WEBVTT 00:00:08.074 --> 00:00:08.575 Okay. 00:00:08.575 --> 00:00:13.947 Welcome to the Laboratory Information Systems portion of your class. 00:00:14.347 --> 00:00:18.218 My name is Mitch Perkins, and we'll go through 00:00:18.218 --> 00:00:21.254 some different topics about the labs. 00:00:21.755 --> 00:00:25.725 First thing I'd like to do is give an introduction of who is this guy? 00:00:26.926 --> 00:00:29.929 I currently manage RIT Clinical Systems. 00:00:31.798 --> 00:00:33.900 Over at r u p. 00:00:33.900 --> 00:00:36.803 I have 20 years experience in clinical systems. 00:00:36.803 --> 00:00:39.839 Places that I have worked is, Cerner, 00:00:41.341 --> 00:00:43.910 across health care systems worldwide. 00:00:43.910 --> 00:00:46.279 Help them implement that system. 00:00:46.279 --> 00:00:49.282 Worked at University of Washington health care, 00:00:49.916 --> 00:00:52.452 Intermountain Healthcare here in Utah. 00:00:52.452 --> 00:00:56.523 Providence Saint Joe's health Care, which is based in Washington. 00:00:57.490 --> 00:01:02.629 Has hospitals in Texas, California, Alaska, Montana. 00:01:02.729 --> 00:01:04.831 It's a very big health care system. 00:01:04.831 --> 00:01:07.667 And then currently at r u p, 00:01:07.667 --> 00:01:12.038 my education is Utah State, where I studied business, 00:01:12.505 --> 00:01:15.508 both at a bachelor's level and a master's level. 00:01:15.842 --> 00:01:18.511 And then at the university of Utah, 00:01:19.579 --> 00:01:22.582 studying biomedical informatics. 00:01:24.851 --> 00:01:28.088 Okay, here is the outline of the things 00:01:28.088 --> 00:01:31.458 that you should be able to do after this course. 00:01:31.458 --> 00:01:33.259 You should be able to describe them. 00:01:33.259 --> 00:01:36.629 We won't go through each bullet point on this outline. 00:01:37.263 --> 00:01:39.299 Just, look at it after. 00:01:39.299 --> 00:01:41.167 And you should be able to answer 00:01:41.167 --> 00:01:44.170 or describe each of those things that are listed there. 00:01:45.472 --> 00:01:47.574 Okay. So why do you need to know this stuff. 00:01:47.574 --> 00:01:51.845 And that's something I always ask myself when I either participate in a class 00:01:51.845 --> 00:01:56.249 or a lecture or go to, a conference, 00:01:57.550 --> 00:01:59.652 is to create that context. 00:01:59.652 --> 00:02:04.724 The key things that you need to know is as a IT professional. 00:02:04.757 --> 00:02:10.864 We use lab personnel a lot in our labs, either development to fix problems 00:02:10.864 --> 00:02:13.967 or actually to select and labs or other pieces 00:02:13.967 --> 00:02:17.036 of software used in the clinical environment. 00:02:18.671 --> 00:02:21.241 So we might have you do some testing. 00:02:21.241 --> 00:02:25.478 So we purchase in labs or we, do an upgrade. 00:02:25.478 --> 00:02:29.015 We'll use the lab personnel, to be able to test 00:02:29.015 --> 00:02:32.018 and make sure that software meets the needs of, 00:02:32.318 --> 00:02:35.822 our customer, the lab, and also will help you 00:02:35.822 --> 00:02:39.592 when softwares, we all use software where, you know, things go wrong, things 00:02:39.592 --> 00:02:42.929 break, or things just don't work the way they should. 00:02:42.929 --> 00:02:47.133 And this will help you kind of understand the different pieces between software, 00:02:47.133 --> 00:02:50.136 hardware and maybe just some workflow issues. 00:02:51.404 --> 00:02:52.005 And then most 00:02:52.005 --> 00:02:55.608 importantly from my perspective, as if you might want to work in the lab, 00:02:56.009 --> 00:02:59.145 if you look at my staff across all the organizations, 00:02:59.512 --> 00:03:02.749 majority of the staff came from the clinical environment. 00:03:03.149 --> 00:03:05.885 And then they either studied a little bit of it 00:03:05.885 --> 00:03:08.855 in school or we trained them on that aspect. 00:03:08.855 --> 00:03:14.060 And so we definitely want people who understand this type of information. 00:03:16.429 --> 00:03:16.763 As we 00:03:16.763 --> 00:03:21.034 begin our discussion, as we go through this slide, sometimes in this area, 00:03:21.834 --> 00:03:25.071 we talk about in labs and a L 00:03:25.238 --> 00:03:28.141 and elements of Lims system, 00:03:28.141 --> 00:03:30.843 and we kind of confuse them or we combine them. 00:03:30.843 --> 00:03:33.713 And so we kind of want to separate those to help you as you 00:03:33.713 --> 00:03:36.482 as you think through it, as you go through your classes. 00:03:36.482 --> 00:03:39.352 And less is very patient centric. 00:03:39.352 --> 00:03:40.787 It's where we store the data. 00:03:40.787 --> 00:03:43.323 It's where the tests are created. 00:03:43.323 --> 00:03:46.326 Results are generated, results are sent out. 00:03:46.926 --> 00:03:49.929 Again, we might store patient demographics. 00:03:49.963 --> 00:03:51.998 Again, we store key information. 00:03:51.998 --> 00:03:54.567 We track our samples, 00:03:54.567 --> 00:03:56.903 from device, from devices, 00:03:56.903 --> 00:03:59.906 from one device to another, from a track and such. 00:04:00.540 --> 00:04:02.842 And we also store historical 00:04:02.842 --> 00:04:05.845 clinical data within and less 00:04:06.446 --> 00:04:09.082 we also integrate between the devices 00:04:09.082 --> 00:04:12.485 and other systems and we'll go through more about that. 00:04:13.353 --> 00:04:17.523 A Lims kind of as we define it is more of a management tool. 00:04:17.824 --> 00:04:21.561 It's not, patient centric, it's sample centric. 00:04:21.561 --> 00:04:27.900 And so we were able to track a, a sample or a test tube from start to finish. 00:04:28.201 --> 00:04:31.904 That's where we really focus on workflow. 00:04:32.338 --> 00:04:34.974 It's where we focus on inventory of 00:04:34.974 --> 00:04:37.977 maybe some of our reagents and things like that. 00:04:38.011 --> 00:04:42.382 So where we track a lot of our QC and it's more sample 00:04:42.649 --> 00:04:45.385 specific and not patient centric. 00:04:45.385 --> 00:04:49.989 And so I just want to kind of define those two areas. 00:04:49.989 --> 00:04:54.694 And so as we look at it today we'll be focusing on lab system. 