with the lab to configure test scripts emulating their workflow and begun performing automated validation using SoftLab Scenario. Soon after, SoftBank Scenario test scripts were similarly configured and operational. ARHS used these scenario tests for almost all of their remaining validation.

By automating the validation, the lab was able to offload time-consuming tasks from their technologists to STS’s technology. Further, because the scripts ran unattended and didn’t take breaks or vacations, the lab was able to accelerate the remaining project tasks, cutting the remaining six months of the LIS upgrade schedule in half – successfully reducing the original nine month timeline by a third.

Extracting reports from STS that show successful or failed validation steps was another big win for the lab. After encountering an unexpected outcome, the laboratory was able to make corrections and easily rerun just that part of the validation to assure the corrective action was effective.

“The validation reports from STS were very detailed and included explanation for the expected results of a given test case,” states Candace McCoy, Blood Bank Supervisor.  “This allowed easy identification of failures so that corrections could be implemented sooner.  Using STS allowed us to perform a superior validation than what I could have done on my own given our condensed validation timeframe.”

Linda Boney, LIS Administrator says “We knew that our lab system functioned, but STS proved it and provided the evidence that shows it. Our Medical Director, a former blood banker, was impressed with the reports produced by the system.”

Indeed, the laboratory has undergone multiple inspections and the reports have satisfied all inspectors – a very welcome benefit!

After the functional workflow testing was complete the lab used the SoftLab and SoftBank Volume scripts to validate new interfaces to Sunrise and more recently to the new Mosaiq Oncology system. Volume scripts can be set up to use some or all of the orderable tests including reflex tests. ARHS analysts estimate that the volume scripts, which automatically order and result tests in the LIS, have saved them 50 – 60% of their required testing time during interface testing.

Because STS’s maintenance agreements include testing assistance and keeping the software compliant with SCC releases, ARHS can automate all future LIS upgrade validations and interface testing.

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