Special Feature

Transforming the LIS

By Richard R. Rogoski

Rapidly evolving technologies and healthcare reform are major challenges now facing LIS developers. HEX Laboratory Systems in Encinitas, CA, offers its Linux-based LAB/HEX LIS to independent commercial labs. And its customers keep asking for upgrades, says Susan Bollinger, director of sales and marketing. "We have two to four releases a year." While the company is totally revamping its Web module, Bollinger says it is also adding additional management report capabilities to accommodate the shift from ICD-9 to ICD-10 and from ANSI 4010 to ANSI 5010. Many vendors have dropped billing from their systems because of its complexity, she says, but adds, "We have fully integrated billing in our system and we also sell our billing system separately."

Concerns over regulatory issues and the future of healthcare delivery also were expressed by Gilbert Hakim, CEO of Clearwater, FL-based SCC Soft Computer. Regardless of what government-mandated healthcare reforms will require, Hakim says labs will need to automate more processes to balance work done with reimbursements while avoiding hiring more staff.

And staffing definitely is a critical issue, says Joseph Stabile, product marketing manager for Horizon Laboratory Solutions at McKesson Provider Technologies. "Currently, there is a 13% vacancy rate for laboratory personnel. That number is expected to double in the next few years. In addition, the number of ‘baby boomers’ entering the retirement ranks will also continue to grow substantially over the next decade. Senior citizens, under the current healthcare model, will flood the laboratory with requests for more services. With less staff and more test requests, laboratory systems must be able to process this clinical data with minimal human interaction. The technologist must be able to view just the exceptions and allow those results that meet acceptable criteria to be released to the clinicians with minimal involvement from the human. Laboratory systems must have intelligent workflow engines that provide the technologist on the bench with the most efficient workflow."

It may not be long, however, before more people enter the field because of new technologies, forecasts Curt Johnson, vice president of sales and marketing at Carmel, IN-based Orchard Software Corp. "The diagnostic industry will play a more prominent role as molecular testing becomes more prevalent," he says. Short term, that may present software developers with another challenge. "You have to design systems that are easier until you get to molecular, which is more sophisticated," he adds.

To accommodate molecular, genetic, and anatomic pathology testing, the LIS will need to be upgraded because these tests require more data, as well as large digital images, slides, and diagrams, Johnson says. Hakim agrees, saying that besides offering its flagship product, SoftLab LIS, his company also now offers separate genetic, molecular, and anatomic pathology information systems. But he cautions end-users, "Molecular testing would be a paradigm shift, forcing hospitals with legacy systems to change." And that changeover could come as soon as three to five years, he says.

With less staff and more test requests, laboratory systems must be able to process this clinical data with minimal human interaction.

Interoperability issues

LIS developers continue to work on interoperability — pitting best-of-breed against single-vendor systems. McKesson’s laboratory information applications are integrated with other McKesson products, minimizing the need for interfaces to other applications like pharmacy, nursing documentation, and provider order-entry products, says Stabile. "As such, the dollars that are associated with purchasing and maintaining these interfaces are essentially eliminated.

"McKesson participated in an interoperability demonstration last year at the LabInfoTech Summit (LITS Interop)," he continues. "The system demonstrated the ability to share lab results, through a federated architecture and across a disparate set of LIS solutions, for the same patient. And in regard to the American Recovery and Reinvestment Act, Horizon Lab supports the ability to encode lab results using LOINC." According to its website http://loinc.org , "The purpose of LOINC (logical observation identifiers names and codes) is to facilitate the exchange and pooling of clinical results for clinical care, outcomes management, and research by providing a set of universal codes and names to identify laboratory and other clinical observations."

Hakim is taking a different approach with his Java-based systems. By using "cloud computing," or Web-services interfaces, systems can connect point-to-point, he says. While still in its infancy, this technology is already being adopted by large teaching hospitals, he notes.

Johnson says his company’s systems still use an HL-7 interface and embedded PDFs. But he adds, "The next generation is XML and Web-services interfaces." Since healthcare IT changes slower than other industries, however, adoption of these newer technologies will take time. "There will have to be a tipping point," he states.

According to Sandy Laughlin, product manager for LabDAQ LIS and DAQbilling Practice Management System at Antek HealthWare, "With legacy systems still in place, it is very challenging for laboratories to grow their business and stay competitive. It is a challenge for both LIS vendors and end-users to stay up to speed with automation and provide innovative features to increase productivity without risking safety." Currently, Antek’s Client Services Module for its reference lab clients documents and tracks client issues and communications to better serve their needs. Next in the Antek
pipeline is a specimen storage and reagent inventory module for the LabDAQ system.