00:04:55.895 --> 00:04:56.596 Many labs 00:04:56.596 --> 00:05:00.433 use both labs and lymph systems. 00:05:00.433 --> 00:05:03.336 They just have different functions. 00:05:03.336 --> 00:05:03.636 Okay. 00:05:03.636 --> 00:05:06.906 So we want to talk a little bit about the Lis hardware, just to give you 00:05:06.906 --> 00:05:12.011 a brief overview of what it is and how the system uses the hardware. 00:05:13.913 --> 00:05:15.848 In today's environment, 00:05:15.848 --> 00:05:21.454 most la s is run on client server technology and, you know, several 00:05:21.454 --> 00:05:25.458 years ago is more, mainframe based, but today it's client server. 00:05:25.892 --> 00:05:29.162 So the server is where the live software exists. 00:05:29.429 --> 00:05:32.198 It sits in data center and those data centers 00:05:32.198 --> 00:05:35.568 can be physical data centers, or it can be a cloud 00:05:35.568 --> 00:05:38.571 based data center. 00:05:38.638 --> 00:05:41.207 The information entered into the early S 00:05:41.207 --> 00:05:45.011 is stored on those servers in an SQL type database. 00:05:45.978 --> 00:05:49.615 So you can access that information from wherever you are. 00:05:49.982 --> 00:05:54.253 You, in the, in the clinical space and the office space, 00:05:54.821 --> 00:05:58.391 wherever you are in the country or wherever the client is. 00:05:58.424 --> 00:06:01.327 The way you think about a client is just your desktop laptop. 00:06:02.462 --> 00:06:02.762 And it 00:06:02.762 --> 00:06:06.632 interacts and it's directly connected to the Lis 00:06:06.632 --> 00:06:11.371 or the server, through software that's also connected to the network. 00:06:11.371 --> 00:06:15.641 So if you look at the graphic, you have multiple clients hitting a server. 00:06:16.409 --> 00:06:20.046 Entering in those information connected through the network. 00:06:20.613 --> 00:06:23.149 There's two types of clients. 00:06:23.149 --> 00:06:26.619 There's a thin client, and then there's what we call a fat client. 00:06:26.986 --> 00:06:29.989 A thin client doesn't generally have a hard drive, 00:06:30.390 --> 00:06:34.127 and it's directly connects through icons, through the network 00:06:34.127 --> 00:06:37.130 to that lass, or rather, a particular software. 00:06:37.964 --> 00:06:39.399 They're a lot cheaper to buy. 00:06:39.399 --> 00:06:41.501 There are a lot cheaper to run and maintain, 00:06:41.501 --> 00:06:44.504 but you have less flexibility with thin clients. 00:06:44.971 --> 00:06:47.940 A fat client is generally what you have. 00:06:48.007 --> 00:06:50.943 When you think of a desktop, it's got a hard 00:06:50.943 --> 00:06:53.946 drive and, and a bunch of other things within it. 00:06:54.347 --> 00:06:58.951 And the thing about a fat client, there's more flexibility in what you can do. 00:06:58.951 --> 00:07:03.790 You can operate some things on that fine client and then interact within labs. 00:07:06.692 --> 00:07:07.026 They are 00:07:07.026 --> 00:07:10.029 more expensive to buy and more expensive to maintain. 00:07:10.897 --> 00:07:13.900 And so some people choose that thin client because of that 00:07:14.801 --> 00:07:15.268 network. 00:07:15.268 --> 00:07:18.204 You've what majority of you know what a network is? 00:07:18.204 --> 00:07:23.176 A network is just connecting clients to servers or from client to client. 00:07:23.176 --> 00:07:26.179 It's just connecting a bunch of computers together. 00:07:26.546 --> 00:07:28.281 For a purpose. 00:07:28.281 --> 00:07:31.684 Networks are extremely important, as you hear in the news 00:07:31.684 --> 00:07:35.788 about, cybersecurity and everything goes on there. 00:07:36.122 --> 00:07:40.159 So you can have a closed network, which majority of them are now. 00:07:40.159 --> 00:07:44.430 So you have to give or grant access to that network to access 00:07:44.430 --> 00:07:49.368 either a server or even a client and, and obtain that information. 00:07:49.769 --> 00:07:52.972 So network security is extremely critical right now. 00:07:54.540 --> 00:07:54.907 Okay. 00:07:54.907 --> 00:07:57.310 So we want to talk about the software itself. 00:07:57.310 --> 00:08:01.481 And there's going to be a couple different topics as we talk about layer software. 00:08:01.948 --> 00:08:02.548 The benefits. 00:08:02.548 --> 00:08:07.520 So when I started my career 20 years ago, majority of this stuff was done on paper. 00:08:08.521 --> 00:08:08.888 And we 00:08:08.888 --> 00:08:13.659 had to define some of the benefits of an Las or an EMR system, 00:08:13.659 --> 00:08:16.662 because paper is actually a little bit more efficient, 00:08:17.964 --> 00:08:19.632 to document results. 00:08:19.632 --> 00:08:24.170 But there's a there's many more positives to electronic, such as nelia. 00:08:24.170 --> 00:08:26.005 So let's talk about that. 00:08:26.005 --> 00:08:29.675 A large portion of the medical decisions are based upon labs. 00:08:30.243 --> 00:08:33.412 And so doctors need providers 00:08:33.412 --> 00:08:36.682 need those results as quick as possible. 00:08:37.216 --> 00:08:40.219 And so they can make 00:08:40.620 --> 00:08:42.321 medical decisions. 00:08:42.321 --> 00:08:45.992 And so we need to be able to get the labs to them as quick as possible. 00:08:45.992 --> 00:08:47.360 And it's critical. 00:08:47.360 --> 00:08:51.764 And most important is those lab results have to be right. 00:08:52.164 --> 00:08:54.901 And so the AI system helps, 00:08:54.901 --> 00:08:57.537 in both of those endeavors. 00:08:57.537 --> 00:09:01.274 L a s is help improve efficiency and reduce errors. 00:09:02.308 --> 00:09:05.311 Again, we just talked about how increases the access, 00:09:05.344 --> 00:09:09.181 the ease of access to the data and actually the turnaround time. 00:09:09.315 --> 00:09:12.685 When you think about paper, you document on paper, then you either have to fax 00:09:12.685 --> 00:09:17.256 or run that paper over and then, the provider can look at it 00:09:17.590 --> 00:09:20.593 and it doesn't have trending or anything like that. 00:09:20.793 --> 00:09:23.763 Clerical errors are extremely important. 