In the News

Labs Are Challenged, But They Don’t Have To Be The Weak Link In The Healthcare Value Chain – January 2019

Physician’s offices are so reliant on electronic health record (EHR) systems that sub-par performance is rarely tolerated. While laboratories are equally dependent on quality tools, too often they continue to rely on legacy systems that don’t help the lab keep up with increasing demands, and don’t adequately serve clients or patients with the timely accurate information they need. A recent article entitled “Increasing Workforce Productivity in the Diagnostic Laboratory ( ,” noted that labs face growing test volumes, staff shortages, and declining reimbursements. An aging population, introduction of new lab tests, and increasingly proactive care required under value-based reimbursement models all contribute to the growing test volume. The article explains how labs can fight these trends by increasing productivity via people and processes, hardware, and digitization. The latter is credited with “better management of testing processes, leading to improved workflow and better clinical outcomes.” C4 has always acknowledged its responsibility in digitally transforming laboratory processes. Streamlining through unprecedented interoperability and cloud-based convenience, we strive to help you and your employees function more efficiently and meet modern laboratory personnel and workload challenges. Intuitive tools means less time training staff; they allow each technician to be more productive. One area of digitization that the article calls out is remote system support. As a boutique company, C4 maintains a hands-on approach with every customer. You don’t wait days to get a response to an issue or a query. You deal immediately with a stateside expert who knows your system, not a minimally knowledgeable help desk assistant half a world away. You quickly get the support you need to utilize your software effectively. For us, there’s an emphasis on the “service” part of SaaS. As you work to improve lab efficiency and productivity, C4 will be there to ensure that your software tools keep up with the increased demands on your processes and staff, helping you ease the burden.


C4 Holiday Greeting and Update – December 2018

Sharing our holiday spirit, C4 staff is once again happily contributing volunteer time this year to the Christmas for the Children organization ( . It’s a wonderful community effort with many sponsors who ensure that 200 kids from the middle Tennessee region are taken out to breakfast, then on to a shopping trip with $150 to spend on holiday gifts. The trip finally ends with a celebratory pizza party. It’s a truly heartwarming time for unfortunate families that culminates with a meal on Christmas Eve. C4 gives back because we’ve got plenty to be thankful for. Looking back at the year, there are so many things to reflect about…some of which may help you with your own work challenges. The biggest progressive development in 2018 has been PORTRA – our SaaS platform for requesting, managing and distributing lab reports. It has really taken off and taken hold as you can read about here ( . Having implemented multiple platforms, the amount of customization has been remarkable and many tasks have been simplified. Aside from PORTRA, our Patient Integrity Services toolset for continuous database maintenance has also expanded. As shared last month ( , the alerts and report details have grown, so watch for these new capabilities rolling out in January of 2019. We are so proud of our database administrator team’s inventive coding work. Finally, our customer roster has gotten longer. The longstanding customers who helped launch C4 Database Management deserve a lot of credit as they’ve continued to refer others in the industry. Many thanks to those trusted customers who have worked hard to help C4 become an even healthier company over this past year. In closing, we’ve had our best year yet at C4. It would not have been possible without each and every customer. Thank you all. We look forward to sharing our plans for 2019 with you next month and wish you safe travels and warm family times during the upcoming holidays.


Orchard Newsletter – November 2018


New Features in Patient Integrity Services – November 2018

C4’s Patient Integrity Services platform is critical to meeting fast data retrieval and preservation, best practices, system security, and data requirements.  We are pleased to announce our newest version, coming in January 2019.

Some of the new features and benefits will include:

  • Real-time transaction log auto-grow alert notifies you if any database transaction log is growing in a way that can impact performance
  • Real-time database auto-grow alert notifies you if any database is growing at an unhealthy rate
  • New report based on the scheduled database integrity check to help ensure that you follow and adhere to best practices
  • The scheduled Database Summary report now sorts by percentage capacity to highlight databases nearing a growth change
  • Email failures now display in red in the scheduled Email Summary report to ensure prompt action
  • Duration metric added to the scheduled Jobs Summary report for better management and to help you spot trends

We regularly see the negative impacts of unmanaged databases. If they don’t get required attention, they can grow sluggish, temperamental, consume additional disk and processor space, and generally perform below spec. This can add significant time to required tasks, and that can mean significant costs to your organization, and inconvenience to your patients.

C4 was founded to help laboratories better manage their databases. Through closely monitoring customer needs, we regularly update and refresh features and capabilities to ensure database servers continue to help improve patient care. We hope you find these new features helpful.


Afraid to upgrade your LIS? – October 2018

We’ve had many customers express their desire to upgrade or change their current LIS. Ultimately, most delay doing so, despite the fact that long-term gains from such an upgrade could be tremendous. Why the great reluctance?

