Insights from thought leaders: the future of software in the laboratory

Connection—and collaboration

Today’s market drivers, including support for ACOs and HIEs as well as adherence to new federal regulations, are making the laboratory more and more patient-centric, as well as more nimble and strategic in order to survive and thrive. The patient, as a consumer, is quickly blending into the mix. Labs are looking for better ways to deliver services to these consumers, such as identifying methods to provide patients with access to results—addressing the upcoming compliance deadline for federal regulation—as well as offering services such as patient payment and consolidated billing. It has been noted that labs produce approximately 70% to 80% of the clinical data that is used throughout the healthcare enterprise. They must find new, strategic ways to leverage the value of diagnostics to support the continuum of care. Providing ACOs and other caregivers with longitudinal reports, case management, and alerts to the care coordinator to address hospital readmission reimbursement challenges, and more advanced interoperability—getting data in the right form to the right system—are key examples. Labs must collaborate, not just connect. Enabling collaboration, and going beyond the four walls of the lab, will help position the lab for greater success—starting now.

— Bob Gregory, Chief Business Officer

Atlas Medical

Provider of patient-centric outreach and connectivity solutions including LabWorks, as well as HealthCentric EMPI

Supporting interoperability

As Meaningful Use, ICD-10, and other regulatory measures take hold and the emphasis in healthcare shifts from test volume to test value, the ability of lab software to support interoperability among multiple hospital, independent, and physician office laboratories is becoming increasingly important.

Further, with upward of 20 different reporting standards vying for popularity, adding more standards for providers to meet could cause unnecessary stress. A better answer lies in a single software solution that can be used to translate different types of lab data and, like a scaffold, support connectivity and interoperability among laboratory service providers using any number of different technologies and data reporting standards.

Enter today’s emerging enterprise-grade server and application development frameworks. Such solutions provide a real-time, bidirectional data and services platform that permits providers and lab services to cleanly and efficiently exchange data regardless of type, standard, hardware, or laboratory information system characteristics. In addition, such solutions function in real time and provide zero-downtime deployment of bidirectional data packages.

In a field still dominated by legacy systems, these solutions can work with a wide range of programming languages and compliance standards, enabling laboratories of all sizes and types to communicate with each other, as well as outside facilities, easily and efficiently. Moreover, healthcare organizations are able to transmit patient test results and other data directly into electronic health records.

These capabilities not only have immediate application to today’s challenges with respect to laboratory connectivity, but will continue to be required well into the future as labs strive to meet the demands of an increasingly diverse and value-driven clinical environment.

— Ralph Katieb, solutions architect

EISe Enterprise Integration Server

Document Storage Solutions Inc. (DSS)

“Cherry-picking” the pieces

The future means flexibility, which can be seen as two-pronged. One aspect is that clinical labs will be freed up from major, monolithic software deployments; instead, software will be more modular and flexible, which enables labs to cherry-pick the pieces of software they need. For example, for lab quality management, they might need only the modules related to equipment management or document control, versus a whole QMS package.

Another aspect to this flexible future is that lab software will be hosted in the cloud, which again frees the labs from old-fashioned, huge installations like LIS systems. It gives the lab almost instant and untethered software access, which enables management of the lab from any workstation or laptop at any location. Because cloud-based hosting makes for an easy and quick deployment, the lab can leapfrog over old-fashioned server and network requirements.

To sum up, when it comes to clinical lab quality management and document control software, the features and functionality have reached maturity, and have high rate of uptake. But what’s new is how labs can access them and purchase them, using cloud-based technologies and cherry-picking exactly what they need—giving them maximum flexibility.

— Craig Madison, Senior Partner

SoftTech Health

Developer of the SoftTech Health LabQMS system

Extending beyond the lab

As software becomes more regulated to comply with standardization, labs will be able to focus less on the compliance side of the software offerings in the industry. This means they will be able to go through a simple checklist of requirements for their compliance needs—meets ICD-10, Meaningful Use, HIPAA, HITECH, CAP and CLIA, etc.—as the requirements apply to their lab. They will be able to focus on the features and workflow that will enable them to differentiate themselves from their competitors to meet their business objectives as well as to achieve better ROIs on their IT investments.

This, in turn, means that software providers will need to focus their efforts both on meeting the regulatory requirements and providing more innovation within their solutions. With cuts and more oversight being focused on the billing and reimbursement of tests, the labs need to be focused more on the operational aspect of their business in order to be successful. One of the most important areas, and the foundation of that analysis, is within the laboratory solutions. LIS vendors need to provide better connectivity with more reach throughout the lab.

An LIS solution is no longer just a single component; it is a central component that needs to extend beyond the lab. The view needs to extend from the patient in the physician’s office who, it has been determined, needs lab work all the way through to the delivery of the diagnosis and treatment plan—and back to the patient. In the case of molecular and cytogenetic testing, the process may begin even earlier—when a couple starts to think about pregnancy—and continue through generations. The lab, as a business, needs to ensure that each of its areas is functioning to capacity both through the laboratory solutions that are implemented and through the full use of those as a management tool for conducting analysis in every aspect of the business, from the time a test order is initiated until that test is paid for.

