Herself Health | Lab Strategy · Clinical Advancement Initiative · Created Feb 2026

Purpose

This document outlines the current state lab workflow, identifies key pain points, and presents the future state redesign to standardize how labs are ordered, collected, documented, and submitted across all Herself Health clinics.

📍 Current State Lab Workflow

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Key challenges: Inconsistent processes across clinics, unsigned orders, specimen handling errors, and fragmented handoffs between Providers, MAs, and Quest.

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Current State — High-Level Flow

flowchart TD
    A["Patient Checked In"] --> B["Provider Places Lab Order"]
    B --> C{"Order Signed?"}
    C -- No --> D["Order Sits Unsigned<br>(MA may not catch)"]
    D --> C
    C -- Yes --> E{"Lab Type"}
    E -- Quest Send-Out --> F["MA Opens Quest Portal<br>& Locates Order"]
    E -- In-House POC --> G["MA Performs<br>Point-of-Care Test"]
    F --> H["MA Edits Specimen<br>Details in Quest"]
    H --> I["MA Submits Each<br>Lab Individually"]
    I --> J["Print Labels &<br>Requisition from Quest"]
    J --> K["Draw Specimen"]
    K --> L["Bag & Hand Off<br>to Quest Courier"]
    G --> M["Results Documented<br>Manually / Scanned"]

Current Pain Points

Pain Point Impact Example
Unsigned / auto-routed orders MAs proceed without signed orders → labs rejected or delayed MAs see "unsigned" status but no clear escalation path
Labs submitted individually Quest only receives partial orders; patient must return for remaining draws 7 labs ordered, Quest received only 2 (TIC-1447)
Dual-system confusion (Athena + Quest Portal) MAs toggle between Athena and Quest portal, increasing error risk Inconsistent training on which system to use for submission
No POC vs. send-out distinction Providers can't easily see which labs are in-house vs. sent to Quest No dashboard or chart-level indicator exists (TIC-3013)
Specimen handling inconsistencies Mislabeled or mishandled specimens → rejected or lost results Tube type / temperature requirements not readily available
Lab results hard to find Providers miss historical results; only one lab visible, others buried Results grouped under "1 Historical" toggle (TIC-3656)
ABN process unclear ABNs not consistently printed or signed before draw ABN printing with Quest req still being investigated

🚀 Future State Lab Workflow

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Goals: Improve provider ownership · Reduce unsigned errors · Standardize documentation · Improve specimen accuracy · Build a sustainable long-term process

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Future State — High-Level Flow

flowchart TD
    A["Patient Checked In"] --> B["Provider Places & Signs<br>Lab Order in Athena<br>(Exam > A/P with Dx Code)"]
    B --> C["MA Verifies All Orders<br>Show 'Perform' Status"]
    C --> D{"All Signed?"}
    D -- No --> E["MA Flags Provider<br>to Sign Before Proceeding"]
    E --> D
    D -- Yes --> F{"Lab Type"}

    F -- Quest Send-Out --> G["MA Opens Order<br>in Athena"]
    F -- In-House POC --> H["MA Performs POC Test<br>(Piccolo / UA via RelayMed)"]

    G --> I["Enter Specimen Details<br>• Collection: Office<br>• Source, Collector, Date/Time"]
    I --> J["Apply Specimen Details<br>to ALL Labs at Once"]
    J --> K["Add Fasting Status<br>(if applicable)"]
    K --> L["Submit → 'With In-House<br>Specimen Draw'"]
    L --> M["Check Box: Apply to<br>All Additional Labs"]
    M --> N["Click Save"]
    N --> O["View ALL Orders in Submit<br>→ Check/Uncheck All"]
    O --> P["Print All →<br>'Print and Mark Submitted/Closed'"]
    P --> Q["Attach Athena Labels<br>to Specimens"]
    Q --> R["Place Requisition &<br>Specimens in Quest Bag"]
    R --> S["Quest Phlebotomist<br>Packages & Processes"]

    H --> T["Results Auto-Interface<br>to Athena via RelayMed"]

    style B fill:#e8f5e9,stroke:#2e7d32
    style J fill:#e8f5e9,stroke:#2e7d32
    style M fill:#e8f5e9,stroke:#2e7d32
    style T fill:#e3f2fd,stroke:#1565c0

What's Changing — Side-by-Side Comparison

Area Current State Future State
Order Placement Provider may or may not sign; MA sometimes places order Provider owns the order — places with Dx code and signs in Athena before MA proceeds
Order Verification No consistent check; unsigned orders slip through MA verifies all orders show "Perform" status; flags unsigned orders back to Provider
Ordering System Mix of Athena and Quest Portal depending on clinic All ordering and submission through Athena natively
Lab Submission Each lab submitted individually → partial orders reach Quest Batch submission: "Apply specimen details to all labs" → submit all at once
Specimen Details Entered inconsistently; often missing collector or timestamp Standardized fields: Collection (Office), Source, Collector, Date/Time with one-click auto-fill
Requisition Printing Printed from Quest Portal; ABN process unclear "Print All" → "Print and Mark Submitted/Closed" directly from Athena; ABN integration in progress
Specimen Labeling Quest barcode labels or manual labeling Athena-generated labels attached to specimens with matching requisition
In-House / POC Testing No interface; results scanned or manually entered Piccolo and UA machines interfaced via RelayMed → results auto-populate in Athena
Quest Phlebotomy MAs draw all specimens in-house Quest phlebotomists on-site at clinics for draws; billing is Quest's responsibility
Tracking & Visibility No way to track POC vs. send-out volume Dashboard to track in-house vs. Quest testing by clinic, provider, and appointment type

📋 Future State — Detailed MA Steps (Quest Send-Out)