There many reasons, but they seem to fall into two major categories. The first category is psychological and the second is workflow. On the psychological side, it’s human nature to be apprehensive about change, especially when confronting the many unknowns involved with a new LIS. The magnitude of change can seem overwhelming. There are technical aspects like conversions and interfaces as well as staff impacts like training and ramp up time. Needless to say, it’s not turnkey.

On the workflow side, questions surround the time it takes to get back to normal routines and workflows, and when the upgrade ROI will kick in.

The answers aren’t easy to provide. For example, it could take quite a while to get back to the same settled, productive, efficient pace of operations. It depends on how efficiently the organization takes advantage of the upsides of the change.

The first step is overcoming the fear of the unknown. Only then can you begin to gather the answers that will help you determine the best path forward.

C4 knows that making an LIS change is not easy. It can take 12 to 18 months and it can be rough, but it does get better each month when a lab maintains tight accountability working closely with their vendor on refinements. Those involved should be prepared for challenges. But determining what is possible is surprisingly easy. Virtually every LIS vendor will provide demos for free. C4 recommends taking advantage of them as they provide insights into possible ways to proceed. The only cost of learning is the time spent.

Keep in mind, in this process the billing side does not need to change simultaneously. This allows specific focus on the LIS side of things. A stepped approach is more judicious. First change LIS, then billing. We recommend not changing all at once. As a matter of fact, C4 customers don’t need to change their billing systems.


I can get fined for not knowing? – September 2018

It shocks many in the healthcare industry to learn that they can get fined for “not knowing” they are out of compliance. According to HIPAA fine ranges, this named violation category carries a maximum of $1.5 million per inspection. Category fines per violation range from $100 to $50,000 and numerous violations can rack up, one for each non-compliant find.

This shock can be avoided by knowing the rules. According to the HITECH Act portion of HIPAA compliance, Standard §164.308(a)(1)(i) implies a need to implement procedures to prevent security incidents including software updates and patch management as part of security management processes. Similarly, Risk Management section §164.308(a)(1)(ii)(B) explains how software updates are not optional and should be implemented if possible.

The implications of non-compliance can be financially painful. For example, Metro Community Provider Network got fined $400,000 in 2017 for lack of security management around patient healthcare information. To avoid this, IT management needs to work to assure all versions of system software are supported by their manufacturers to address security threats.

Since “not knowing” won’t be an accepted excuse, laboratories must keep their systems up to date like any other healthcare facility. This means applying all Windows Server and SQL patches and upgrades. If one is running on unsupported software, security won’t be possible. Also, not applying Windows updates makes it very challenging to keep most apps working correctly.

We talked last month about “sunsetted” software. Much of it is still in use. We’ve seen it. These sunsetted versions contribute directly to non-compliance and can lead to the nasty fines some facilities have paid. We can help with a quick consultation and let you know how compliant you are. After we talk, you’ll be “in the know.”


Are You Ready To Be ‘Sunsetted’? – August 2018

In the language of LIS systems, “sunsetting” is when a software product is no longer supported. Naturally, this makes adding capacity via that software extremely challenging. Whenever growth is desired, upgrades or workarounds become necessary.

Examples of sunsetted software include Microsoft products that many LIS systems require, including Windows Server or SQL Server. For example, some existing LIS systems run on SQL 2008, which lost mainstream support in 2014 and will lose extended support in July 2019.

Other sunsetted or soon-to-be-sunsetted software include Windows Server 2003, which lost all support in 2015, and Windows Server 2008, which will lose extended support in January of 2020. Similarly, Windows 7, which is still used broadly, will lose extended support in 2020, having lost mainstream support 3 years ago. Since system upgrades require lead time and planning, it’s important to be fully aware of what the future holds for your software environment.

If you want to ensure that you are optimized to grow your capacity as needed, be sure to learn whether your software tools will remain viable. We see customers using workaround 3rdparty products to mitigate their expired products. However, these can involve their own maintenance and version management headaches.

You can get a handle on this through an audit of your system versions. In some cases, C4 already knows your systems and can let you know your status right away. Otherwise, we’d be happy to quickly review your systems and provide recommendations or upgrade paths.


The Importance Of Managing Your Data And Systems – July 2018

Patient information is a grave responsibility. Failing to effectively protect and manage it can have grave consequences.

Not only must you effectively manage patient data, sometimes you must prove that it’s being effectively managed (think CAP inspections or a customer asking if you are HIPAA compliant in following data guidelines and maintaining backups).

Poorly managed data can also eat up time and money. Non-indexed data significantly slows system responses, resulting in waste that touches every person using your database.

C4 is a leader in database solutions. We can tell you, in simple terms, how well your data and systems are being managed, make recommendations for improvements, and even help you achieve continual improvement.