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Clinical Laboratory Management Indicators

Clinical Laboratory Management Indicators. CLMI. MSgt Christopher A. Bartley AF DoD CLIP Program Manager 202-782-2585/DSN: 662 Christopher.bartley@afip.osd.mil. Overview. Why CLMI? Data Requirements Problem Areas Fixes CLMI Data: Where were we?. Overview (continued).

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Clinical Laboratory Management Indicators

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  1. Clinical Laboratory Management Indicators CLMI MSgt Christopher A. Bartley AF DoD CLIP Program Manager 202-782-2585/DSN: 662 Christopher.bartley@afip.osd.mil

  2. Overview • Why CLMI? • Data Requirements • Problem Areas • Fixes • CLMI Data: Where were we?

  3. Overview (continued) • CLMI Data: Where are we? • Quarterly Summary Report • How do I use CLMI? • Point of Contact • Questions

  4. Why CLMI? • CLMI is the laboratory benchmarking system in use by the Air Force and Navy • Army uses ASAMS • It Provides tools to: • Evaluate operational and financial performance • Improve utilization of services, productivity, and cost effectiveness

  5. Data Requirements • Report due by the 15th of the next month • Facility and General Information • Bed size • Facility type (medical center, hospital, clinic) • Month, FY, FY Quarter, End Date of report • Clinical Lab • Workload Data • In-house Reportable Tests (RT) for each lab section • Broken down by CPTsuffix • 00 – Tests performed in-house • 26 – Pathology Consults • 32 – Tests performed for another lab (shipped-in)

  6. Data Requirements • Clinical Lab • Off-Site Workload • Clinical Lab, Histopathology and Cytology RTreferred out • To Civilian Labs (including monthly cost) • To Military Labs • Utilization Data • Outpatient RT • Outpatient Visits • Inpatient RT • Admissions

  7. Data Requirements • Clinical Lab • Staffing/Productivity Data • Full time equivalents (FTE) by Grade • O-6, O-4/5, O-3, O-1/2 • E-9, E-8, E-6/7, E-5, E-1/4 • GS-13/14, GS-10/12, GS-7/9, GS-4/6, GS-1/3 • Used with RT to calculate productivity • Cost Data • Supply costs (EEICs 600-619)

  8. Data Requirements • Histology • Surg Path, EM, Cytogen and Autopsies • In-house, referred-in • Specimens referred • AFIP, Other Federal and Civilian Agencies • Blocks • HE Stains • Special Stains • Immuno-Histo

  9. Data Requirements • Histology • Frozen Sections • Autopsy Backlog • FTE – same breakouts as clinical • Supply money spent

  10. Data Requirements • Cytology • Slides Examined (Gyn/Non-Gyn) • Cytotechnologist • Pathologist • FTE – same breakouts as clinical • Total cases (Gyn/Non-Gyn) • Normal DXS (Gyn/Non-Gyn) • Abnormal Gyn

  11. Data Requirements • Cytology • Slides • Unsat • Limited • QA • Average in-house TAT (Gyn/Non-Gyn) • Supply Money Spent

  12. Problem Areas • 1500 duplicate entries between FY07-FY09 • Example: one base had 34 entries for FY08 • Most didn’t duplicate all data fields-blanks/nulls • Database didn’t recognize/restrict duplicate months and gave each entry a unique number • Duplicate entries included in CLMI calculations • Wrong date for end of month • Example: 10/30/2008 instead of 10/31/2008 • Entry not included in CLMI calculations

  13. Problem Areas • Wrong year format • Example: 09 or 9 for 2009 • Entry not included in CLMI calculations • Wrong quarter • Oct-Dec=1, Jan-Mar=2, Apr-Jun=3, Jul-Sep=4 • Entry not calculated in correct quarter

  14. Problem Areas • No easy way to import data • Website entries stored on one table • Report generated from local table • Importing difficult, handled by network person • Copy/paste ignored blank areas; data filled in from left to right • No way to specify quarter or year for report • Discovered during calculation validation • Generated report for 2nd Qtr 2008, next day generated 3rd Qtr 2008