— Lisa-Jean Clifford, CEO

Psyche Systems Corporation

Provider of WindoPath LIS and EMR Hub

Promoting rapid diagnostics

Because of the rapid changes taking place in the healthcare industry and the focus on value-based healthcare combined with cost savings, prompt and accurate diagnosis, leading to the best treatment plans, has become paramount. Laboratories play a vital role in supporting this by providing rapid diagnostic information. And having the right LIS to promote this is critical.

Clinical laboratory software, now and in the future, must have the functionality to allow the laboratory to be a part of the clinical decision support system for providers—enabling laboratorians to monitor test utilization and be involved in promoting appropriate test selection, use rules-based support tools to automatically implement testing cascades and algorithms, and provide valuable reports with the desired clinical data to support organizational goals.

In the future, as diagnostics moves toward the use of genomics and personalized medicine and we traverse down new pathways, laboratories will need a strong software partner that is extremely agile and able to adapt as testing patterns shift and diagnostics continues to move to the forefront. The LIS and the EHR will need to work in tandem to monitor population health dynamics, and these software capabilities must be able to continually advance and become more sophisticated to support more standardized, data-driven, best practice models.

— Curt Johnson, Chief Operating Officer

Orchard Software

Provider of Orchard Harvest LIS, Orchard Pathology, Orchard Sequoia, Orchard Trellis, Orchard Copia

Monitoring pain management

Tremendous growth has been seen in the area of pain management testing. This is due to the new provider requirements when prescribing pain management drugs. In addition to drug screening, providers must obtain quantitative testing on positive results to confirm results are accurate. Physicians must also review the testing to ensure that the patient is compliant. By selecting the prescribed medications when creating a lab order, the LIS is able to recognize if testing results are consistent or inconsistent with the prescribed medications. Advanced reporting of this information in an easy-to-read format assists in identifying any inconsistencies.

The results are displayed in an easy-to-read tabular format. Medication dosages should be tracked, and the LIS allows users to enter the dosage for each prescribed medication. For those labs that only provide drugs of abuse screening, an interface with the confirmation lab will electronically send orders to the reference lab and provide a consolidated final report.

Specific pain management features may include:

Drug Adherence Report for easy identification of consistent and inconsistent test results
Connectivity to both drug screening and confirmation testing instruments
Automated rules to alert if a specimen is suspected of adulteration
Automated ordering of confirmatory tests based on screening test results.

— Jim Kasoff, President, Laboratory Division

CompuGroup Medical

Provider of CGM LabDAQ Laboratory Information System, CGM Labnexus Laboratory Outreach Solution

Lab management in a single system

Today, clinical lab software must be able to deliver complete clinical lab management in a single system. Paramount to this capability is an open-architecture, scalable solution that can manage anything from a single lab to a complex multi-lab enterprise system. The ability to deploy a workflow solution across the entire breadth of lab disciplines—core lab, POL, blood bank, microbiology, etc.—will improve the efficiency and ensure standardization across the clinical laboratory.

The power to manage the entire clinical laboratory provides the opportunity to have a complete holistic view of the laboratory, driving the development of business intelligence reporting and dashboards. These metrics will enable labs to baseline their performance, identify inefficiencies, and implement improvements. This process will ensure that lab operations are continuously monitored for performance and that improvement is implemented throughout the clinical lab. In addition, as the number of labs with outreach programs increases—accounting for an estimated 25% of hospital testing—software that supports quality metrics for new reimbursement models and physician satisfaction will become a necessity.

In the future, cloud-based computing will certainly play a role as laboratories and IVD vendors explore the benefits and challenges of adopting this technology in a clinical care environment. Of course there will be challenges to overcome—for example, delivering a cloud solution that can ensure that critical software applications continue to have optimal up-time. Also, laboratories will need to become more comfortable with their sensitive data residing outside their premises.

— Jeff Raponi, Senior Informatics Manager

Beckman Coulter Diagnostics

Provider of diagnostic and clinical IT products

Adapting to a changing environment

The future of clinical laboratory software lies in its ability to adapt to the ever-changing laboratory environment. Software used in the clinical laboratory must provide functionality that improves workflow efficiency, increases productivity, and provides real-time data to improve business management. Moving forward, software in this industry must continue to adapt to new technology, including mobile devices and cloud-based computing. Delivering applications using a Software-as-a-Service model will be increasingly important in order for software to evolve quickly enough and have an active lifecycle that can adapt to changes in the market and new regulations, as well as provide tools to help maintain compliance. In addition to this, software developed for this marketplace requires feedback and direction from its users in order to continue to grow and offer all of the needed functionality.

— Jim Terrano, President & CEO

TELCOR Inc.

