Transforming the LIS

Feb. 1, 2010
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

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

“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
, “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

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

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

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
[email protected]