Lab tests are usually the first item ordered for patients, whether they are in the ED or a specialty clinic. Since most clinical decision-making depends on these results, visibility and timeliness is crucial. Laboratory information systems (LIS) have been around for years and represent a mature market in the hospital world. Today, just about every hospital in the United States has an automated lab system, and many are on a second or third generation. It seems when it comes to LIS, the biggest question for CIOs is best of breed or enterprise.
And right now, according to Jason Hess, director of research, clinical ancillary at Orem, Utah-based KLAS, the pendulum is swinging back and forth. With no real interoperability standard for lab and notoriously hellish interfaces, is there really a compelling reason for best of breed?
It depends on whom you ask.
According to Vince Ciotti, principal at Santa Fe, N.M.-based HIS Professionals, if it's the lab department that is making the decision, best of breed will usually be the first choice. He says that occurs more often in larger hospitals for a simple reason: revenue. “In bigger hospitals, pathology usually dominates,” says Ciotti. “A pathologist will generate $40 to 50 million a year in revenue [from the lab] and he'll do his own thing — and don't get in his way.”
In smaller hospitals, however, Ciotti says an integrated LIS is much more prevalent. “You get down to a 150-bed hospital and a pathologist is just one of the team,” he says. “He'll go with an integrated system because he's a team player.”
Dallas-based Baylor Health Care System, with its 14 hospitals, is a good example. CIO David Muntz says the organization's governance process encourages users to make decisions about which systems they want. Baylor's pathology department typically chose best of breed. Baylor, which currently has a Kansas City, Mo.-based Cerner lab system, recently committed to a new LIS from Clearwater, Fla.-based SCC Soft Computer. “If it was just an IS decision, I would have chosen to upgrade with Cerner, perhaps,” Muntz says. “But the users have to be satisfied with their product.”
Muntz follows a philosophy of focusing on the “customer's customers.” For lab, he says, that means not just pathologists, but the end users of the lab information — nurses and doctors. “If you don't focus on that, you won't be successful,” he says. “Get the end user involved.”
If PHRs gain traction, that end-user may soon be the patient. Like many hospitals, Muntz says Baylor gives paper copies of lab results to patients, but that is one area where laboratory systems have room for improvement. “We don't really address how to interpret what's on the page, and that should be part of the human engineering that goes on in laboratory roll outs.“
With so many hospitals like Baylor using best of breed solutions, interfaces become more important, but rarely less painful to maintain. Because there is no standard format, all codes are proprietary, and testing is required for each one. And, say many, it will only get worse. According to Hess, as closed loop medication administration becomes an industry standard, the strength and reliability of the LIS interfaces will be challenged even further. Hess cites the example of the nurse who has to wait for the results of a patient's sodium level before giving a medication. “That's a scenario where an interfaced lab may not have the same level of interoperability,” he says.
Another potential issue is pushing pathology data to the PACS system for anatomical pathology that includes images. “How much of that data is getting pushed to a solution that can be seen by the rest of the hospital?” Hess asks. Many say they feel that an interfaced LIS cannot have the access and transparency of an integrated one. KLAS, which recently reached out across the country to survey hospitals on LIS, plans to release its LIS perception report in November to help answer that question.
And when it comes to LIS, what many call integration often turns out to be anything but. According to Ciotti, if a vendor has true integration (even at the cost of reduced functionality) the CIO is lucky. Because so many EMR vendors have been on a buying spree, Ciotti says many of those “integrated” systems are in name only. “I call that ‘interfarce,’” he says, “when a vendor buys a lab system and claims, ‘We integrated the brochures, the PowerPoints — everything but the systems.’”
He claims the larger vendors, who have acquired niche LIS, are building interfaces under the covers and calling it integration. Ciotti says that under those circumstances, a CIO really has no control of the interface. “That's what drives a CIO nuts, because the vendor is totally responsible for that.”