Improving workflow efficiencies within the laboratory with middleware is of special interest in the current economic climate.

Middleware usage

"Some LIS companies support the use of third-party middleware systems," says Jennifer Wheeler, middleware sales specialist from Data Innovations, a middleware provider, "either by incorporating them as part of their LIS solution or implementation, or supporting their customers’ efforts to implement middleware from third parties on their own."

Improving workflow efficiencies within the laboratory with middleware is of special interest in the current economic climate, reports Wheeler. High-quality data and larger test volumes can be generated by providing functionality otherwise not available or difficult to implement.

Middleware helps to automate manual tasks (e.g., documenting of equipment maintenance, and the storage and retrieval of specimens) as well as improve automated functions (e.g., allowing labs to reach 80% to 90% autoverification, whereas the lab’s LIS might only provide the ability to autoverify 50% of their data).

Kelly Feist, vice president of marketing for Tuscon, AZ-based Sunquest Information Systems, says interoperability is a crucial factor in reporting results. Not only do labs need to provide metrics back to the enterprise, but she says, "There’s a need to report to the CDC and to state departments of health." In addition, connectivity needs to be established between the lab and its community outreach partners, courier services, and physician offices, she says. As a result, Feist believes one of the biggest challenges for LIS developers is business intelligence, especially creating portals for physicians who have yet to adopt the EMR.

Staying current

With the advent of newer technologies, LIS developers are diligently working to improve their systems. Sunquest, whose Sunquest Lab has been available for nearly 30 years, is working to improve the business-intelligence aspects of its system by creating dashboards so laboratorians and techs can track operational, productivity, and clinical metrics in real time, Feist says.

Brian Keefe, director of Clinical Product Marketing at Psyche Systems, says his company is integrating traditionally disparate disciplines of clinical, pathology, and picture archiving and communication system (PACS)/radiology and is helping laboratories make the case for bringing esoteric testing and new methodologies into the mix in order to have new ways to attract business and compete with reference labs for the growing physician-provider market segment. "The most critical testing issue for any commercial or hospital lab is that, in too many cases," Keefe claims, "clinical and pathology testing are disconnected, utilizing separate and non-interfaced LIS."

LIS app for the iPhone?

Bollinger says HEX is continuing to develop EMR interfaces which she predicts is going to be an area of rapid growth. Johnson says to expect LIS developers to continue to improve interoperability, especially with EMRs and personal health records. As for the latter, he says Orchard is working closely with personal health companies, like Google Health, which will be instrumental in moving patient data — including lab results — from the EMR to the personal health record, or PHR. He also says his company is working to improve IT technology like virtual servers, Web-services interfaces, and applications for mobile devices. "Are there going to be LIS apps for the iPhone?" he ponders.

McKesson not only is working on incorporating molecular and genetic testing applications into its LIS but also is focusing on analytics. "Our analytics module was introduced last year," says Stabile. "Horizon Lab Analytics provides essential management-decision support tools and scorecards to quickly measure the laboratory’s performance. This unique application integrates clinical and operational data into visual intuitive displays to monitor laboratory initiatives, optimize performance, and enhance regulatory compliance.

"With the advent of digital pathology, McKesson has expanded its pathology offering to include seamless access to these third-party solutions. In addition, we have enabled our pathology solution also to access PACS images from radiology as well as patient-specific documents from document-imaging systems," continues Stabile. This provides the pathologist the ability to easily aggregate pertinent patient information from disparate applications from a single launch point to assist in rendering the diagnosis without ever leaving the host application."

Says Psyche Systems’ Keefe, "There were traditionally two choices: Do nothing and struggle to survive, or change out the entire LIS environment, which for a commercial lab is far too costly and risky to the workflow operation." Neither are particularly encouraging options, he maintains. Innovative solutions are being developed to supplement, with minimal impact, the LIS’s abilities to integrate with external systems, particularly EMR and practice-management systems.

Yet, some formidable challenges still remain. With so many new innovations, Feist admits, "The biggest challenge is that there are so many opportunities. How do we prioritize what we build?"

Richard R. Rogoski is a freelance journalist based in Durham, NC. Contact him at rogoski@aol.com .