00:09:23.763 --> 00:09:28.234 Within the paper you can write it down and correct, within electronic systems. 00:09:28.234 --> 00:09:30.002 And we'll talk about this a little bit later. 00:09:30.002 --> 00:09:35.041 Through interfaces, we have reduced these type of errors tremendously. 00:09:35.641 --> 00:09:36.809 And scalability, 00:09:37.777 --> 00:09:40.780 you can do many more tests when you have lapses, 00:09:40.913 --> 00:09:44.817 because they do a lot of the processing within the system and it's not manually 00:09:44.817 --> 00:09:47.820 or they're done by a technician. 00:09:48.754 --> 00:09:50.756 We'll talk a little bit more about interfaces. 00:09:50.756 --> 00:09:53.859 Interfaces in Las make things much easier 00:09:53.859 --> 00:09:56.862 and more efficient on many, many, 00:09:57.863 --> 00:10:00.032 different areas. 00:10:00.032 --> 00:10:02.969 And then, automation is great. 00:10:02.969 --> 00:10:04.403 With lean data management. 00:10:04.403 --> 00:10:07.273 You might have heard about that through some of your business classes 00:10:07.273 --> 00:10:08.908 or even through your curriculum that you do. 00:10:08.908 --> 00:10:12.244 Now, this is where we can help identify waste, 00:10:12.812 --> 00:10:15.448 within our laboratory operations, 00:10:15.448 --> 00:10:19.986 increase our quality and, important, increase our bottom line. 00:10:19.986 --> 00:10:21.420 We have to pay for all this stuff. 00:10:21.420 --> 00:10:25.091 And so we're looking for ways to be able to do that in your labs. 00:10:25.391 --> 00:10:27.393 Helps identify those particular areas. 00:10:30.229 --> 00:10:31.397 Okay. 00:10:31.397 --> 00:10:32.898 So what is in LA? 00:10:32.898 --> 00:10:36.736 So if you look at the graphic, it's kind of a busy graphic, the top one, 00:10:36.736 --> 00:10:40.306 but it shows you what an la s is and what it does. 00:10:40.306 --> 00:10:43.209 And we'll spend a little bit of time discussing it. 00:10:43.209 --> 00:10:46.212 So la s is a very, very complex, 00:10:46.679 --> 00:10:50.983 but it's mainly where your assays or your tests are stored or created. 00:10:50.983 --> 00:10:52.785 They're built and modified. 00:10:52.785 --> 00:10:55.788 It's where you place the orders. 00:10:55.855 --> 00:10:58.858 Other orders come through the interfaces and we'll talk about that later. 00:10:58.891 --> 00:11:01.060 It's where your results are stored 00:11:01.060 --> 00:11:04.296 and that's where how we can share those results with other systems. 00:11:04.797 --> 00:11:07.800 And we'll talk a lot more about that in just a minute. 00:11:08.401 --> 00:11:11.404 Your access early S is through generally a, 00:11:12.004 --> 00:11:16.108 icon on your desktop or through, a link on your website, 00:11:17.510 --> 00:11:20.346 through that client and what other. 00:11:20.346 --> 00:11:24.517 It's important to also understand there's many other pieces of software, 00:11:25.751 --> 00:11:28.888 that you need to have along with your labs. 00:11:29.522 --> 00:11:32.491 So we talked about, accessing, 00:11:33.693 --> 00:11:35.895 connecting your client to your server. 00:11:35.895 --> 00:11:39.031 So there's a piece of software that they're able to do that 00:11:39.031 --> 00:11:42.034 to connect those two pieces, those two devices. 00:11:42.101 --> 00:11:44.704 We talked about securing the network. 00:11:44.704 --> 00:11:48.774 And so you need some type of antivirus encryption and security on your network. 00:11:50.076 --> 00:11:52.311 Connecting your list to other IIs is. 00:11:52.311 --> 00:11:54.547 So in other places I have worked, 00:11:54.547 --> 00:11:59.118 we might send data from one labs to a customer's labs 00:11:59.118 --> 00:12:02.121 and store those results, or from, 00:12:02.221 --> 00:12:04.623 one EMR to the labs 00:12:04.623 --> 00:12:08.694 or to multiple EMR, depending on, what type of organization you live. 00:12:08.861 --> 00:12:11.430 And we do that through Rachel seven interfaces. 00:12:11.430 --> 00:12:12.431 We'll talk about that more 00:12:13.833 --> 00:12:15.067 and more and more often. 00:12:15.067 --> 00:12:18.170 Now all your lab instruments are connected directly 00:12:18.170 --> 00:12:21.173 to labs through what we call MDI interfaces. 00:12:22.508 --> 00:12:24.510 And those are very important. 00:12:24.510 --> 00:12:28.280 And sometimes there's middleware that sits in between those MDA 00:12:28.280 --> 00:12:31.283 interfaces and your labs. 00:12:31.984 --> 00:12:33.352 Okay. 00:12:33.352 --> 00:12:34.386 So what's included. 00:12:34.386 --> 00:12:37.456 So if you look at the two graphics on this side, it kind of gives 00:12:37.456 --> 00:12:40.493 you an idea of what's included within your lab. 00:12:40.493 --> 00:12:44.730 So there's three main areas pre analytic Atlantic and post analytic. 00:12:44.730 --> 00:12:47.500 So pre analytic is receiving the orders. 00:12:47.500 --> 00:12:50.503 And then it's where we collect we a session. 00:12:50.770 --> 00:12:53.572 We assign a number to those labs or those tubes. 00:12:53.572 --> 00:12:56.242 And then we track 00:12:56.242 --> 00:12:58.611 and a lake is are actually where the tests are performed 00:12:58.611 --> 00:13:01.614 whether it's performed by an individual or a device, 00:13:02.214 --> 00:13:03.749 the information is stored within. 00:13:03.749 --> 00:13:07.820 Then the labs workload management is very, very important. 00:13:07.853 --> 00:13:11.123 You only process certain tests at certain times generally, 00:13:11.590 --> 00:13:14.860 and then certain tests are prioritized higher than others. 00:13:14.860 --> 00:13:16.328 And a lot of that is stored 00:13:16.328 --> 00:13:20.432 within your labs as you create work lists and things like that. 00:13:20.900 --> 00:13:22.134 Quality control. 00:13:22.134 --> 00:13:26.238 As we've talked briefly about, is very, very important with your labs, 00:13:26.238 --> 00:13:29.642 because the information that's stored there and the information 00:13:29.642 --> 00:13:33.612 that is shared to those providers cannot be wrong, 00:13:33.879 --> 00:13:37.716 has to be important, because lives truly are dependent upon those results. 