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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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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
Overview
  • Why CLMI?
  • Data Requirements
  • Problem Areas
  • Fixes
  • CLMI Data: Where were we?
overview continued
Overview (continued)
  • CLMI Data: Where are we?
  • Quarterly Summary Report
  • How do I use CLMI?
  • Point of Contact
  • Questions
why clmi
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
data requirements
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)
data requirements1
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
data requirements2
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)
data requirements3
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
data requirements4
Data Requirements
  • Histology
    • Frozen Sections
    • Autopsy Backlog
    • FTE – same breakouts as clinical
    • Supply money spent
data requirements5
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
data requirements6
Data Requirements
  • Cytology
    • Slides
      • Unsat
      • Limited
      • QA
    • Average in-house TAT (Gyn/Non-Gyn)
    • Supply Money Spent
problem areas
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
problem areas1
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
problem areas2
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
problem areas3
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
fixes
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
fixes1
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
fixes2
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
fixes3
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
where were we
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
where were we 2009 data
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
where were we 2010 data
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
where were we1
Where were we?
  • 3 Feb – trouble ticket for CLMI website
  • 5 – 11 Feb – DC blizzard Blizzard
  • 1 Mar – website still down email form live
where are we
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
where are we1
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
where are we 2009 data
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
where are we 2010 data
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
quarterly summary report
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”
quarterly summary report1
Quarterly Summary Report
  • Clinical Lab
    • 1-3: Civilian referrals/cost, Military referrals
      • Added “Months Entered”
    • 1-4: Utilization (outpatient, inpatient)
      • Added “Months Entered”
quarterly summary report2
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”
quarterly summary report3
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”
how do i use clmi
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
how do i use clmi1
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)
how do i use clmi2
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
how do i use clmi3
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
how do i use clmi4
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
how do i use clmi5
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
how do i use clmi6
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
how do i use clmi7
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
how do i use clmi8
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
point of contact
Point of Contact

MSgt Christopher A. Bartley

christopher.bartley@afip.osd.mil

DSN: 662-2585

Commercial: (202) 782-2585

Fax: x6022

clmi form fixes
CLMI Form Fixes

Reference sheet for email form has instructions/formats for End Date, Year and Quarter

blizzard
Blizzard

Where were we?