Providers of point of care data management and revenue cycle management software solutions

Combining best-of-breed and enterprise-wide

Innovations in medically related software will continue to evolve to keep pace with the evolution of our healthcare system. Over the coming years, software vendors will enhance their existing offerings by providing new applications, algorithms, and programs, all focused on improving patient safety and streamlining efficiency while at the same time reducing costs. What will change is the question often asked by healthcare providers: “What is the best software approach for my particular business model?”

Today, the debate centers on considering a best-of-breed approach, where the healthcare provider selects software systems to address each departmental need regardless of the number of vendors involved, or an enterprise-wide approach, where the healthcare provider selects a solitary vendor to meet the needs of all of the departments. The best approach will be a combination of both lines of thinking: reduce the number of vendors to a manageable few while at the same time augmenting the enterprise-wide solution with a best-of-breed approach when the enterprise-wide vendor has an application that falls dramatically short of meeting the business needs. The best-of-breed vendors that will survive in this new environment will be those that seamlessly interface to other software systems while providing departmental functionality that surpasses that of the solution offered by the enterprise-wide vendor.

— Rick Callahan, VP, Sales and Marketing

NovoPath, Inc.

Provider of NovoPath Anatomic Pathology Software Platform

Implementation of middleware

Accountable Care Organization pressures to lower healthcare costs while meeting performance standards on quality of care continue to drive clinical laboratories to seek meaningful changes in laboratory operations that enhance quality, turnaround time and efficiency, and control over hematology workflow and results management. As such, clinical laboratories are increasingly applying hematology-specific rules-based software within their testing environment. In fact, it is an integral part of many laboratory operations today, some of which are reporting up to 85% or more of their workload directly to the laboratory information system (LIS) via middleware without technologist review. This middleware solution pushes sample status metrics such as validation and QC review readiness to the user and generates “business intelligence” tools such as on-demand reports aimed at facilitating management decisions related to optimizing laboratory efficiency.

The key to the successful implementation of middleware is the testing of the middleware in conjunction with the LIS to verify accuracy among all systems. Automated testing and migration tools that help streamline this software implementation process and easily move customers from version to version with all rules, settings, and patient data intact are being sought by clinical laboratories that want to implement their middleware faster, with less effort, and with a greater degree of standardization.

— Anne Tate, Group Manager/IT Automation

Sysmex America, Inc.

Maker of Sysmex WAM Decision Support Software for the Clinical Laboratory

Vertically focused data platforms

After the adoption and popularity of Software-as-a-Service (SaaS) platforms, we are emerging on the next incarnation of Cloud software that’s widely being recognized as the “Industry Cloud.” SaaS is no longer a differentiator as healthcare organizations are looking for a quick solution to their immediate problems. Today’s laboratories need reliable access to data to manage all aspects of their business. With a variety of data systems in production, it is impractical to expect the user to collect data across these systems at decision time. The laboratory of the future will need a data platform that automates extraction, cleansing, and aggregation across these systems.

These data platforms will serve business applications across the spectrum such as analytics, regulatory reporting, physician reporting, patient reporting, mobile access, etc. Building a data platform such as this will require:

Laboratory expertise: a deep understanding of the laboratory ecosystem and the challenges our industry is facing today; and
Versatile technology: Aggregating, cleansing, and managing data that scales across the laboratory’s requirements needs a consolidation of technologies such as data aggregation, big data, and a scaling infrastructure

Limited IT resources continue to be a challenge and cannot scale fast enough to the laboratory’s needs. Data platform technologies will form the basis of data access and delivery at the next generation laboratory.

— Dhiren Bhatia, CEO

Viewics, Inc.

Provider of the Viewics Health Insighter and Viewics Pulse Business Intelligence Platforms

The importance of interoperability

The future of healthcare continues to change at an exponential rate—almost to the point that it’s hard to determine what is the next move for laboratories. Some of the largest software requirements today, and even more so in the future, are revolving around interoperability, and for good reason. Declining inpatient visits are forcing the laboratory to expand its services outside the hospital walls and become even more connected to physician EMRs, nursing homes, clinics, and pharmacies. Additionally, CMS guidelines in Stage 2 for Meaningful Use require major certified technology changes to interfaces, to standardize on HL7 v2.5.1, to include LOINC, SNOMED CT, and other reporting standardizations. Data warehousing and business intelligence continue to be of utmost importance, especially for the C-Suite; subsequently, interoperability across multi-system platforms is another must-have. As we move more toward population management and a value-based payment, away from a fee-for-service model, the demand for HIEs to provide shared patient information for diagnosis algorithms and clinical test validation increases, while EMPI and interoperability are not only required, but are the keys to success.

— Jamel Giuma, Product Manager, Interoperability & MU,

Sunquest Information Systems, Inc.

As the foregoing contributions from an even dozen industry leaders more than demonstrate, the universe of topics and solutions within the broad subject of software for the clinical laboratory is a large one indeed. New products and services available to labs are emerging as the frontiers of IT technology are extended, and as best practices develop in response to increasing outreach opportunities and changing regulatory requirements. MLO thanks the experts who contributed to this “Future Buzz.” We are confident that their important perspectives are valuable and illuminating to readers.