00:13:37.716 --> 00:13:41.220 And so quality control, make sure that those are right. 00:13:41.220 --> 00:13:43.422 And that's where results are or entered. 00:13:43.422 --> 00:13:45.758 So they're either entered through some device 00:13:45.758 --> 00:13:47.793 through your interfaces or manually entered 00:13:49.295 --> 00:13:49.728 post. 00:13:49.728 --> 00:13:52.031 Analytic is where we do a lot of our reporting. 00:13:52.031 --> 00:13:55.801 And that's how we track some of our QA, management reports. 00:13:55.801 --> 00:14:00.406 This is where we look at workflow and throughput and errors and all of that. 00:14:00.773 --> 00:14:03.776 And again Billings where we get, 00:14:03.843 --> 00:14:06.212 we get paid for the work that we do. 00:14:06.212 --> 00:14:10.015 So if you look at the graphics in this last area, 00:14:10.015 --> 00:14:13.919 so labs are built upon SQL or databases. 00:14:13.919 --> 00:14:17.857 So if you look at the top screen that's what you as a technician 00:14:17.857 --> 00:14:20.192 or an expert or doing whatever you're in the lab. 00:14:20.192 --> 00:14:23.863 That's what we call the jury interface or the user interface. 00:14:23.863 --> 00:14:26.365 And so it makes sense. Right. 00:14:26.365 --> 00:14:29.201 And you can enter things into certain fields. 00:14:29.201 --> 00:14:33.606 And then the second screen down there with the arrows is kind of how it's stored. 00:14:33.973 --> 00:14:39.044 And that just kind of gives you an example of how all the data is stored 00:14:39.044 --> 00:14:43.115 in discrete areas or in certain fields, and then how it all kind of 00:14:43.148 --> 00:14:44.283 interacts with each other. 00:14:45.251 --> 00:14:48.220 It's two type of data in these databases, discrete. 00:14:48.220 --> 00:14:50.222 Discrete is very defined. 00:14:50.222 --> 00:14:53.225 And it's something that's that's easy to do. 00:14:53.225 --> 00:14:57.363 You can just a good example of discrete data is your reference ranges. 00:14:57.997 --> 00:15:03.035 You know, a lab results should fall in between point one and point six. 00:15:03.035 --> 00:15:04.370 If it's below that, it's low. 00:15:04.370 --> 00:15:06.772 If it's above that, it's high. 00:15:06.772 --> 00:15:09.475 That can be very discrete, easily defined, but 00:15:09.475 --> 00:15:12.478 it's a little bit harder to build. 00:15:12.544 --> 00:15:17.283 And then you have free text area, which is a lot of, old physician notes 00:15:17.283 --> 00:15:21.987 and things like that, or pathologist notes and things like that. 00:15:23.222 --> 00:15:24.990 You really want to create as much discrete 00:15:24.990 --> 00:15:28.961 data as possible versus free text, because then you can mine that data. 00:15:28.961 --> 00:15:31.964 You can create your reports, you can start looking at, 00:15:32.431 --> 00:15:35.100 trends and, free text data. 00:15:35.100 --> 00:15:38.470 It's really hard to mine to get information out of it, 00:15:39.204 --> 00:15:42.074 for reporting and things like that. 00:15:42.074 --> 00:15:43.976 Discrete data is harder to create, 00:15:44.977 --> 00:15:47.313 and maintain in free text is easier. 00:15:47.313 --> 00:15:51.216 And that's why a lot of the fields, tend to be free text. 00:15:52.251 --> 00:15:53.519 Okay. 00:15:53.519 --> 00:15:56.055 And then other important information about your lass 00:15:56.055 --> 00:16:00.960 is most of the information in your lass is shared. 00:16:01.360 --> 00:16:04.563 Very few providers or, clinicians 00:16:04.563 --> 00:16:07.533 go into in lass to actually look at the data. 00:16:08.067 --> 00:16:11.070 You share the data to, EMR 00:16:11.170 --> 00:16:14.173 or public health agencies and things like that. 00:16:14.673 --> 00:16:17.409 And the way we do that is through interfaces. 00:16:17.409 --> 00:16:20.079 And many years ago, health care 00:16:20.079 --> 00:16:23.082 basically got together and they said, you know, we're going to be sharing our data. 00:16:23.582 --> 00:16:27.586 So let's create some type of interface system that's common. 00:16:27.786 --> 00:16:31.991 So it's easier to share data from system to system from vendor to vendor. 00:16:32.191 --> 00:16:35.194 And they came with with what we call HL seven interfaces. 00:16:35.461 --> 00:16:40.132 The top graphic over there is an actual message created in HL seven. 00:16:41.367 --> 00:16:42.968 And you start working in it. 00:16:42.968 --> 00:16:47.039 Or if you work with it, you'll be able to start reading those type of messages 00:16:47.039 --> 00:16:50.676 and they're fairly easy to read once you understand them and and go through it. 00:16:51.176 --> 00:16:54.847 But what's nice about it is it's a common language 00:16:54.847 --> 00:16:57.850 that all healthcare uses to create those interfaces. 00:16:58.083 --> 00:17:02.321 And as you work from your labs to your different EMR systems 00:17:02.321 --> 00:17:05.357 or your reference lab or billing patient portals, 00:17:05.491 --> 00:17:08.961 everyone uses it and you just figure out what data you're going to share. 00:17:08.961 --> 00:17:11.964 Within each one of those segments is what they call them. 00:17:12.865 --> 00:17:14.533 HL seven is used worldwide. 00:17:14.533 --> 00:17:18.470 So as I worked with different, healthcare providers or 00:17:19.505 --> 00:17:23.475 EMR systems, across the world, we were able to share 00:17:23.475 --> 00:17:27.746 information in that standard format, which is, kind of unique. 00:17:27.746 --> 00:17:28.881 And it's kind of nice. 00:17:30.215 --> 00:17:30.849 What type of 00:17:30.849 --> 00:17:34.219 information to interfaces usually include. 00:17:34.219 --> 00:17:35.754 So they need to include the emission 00:17:35.754 --> 00:17:39.191 discharge transfer so we can keep track of that patient. 