  15. Problem Areas • Unbundled chemistry data • Data collected since 2005 • Calculations not updated • CLMI reported bundled chemistry number • No archival system • All entries from 1999-2008 stored on website table and local table

  16. Fixes • Duplicate Entries • Removed duplicate entries • Website allows duplicates • BRAC – losing website, at least temporarily • Changed Local table - only allows one entry per month (Checks End Date) • Wrong date • No automated fix – each month table scrubbed manually for wrong end dates

  17. Fixes • Wrong year format • No automated fix – each month table scrubbed manually for wrong end dates • Wrong quarter • No automated fix – each month table scrubbed manually for wrong end dates

  18. Fixes • Data import • Email form – 4 mouse clicks CLMI Form • Can be automated • Report generation • Asks for Qtr/Year each time generated – printed in header of report • Can generate multiple quarters/years sequentially

  19. Fixes • Unbundled chemistry • All formulas updated • Report shows which areas use unbundled data • Archived data • Archived by year • 1999-2006 now stored in separate table • Speeds up database, report generation

  20. Where were we? • May – Dec 09 – identified/fixed problems • 14 Dec – started testing email form to replace website (Travis/Buckley) • 25-29 Jan 10 – server maintenance at AFIP • 29 Jan – sent out 2009/2010 data entry statistics

  21. Where were we? (2009 Data) As of 29 Jan 2010 • 80% of entries needed before report generated • Total Lab Entries per Quarter 219 • Total Cytology Entries per Quarter 120 • Total Histology Entries per Quarter 120

  22. Where were we? (2010 Data) As of 29 Jan 2010 • 80% of entries needed before report generated • Total Lab Entries per Quarter 219 • Total Cytology Entries per Quarter 120 • Total Histology Entries per Quarter 120

  23. Where were we? • 3 Feb – trouble ticket for CLMI website • 5 – 11 Feb – DC blizzard Blizzard • 1 Mar – website still down email form live

  24. Where are we? • 1 Mar – 19 Mar • 91 entries for 09 10% of 09 data • 119 entries for 10 14% of 10 data • Email form has to be viewed as HTML • Must press “reply” to enter data • Cyto/Histo forms have to be designed

  25. Where are we? • Data needs to be validated at base level • Compare data entered each month • Use instrument test counts (if your instrument keeps this data) to validate test counts on the SDR • Use the Issue/Turn-In Summary Report in DMLSS to validate supply charges • Use current recall roster to validate number of military personnel/ranks • Talk to person in charge of timecards to validate number of civilian personnel/GS levels

  26. Where are we? (2009 Data) As of 19 Mar 2010 • 80% of entries needed before report generated • Total Lab Entries per Quarter 219 • Total Cytology Entries per Quarter 120 • Total Histology Entries per Quarter 120

  27. Where are we? (2010 Data) As of 19 Mar 2010 • 80% of entries needed before report generated • Total Lab Entries per Quarter 219 • Total Cytology Entries per Quarter 120 • Total Histology Entries per Quarter 120

  28. Quarterly Summary Report • Clinical Lab • 1-1: RT, FTE, productivity, and supply cost • Added “Months Entered” • Removed “Total Budget”, “Total $/RT”, “Salary” and “Salary $/RT” • 1-2: RT by section • Added “Months Entered” • Removed all section “RV”

  29. Quarterly Summary Report • Clinical Lab • 1-3: Civilian referrals/cost, Military referrals • Added “Months Entered” • 1-4: Utilization (outpatient, inpatient) • Added “Months Entered”

  30. Quarterly Summary Report • Histopathology • 2-1: In-house, referred-in, referred out workload • Added “Months Entered” • 2-2: Procedures, FTE, productivity and supply cost • Added “Months Entered” • Removed “Total Budg $”, “Total $/Spec”, “Salary $” and “Salary $/Spec”