00:17:39.658 --> 00:17:42.327 And that usually starts from your EMR and shared 00:17:42.327 --> 00:17:46.432 with your Lis order eventually can be from an EMR. 00:17:46.432 --> 00:17:47.366 It usually is. 00:17:47.366 --> 00:17:50.602 You get your orders from your providers or your Mid providers, 00:17:50.602 --> 00:17:53.605 and it flows over to your Las. 00:17:54.440 --> 00:17:58.210 The results we usually get those in our labs, 00:17:58.210 --> 00:18:01.613 and then we send those out to the EMR using 00:18:01.613 --> 00:18:04.616 that order entry data and your 00:18:04.950 --> 00:18:08.087 patient identifiable data instruments, 00:18:08.687 --> 00:18:11.156 when the orders come from your list 00:18:11.156 --> 00:18:14.293 or sent to that instrument, your instrument processes that lab, 00:18:14.493 --> 00:18:17.463 and then it sends the results back to your labs, 00:18:19.064 --> 00:18:21.867 reference labs or larger labs. 00:18:21.867 --> 00:18:24.837 They do very specific tests. 00:18:24.837 --> 00:18:27.106 Some tests are only done by certain labs. 00:18:27.106 --> 00:18:31.343 And so your hospital labs or people might send them to a reference lab, 00:18:31.710 --> 00:18:34.413 and they'll interface back and forth between 00:18:34.413 --> 00:18:36.482 the hospital lab and a reference lab. 00:18:36.482 --> 00:18:38.150 And then billing again is important. 00:18:39.118 --> 00:18:41.920 You get you want to get paid for all the work that you do. 00:18:41.920 --> 00:18:47.493 And so your lab stores that information and it can send it to a billing system 00:18:47.493 --> 00:18:50.496 to, bill for each, each of those tasks or 00:18:50.496 --> 00:18:53.499 each of those labs that you do 00:18:53.832 --> 00:18:55.000 two types of interfaces. 00:18:55.000 --> 00:18:58.770 And the bottom graphic kind of shows that there's a one way interface 00:18:58.770 --> 00:19:02.975 where one system might send information to another system, 00:19:03.675 --> 00:19:06.445 and that's then that other system 00:19:06.445 --> 00:19:09.448 doesn't send information back. 00:19:09.581 --> 00:19:13.352 That happens a lot just for reference data and things like that. 00:19:13.685 --> 00:19:17.022 Two way interfaces is where you share information back and forth. 00:19:18.390 --> 00:19:20.626 Obviously they're a little bit harder to create. 00:19:20.626 --> 00:19:25.531 And you have, you might hear in meetings that you go to one of those systems 00:19:25.531 --> 00:19:29.801 needs to be the source of truth, and the other one's just the receiving system. 00:19:31.403 --> 00:19:34.406 For example, two way interface that we created for, 00:19:34.806 --> 00:19:37.809 one organization took about a year to develop. 00:19:37.976 --> 00:19:40.979 As you work through, who is going to own that data, 00:19:41.046 --> 00:19:44.216 and how you're going to share that data and, overwrite certain 00:19:44.216 --> 00:19:47.219 data and match it up and, and things like that. 00:19:47.219 --> 00:19:51.523 So there are a lot harder again, to create, but they're much better 00:19:51.690 --> 00:19:54.693 just to make sure the data matches up. 00:19:55.327 --> 00:19:58.263 So that is how we share the data okay. 00:19:58.263 --> 00:20:02.601 So we want to talk a little bit about lab software and quality initiatives. 00:20:04.102 --> 00:20:05.804 And this is where you really, truly 00:20:05.804 --> 00:20:08.807 get a lot of your power from you really as 00:20:09.408 --> 00:20:12.010 quality initiatives are very, very important. 00:20:12.010 --> 00:20:15.514 Kind of as we talked about, the data 00:20:15.514 --> 00:20:20.319 the labs share with EMR systems and public health has to be right. 00:20:21.753 --> 00:20:24.756 As we increase our quality, we decrease our errors. 00:20:25.057 --> 00:20:27.092 And that, 00:20:27.092 --> 00:20:29.061 makes it so we have better patient outcomes. 00:20:29.061 --> 00:20:32.364 Our labs are more efficient and we increase our profit. 00:20:33.031 --> 00:20:35.667 And there's a couple of ways that you have to look at that 00:20:35.667 --> 00:20:39.671 is if you're a hospital lab or a reference lab, 00:20:39.671 --> 00:20:43.075 if you send out bad data, people are not going to go to you anymore. 00:20:44.042 --> 00:20:47.045 And so quality initiatives are very important. 00:20:47.613 --> 00:20:51.216 Most lab errors fall in two areas or you're pre analytical in your post 00:20:51.216 --> 00:20:57.189 analytical pre analytical is you're just labeling that that test tube 00:20:57.189 --> 00:21:01.193 or what whatever collection device you're using incorrectly. 00:21:01.860 --> 00:21:05.664 And that can and that's happens and it happens today. 00:21:05.897 --> 00:21:07.899 And that's a lot of process. 00:21:07.899 --> 00:21:09.534 And your systems can help 00:21:10.535 --> 00:21:10.969 reduce 00:21:10.969 --> 00:21:13.972 that through barcode scanning and things like that. 00:21:14.106 --> 00:21:17.409 And then some of the results that don't come automatically through. 00:21:17.409 --> 00:21:22.114 And MDI from one of your lab instruments that are manually entered, 00:21:22.848 --> 00:21:27.452 you might enter that information incorrectly, and you just might that 00:21:27.452 --> 00:21:31.623 finger it where you were supposed to type in a two, but you hit the one, 00:21:32.791 --> 00:21:35.227 from a paper form and other systems. 00:21:35.227 --> 00:21:40.899 And so, or you can enter in a value that is either high or too low. 00:21:41.099 --> 00:21:44.102 And the systems can also correct that. 00:21:44.703 --> 00:21:46.571 So post analytical is where you're 00:21:46.571 --> 00:21:51.310 basically reporting results from patient A to patient on patient B's record. 00:21:51.777 --> 00:21:54.346 And you can do that because they have a similar name 00:21:54.346 --> 00:21:57.816 or similar Social Security number or whatever you're using to identify. 00:21:58.116 --> 00:22:01.119 And the systems help reduce those errors. 00:22:01.453 --> 00:22:03.188 So once we introduced 00:22:04.222 --> 00:22:06.692 our labs in these quality initiatives, 00:22:06.692 --> 00:22:09.661 we have basically virtually eliminated, 00:22:10.629 --> 00:22:13.231 a ton of those errors because the systems would be able 00:22:13.231 --> 00:22:16.201 to do those checking, 00:22:16.234 --> 00:22:19.204 communication with your electronic medical record 00:22:19.204 --> 00:22:23.675 also reduces your pre and post, analytical errors through interfaces. 00:22:23.675 --> 00:22:27.045 They also do some checking and so calling initiatives. 00:22:27.045 --> 00:22:30.048 The quality of the data has 00:22:30.682 --> 00:22:31.616 increased. 00:22:31.616 --> 00:22:35.487 I know in labs that I have worked with we track all of that information. 00:22:35.887 --> 00:22:40.125 If for some reason some of the data that we send over is incorrect, 00:22:40.625 --> 00:22:44.763 we take that very serious, we look at it and we try to figure out why. 00:22:44.763 --> 00:22:47.032 Or that data was sent incorrectly. 00:22:47.032 --> 00:22:50.035 And we actually spent quite a bit of time investigating that. 00:22:50.235 --> 00:22:52.437 And then we implement the fixes to improve it. 00:22:54.072 --> 00:22:54.439 Okay. 00:22:54.439 --> 00:22:58.276 We wanted to talk a little bit about a medical electronic medical record. 00:22:59.911 --> 00:23:01.446 The EMR is very important. 00:23:01.446 --> 00:23:05.650 And that's kind of the compiles all the information from your Lis, your 00:23:05.650 --> 00:23:10.989 radiology systems, your pharmacy systems are all kind of stored in your EMR. 00:23:10.989 --> 00:23:14.292 So it's important to understand a little bit about EMR. 00:23:14.292 --> 00:23:16.628 And probably a majority of you know about them. 00:23:16.628 --> 00:23:21.400 Again we use HL seven interfaces to share that data with EMR. 00:23:21.500 --> 00:23:24.503 Public health agencies and health exchanges. 00:23:25.404 --> 00:23:28.407 Public health uses the data for many purposes, 00:23:28.740 --> 00:23:33.512 kind of for those that have gone through some pandemic, such as the Covid 19, 00:23:34.646 --> 00:23:36.615 there was a measles one pandemic 00:23:36.615 --> 00:23:39.618 that kind of hit Washington a couple of years ago. 00:23:39.985 --> 00:23:42.788 Some flu RSV hits yearly. 00:23:42.788 --> 00:23:46.024 Public health uses the data from multiple EMR 00:23:46.024 --> 00:23:49.027 lab systems to kind of track that. 00:23:49.027 --> 00:23:51.530 And the way they do that is through health exchanges. 00:23:52.864 --> 00:23:53.732 Health exchanges 00:23:53.732 --> 00:23:58.403 are generally owned by states or a group of states, and each health 00:23:58.403 --> 00:24:02.607 care organization within those states or within those regions share 00:24:03.008 --> 00:24:06.211 certain information to those health exchanges. 00:24:06.578 --> 00:24:10.549 And each of those health care organizations, determine what information 00:24:10.549 --> 00:24:14.152 and how they're going to share that information with those organizations. 00:24:14.152 --> 00:24:17.823 So I know within Utah, when I had some connections with, 00:24:19.057 --> 00:24:23.094 health exchanges, Intermountain Healthcare, UVU, Health Care, Mountain 00:24:23.094 --> 00:24:28.433 Star, steward, another organization, sent information to the Utah Health Exchange. 00:24:28.834 --> 00:24:33.638 And what's nice about that is you can also get some of that data 00:24:33.672 --> 00:24:37.576 when you move from provider to provider or organization or organization. 00:24:38.009 --> 00:24:41.012 And our earmarks help us do that. 00:24:41.580 --> 00:24:42.147 Okay. 00:24:42.147 --> 00:24:45.584 We want to talk a little bit about LA as acquisition, 00:24:46.218 --> 00:24:49.321 because, sometime in your career, as you work in the lab, 00:24:49.454 --> 00:24:52.657 you'll probably be a part of one of, in LA. 00:24:52.657 --> 00:24:54.693 S acquisition. 00:24:54.693 --> 00:24:56.595 There's a couple of things you need to decide. 00:24:57.562 --> 00:24:58.196 When you're thinking 00:24:58.196 --> 00:25:01.600 about acquiring or replacing your current LA. Yes. 00:25:02.133 --> 00:25:05.136 It's very daunting and it's very, very complex. 00:25:05.871 --> 00:25:07.806 A couple of questions you need to ask. 00:25:07.806 --> 00:25:09.741 Do we want to buy or do we want to build? 00:25:09.741 --> 00:25:12.477 So organizations I've worked for have done both. 00:25:12.477 --> 00:25:15.247 Some have built their own Las 00:25:15.247 --> 00:25:18.250 or EMR systems, and some have, but, 00:25:18.450 --> 00:25:20.552 several large 00:25:20.552 --> 00:25:23.522 reference labs actually build their own, which is awesome 00:25:23.788 --> 00:25:27.092 because then they can make it or change it the way that they want. 00:25:27.859 --> 00:25:31.396 As we'll talk about it can be very expensive to do that. 00:25:32.697 --> 00:25:36.501 And if you have the resources, not only monetary but, 00:25:37.035 --> 00:25:40.038 staff to be able to do that might be your best option. 00:25:40.605 --> 00:25:44.242 But we have found that a majority of labs, health care systems today 00:25:44.242 --> 00:25:49.080 by, Vended systems are off the shelf systems, the com cart systems. 00:25:49.814 --> 00:25:53.351 Then you need to decide you want to buy a best of breed, 00:25:53.351 --> 00:25:56.254 or do you want to get an integrated system. 00:25:56.254 --> 00:25:59.925 So a lot of your health care systems out there have an EMR. 00:25:59.925 --> 00:26:03.461 They have a pharmacy, they have a radiology and they have lab systems. 00:26:04.629 --> 00:26:05.130 But there are 00:26:05.130 --> 00:26:08.934 certain vendors out there that just focus on particular areas. 00:26:08.934 --> 00:26:13.138 So there there might be what we call the best of breed list system. 00:26:13.138 --> 00:26:16.141 And that might be what you decide to use. 00:26:16.441 --> 00:26:18.543 But it might not integrate with 00:26:18.543 --> 00:26:21.546 if you're a hospital lab with your, 00:26:21.980 --> 00:26:24.249 EMR system out there. 00:26:24.249 --> 00:26:26.751 So you just kind of need to look at those things. 00:26:26.751 --> 00:26:29.020 And then you also need to establish a budget. 00:26:29.020 --> 00:26:30.655 How much do you want to spend? 00:26:30.655 --> 00:26:33.325 You need to termine your requirements. 00:26:33.325 --> 00:26:36.328 And there's thousands of requirements out there. 00:26:36.628 --> 00:26:38.763 And then when you have this information you create 00:26:38.763 --> 00:26:42.300 what we call a request for a proposal or an RFP. 00:26:42.300 --> 00:26:45.370 And that's where you have defined those requirements. 