  31. Quarterly Summary Report • Cytology • 3-1: workload and productivity • Added “Months Entered” • 3-2: QA data and costs • Added “Months Entered” • Removed “Total Budg $”, “Total $/Slide”, “Salary $” and “Salary $/Slide”

  32. How do I use CLMI? • Data comparison between labs of similar size • RT/FTE (Section 1-1) is a gauge of how well personnel are utilized • $/RT (Section 1-1) can indicate need for a new/modified reagent contract • The individual RTs (Section 1-2) show how your Total RT breaks down

  33. How do I use CLMI? • Section 1-3 shows Clinical, Cytology and Histology Civilian/Military Reference Lab Costs/Totals • An increase here could indicate a need for a new/modified testing contract, need to refer test(s) to a military reference lab or a need to bring a test in-house • Section 2-1 provides the same data for Histology (Total RT and Civilian/Military Reference Lab)

  34. How do I use CLMI? • Section 2-2 provides the same data for Histology (RT/FTE, $/RT and Individual RT) • Section 3-1 provides the same data for Cytology (Total RT and RT/FTE) • Section 3-2 provides the same data for Cytology ($/RT) • It also can indicate a QA issue (Unsat, Limited, QA) showing a need to evaluate technique/additional training

  35. How do I use CLMI? • Using Total RT (Section 1-1) in the manpower calculation (AFMS 5512) • Linear Equation using Reportable Test Volume • Step 1. Refer to the standard manpower equation for formula • Formula: X + Y + (R/1100) = Authorizations

  36. How do I use CLMI? • Step 2. Determine positions requirements Base Cost (X) based on MTF Peer Group start-up cost • Peer 1 Facilities: 2 authorizations • Peer 2 & 3 Facilities: 3 authorizations • Peer 4 Facilities: 4 authorizations • Peer 5 Facilities: 7 authorizations • Peer Rating comes from Max Available Enrollment's • Clinics • PG 1 - less than 10,000 • PG 2 - 10,000 - 15,000 • PG 3 - greater than 15,000 • Bedded Facilities • PG 4 - Non-GME Hospitals • PG 5 - Grad Med Ed Hospitals

  37. How do I use CLMI? • Step 3. Determine positions requirements earned from Additives (Y) • Overseas: 1 authorization (overseas readiness manpower additive) • Isolation/BAT: 1 authorization (high readiness/BAT in isolation, Kunsan only) • Split Operations: In-house: 1 authorization (open door cost), maximum of 2 labs • 24 hr STAT Lab: 3 authorizations (open door cost), maximum of 1 lab

  38. How do I use CLMI? • Step 3. Determine positions requirements earned from Additives (Y) • Shared Ops: 1 authorization (tech commitment to sharing facility) • Free Standing Lab: 2 authorizations (open door cost - outside main MTF), maximum of 4 labs • Active BDC: 4 authorizations open door cost + 1/50 units monthly • Consultant/Flt CC: 1 authorization (activities must consume >50% of time), maximum 1/MTF

  39. How do I use CLMI? • Step 4. Obtain a 12-month average for Reportable Tests (R) using data from the Clinical Laboratory Management Indicators (CLMI) • Step 5. Compute authorizations using the equation • Step 6. MAJCOMs may submit proposed variances to AFCQMI for review

  40. How do I use CLMI? • When do I bring a test in-house or decide to refer it out? • $/RT • Productivity (RT/FTE) • Add/reduce authorizations (RT) • Instrumentation • All tests counted equal • Changes to authorizations start with Sq/CC

  41. Point of Contact MSgt Christopher A. Bartley christopher.bartley@afip.osd.mil DSN: 662-2585 Commercial: (202) 782-2585 Fax: x6022

  42. Questions?

  43. CLMI Form Fixes Reference sheet for email form has instructions/formats for End Date, Year and Quarter

  44. Blizzard Where were we?

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