00:26:45.370 --> 00:26:47.572 You send them out to the vendor market. 00:26:47.572 --> 00:26:50.408 And then each of those vendors will respond. 00:26:50.408 --> 00:26:54.746 They'll submit if they want to, a response to your RFP. 00:26:57.148 --> 00:26:57.749 Okay. 00:26:57.749 --> 00:27:00.952 So what needs to be considered, is there going to be middleware required. 00:27:00.952 --> 00:27:04.990 So some Ilia systems have middleware, already 00:27:04.990 --> 00:27:09.794 developed to your laboratory devices and some don't. 00:27:10.328 --> 00:27:12.163 I'm not saying that they can't develop them. 00:27:12.163 --> 00:27:15.266 It just cost a little bit more money if they have to develop them. 00:27:15.900 --> 00:27:18.803 For your systems. 00:27:18.803 --> 00:27:20.905 Sometimes that middleware also slows down 00:27:20.905 --> 00:27:24.376 your lab processes and can cause some frustrations. 00:27:24.676 --> 00:27:29.481 So you want to reduce the amount of as much middleware as possible. 00:27:29.881 --> 00:27:32.217 Is the system easy to use? 00:27:32.217 --> 00:27:35.220 And why that's important is, 00:27:35.887 --> 00:27:38.790 it's not when you buy the software, if you can't figure it out, 00:27:38.790 --> 00:27:42.093 you're going to spend a lot of time training and retraining 00:27:42.560 --> 00:27:45.563 and training is actually very, very expensive. 00:27:45.563 --> 00:27:49.734 I've got example with one organization I work for, we purchased some systems, 00:27:50.835 --> 00:27:51.803 we implemented those 00:27:51.803 --> 00:27:56.441 systems, and within one hospital we spent over $2 00:27:56.441 --> 00:28:00.145 million in training expense to get that system up to speed. 00:28:00.545 --> 00:28:02.814 And the people used to using that system. 00:28:02.814 --> 00:28:05.817 So you need to consider the ease of use, 00:28:06.785 --> 00:28:09.354 cheap versus most expensive. 00:28:09.354 --> 00:28:12.357 You usually don't want to buy the cheapest, 00:28:12.624 --> 00:28:15.627 because there's a reason it's the cheapest. 00:28:16.327 --> 00:28:19.330 Or the vendor might just be, 00:28:20.331 --> 00:28:23.968 coming in offering a very low price, and then they'll charge you more 00:28:23.968 --> 00:28:27.739 for those interfaces and for fixes and development. 00:28:27.739 --> 00:28:32.577 So you really want to look at, the true cost of that software. 00:28:33.611 --> 00:28:37.182 Focus on your requirements, choose the system that meets your requirements. 00:28:37.182 --> 00:28:39.017 If that's the cheapest, that's fine. 00:28:39.017 --> 00:28:42.053 If that's the most expensive, then you really need to sell it. 00:28:42.687 --> 00:28:46.391 Because the requirements is the most critical piece of it. 00:28:46.758 --> 00:28:47.759 Maintenance cost. 00:28:48.927 --> 00:28:50.095 You also need to figure out 00:28:50.095 --> 00:28:54.332 how are we going to maintain this system or how does the vendor maintain it. 00:28:56.067 --> 00:28:58.002 As you look at the cost of software, 00:28:58.002 --> 00:29:02.040 60% of the software cost ongoing is maintenance. 00:29:02.207 --> 00:29:03.942 So it's a huge portion of that. 00:29:03.942 --> 00:29:07.112 And that's why sometimes the cheapest is not the best, 00:29:07.112 --> 00:29:10.148 because the maintenance cost on some of those is very, very expensive. 00:29:11.116 --> 00:29:13.451 Then you need to decide, how 00:29:13.451 --> 00:29:16.454 customizable is this software? 00:29:16.454 --> 00:29:22.260 Some vendors, out of the box functionality is what you see is what you get, 00:29:22.460 --> 00:29:25.463 and they don't allow a lot of customizations. 00:29:25.830 --> 00:29:29.100 But what's nice about that type of software, it's easy to maintain, 00:29:29.400 --> 00:29:32.370 you know, what you get and you're not going to get anything else 00:29:33.204 --> 00:29:35.373 if that meets your requirements. Do that. 00:29:36.875 --> 00:29:38.843 Some software vendors or 00:29:38.843 --> 00:29:41.813 will allow you to do as much customization as you want, 00:29:41.813 --> 00:29:44.816 which is awesome because that meets your, 00:29:44.883 --> 00:29:47.085 lab needs, 00:29:47.085 --> 00:29:49.654 meets all of your lab needs. 00:29:49.654 --> 00:29:52.791 The thing you need to keep in mind there, it's very hard to maintain. 00:29:52.791 --> 00:29:54.993 It's more costly to maintain. 00:29:54.993 --> 00:29:58.897 Does everything that you do, that vendor has to do custom. 00:29:58.897 --> 00:30:00.865 And so you will be charged with that. 00:30:00.865 --> 00:30:03.902 And then, as you know, software needs to be upgraded. 00:30:04.202 --> 00:30:07.806 And when you upgrade, it's a lot harder to upgrade your software 00:30:07.806 --> 00:30:10.675 because again, everything is customized. 00:30:10.675 --> 00:30:15.313 So you really need to try to reduce the amount of customizations. 00:30:15.313 --> 00:30:19.951 But if you want to do that, then some vendors allow you to do that. 00:30:20.618 --> 00:30:24.489 And then a lot of people forget about your, the reporting capability. 00:30:24.722 --> 00:30:27.125 So again, as we talked about with your quality 00:30:27.125 --> 00:30:30.261 initiatives, your workflow in your lab, 00:30:31.029 --> 00:30:33.464 you want to have some really good, 00:30:33.464 --> 00:30:36.501 depth in the reporting to get down to certain levels 00:30:36.835 --> 00:30:42.941 so you can use your LA system to improve your lab functions and workflow. 00:30:44.843 --> 00:30:46.678 Last thing we're going to talk about is timing. 00:30:46.678 --> 00:30:49.113 So it takes a long time to buy it. 00:30:49.113 --> 00:30:51.716 Or an upgrade in the Las system 00:30:51.716 --> 00:30:54.719 to, to acquire it. 00:30:54.819 --> 00:30:58.890 And this just gives you some general, guidelines within that. 00:30:59.324 --> 00:31:00.391 So it actually takes you. 00:31:00.391 --> 00:31:05.363 So if you have a current list now, it takes you several years. 00:31:05.363 --> 00:31:08.833 Once you start that conversation, should we replace our list 00:31:09.300 --> 00:31:12.270 because you need to talk to all of the different stakeholders, 00:31:12.470 --> 00:31:16.107 people who use the system to get their input into that? 00:31:16.541 --> 00:31:16.808 Okay. 00:31:16.808 --> 00:31:22.146 So replacing a current Las can be very, very expensive and very, very disruptive. 00:31:22.981 --> 00:31:26.217 Most human beings like myself do not like change. 00:31:26.484 --> 00:31:30.822 Once we become an expert in a particular system, that's all we want to use. 00:31:31.122 --> 00:31:34.292 Doesn't matter if that system is bad or good. 00:31:34.292 --> 00:31:35.493 We don't want to change. 00:31:37.228 --> 00:31:39.197 So deciding can take a while. 00:31:39.197 --> 00:31:42.200 Step two is defining your requirements. 00:31:43.167 --> 00:31:46.104 And a lot of times you'll have some of these requirements defined 00:31:46.104 --> 00:31:50.375 because you are already using the system and you have an idea of what you want 00:31:50.375 --> 00:31:54.545 the new system to do, but it still takes 2 to 6 months 00:31:54.545 --> 00:31:57.916 maybe, and a little bit longer to define your user requirements. 00:31:59.550 --> 00:32:02.186 Once you get your user requirements defined, 00:32:02.186 --> 00:32:05.189 you've met with all the people you need to meet with. 00:32:05.556 --> 00:32:10.695 You create that request for proposal, that RFP, which includes your requirements 00:32:10.695 --> 00:32:13.698 and some different things that vendors need to meet. 00:32:14.165 --> 00:32:17.135 And that takes a while to create that document. 00:32:17.135 --> 00:32:20.905 And then you need to give the vendors enough time to, 00:32:21.439 --> 00:32:26.311 take your document, look at requirements compared to what their systems will do. 00:32:26.811 --> 00:32:29.580 And a lot of times they'll say, this is what the system does. 00:32:29.580 --> 00:32:32.850 Now, this is what the system will do in six months, a year. 00:32:33.017 --> 00:32:36.187 So they kind of add in future functionality, 00:32:36.220 --> 00:32:37.822 which you have to be aware of. 00:32:37.822 --> 00:32:41.125 And that takes generally 2 to 4 months for that particular process. 00:32:42.360 --> 00:32:43.594 Once the vendors 00:32:43.594 --> 00:32:47.198 take that RFP, they digest it, they create their proposals. 00:32:47.598 --> 00:32:51.703 You'll want to select a few of those vendors to come on site and do a demo. 00:32:52.670 --> 00:32:55.139 And this is where they kind of sell their product. 00:32:55.139 --> 00:32:57.575 Things you need to ask and be careful when they do. 00:32:57.575 --> 00:33:00.745 Their demo is what we call what is actual functionality 00:33:01.045 --> 00:33:04.382 and then what is future functionality or we call it vaporware. 00:33:04.615 --> 00:33:06.250 Does it exist now? 00:33:06.250 --> 00:33:08.319 A lot of vendors again will come in. 00:33:08.319 --> 00:33:11.389 They'll sell you what they have now, what the systems do, 00:33:11.389 --> 00:33:15.827 and then that future functionality or vaporware hasn't been installed. 00:33:15.827 --> 00:33:17.095 They're still thinking about it. 00:33:17.095 --> 00:33:19.397 It's some great ideas. 00:33:19.397 --> 00:33:22.233 Don't make the mistake of buying too much of that 00:33:22.233 --> 00:33:25.603 future functionality when you when you do your evaluation. 00:33:26.437 --> 00:33:27.105 A lot of times 00:33:27.105 --> 00:33:31.609 it takes a lot longer to incorporate that than they generally want to tell you. 00:33:33.478 --> 00:33:33.978 Once they 00:33:33.978 --> 00:33:38.449 do your demos, you should be able to take 1 or 2 of those and decide 00:33:38.449 --> 00:33:41.552 based upon some different metrics and based on your requirements, 00:33:41.853 --> 00:33:45.656 based on the cost, which ones you want to do. 00:33:46.290 --> 00:33:50.895 You decide on one, and then you begin your negotiations and closing the contract. 00:33:51.396 --> 00:33:54.766 And once lawyers get involved, it takes a lot longer 00:33:54.766 --> 00:33:57.769 than you think to close on that deal. 00:33:58.870 --> 00:34:02.573 You want to make sure you get your functionality and you get your, 00:34:03.274 --> 00:34:06.611 service level agreements, and you get the software that you, 00:34:07.678 --> 00:34:10.982 that they demoed and that you bought, and they want to make sure 00:34:10.982 --> 00:34:13.985 that they're also covered in making sure they control, 00:34:14.585 --> 00:34:19.657 some of your request above and beyond what's in that RFP and things like that. 00:34:19.657 --> 00:34:23.494 And lawyers get involved and it just takes a while to close those deals. 00:34:23.494 --> 00:34:25.096 So just plan on 2 to 6 months, 00:34:26.464 --> 00:34:27.832 to be able to do that. 00:34:27.832 --> 00:34:31.869 One organization I worked with took actually a year from decision 00:34:31.869 --> 00:34:35.973 point to contracts signing, just very, very complex. 00:34:37.442 --> 00:34:40.111 Now, the hard part is, okay, we've decided. 00:34:40.111 --> 00:34:42.847 Yes, we we bought the software. 00:34:42.847 --> 00:34:43.948 The contract is signed. 00:34:43.948 --> 00:34:46.918 Now it's time to build test and implement. 00:34:46.918 --> 00:34:49.921 This can take a long time. 00:34:50.421 --> 00:34:53.191 It depends again on whether it's out of box software. 00:34:53.191 --> 00:34:56.194 What you see is what you get, or there's some customizations. 00:34:57.495 --> 00:34:59.931 One organization that I work for took four years 00:34:59.931 --> 00:35:03.000 from day purchase to implementation. 00:35:03.401 --> 00:35:06.204 Again, that was just making sure the system work. 00:35:06.204 --> 00:35:11.609 Make sure connected with all the devices, make sure that the QA was there. 00:35:11.943 --> 00:35:16.781 And but generally it takes 1 to 2 years to be able to do that. 00:35:17.715 --> 00:35:20.251 So that is it. 00:35:20.251 --> 00:35:23.554 If you have any further questions, you can email me 00:35:23.554 --> 00:35:28.292 at Mitch Perkins at a or up labs, dot com. 00:35:28.292 --> 00:35:31.095 And we can answer any further questions that you have. 00:35:32.096 --> 00:35:33.231 And that's it. 00:35:33.231 --> 00:35:33.764 Thanks.