LIS platform considerations

When choosing a new LIS system, or replacing an old one, there are several key things to consider and evaluate, according to Lisa-Jean Clifford, President at Gestalt Diagnostics. She said a laboratory’s top priorities should be:

• Making sure the vendors clearly articulate the migration plan from existing to new.  
• Making a clear list of the functionality, features and interfaces/interoperability requirements that you have.
• Asking what the vendor’s current, and future roadmap looks like for new features.
• What is the vendor’s upgrade policy and path?
• How often have they had to roll back an upgrade and for what reason(s)?
• What are their support hours and service level agreements (SLAs)?
• What is their history in meeting those SLAs?
• What are their support ticket volumes like per month and what are the top 3 reasons for support tickets/issues?
• Are they using external contractors for development or support and if so, from where and how do they ensure quality and security?
• How do they support true integration with digital pathology platforms?

The most important consideration is whether the LIS can support both the laboratory's current operations and its future growth strategy, said Matt Folsom, Senior Director of Software Engineering at XiFin. “Many laboratories outgrow systems that were designed for a narrower test menu or lower complexity environment. Leaders should evaluate how easily a platform can accommodate new testing modalities, increasing volumes, multi-site operations, and evolving reporting requirements without requiring extensive custom development.”

He highlighted the following five key areas laboratories should focus on:

• Configurability
• Scalability
• Interoperability
• Security
• Workflow visibility

“A modern LIS should provide flexible workflows, integration with instruments and external systems, robust analytics, and a complete audit trail. It should also deliver the operational transparency needed to identify bottlenecks and continuously optimize performance. The goal is for the LIS to be capable of evolving alongside the laboratory and supporting long-term organizational success,” he continued.

Both Richard Gruner, Head of Business Development North America at Elea and Jenny Bull, LigoLab’s Success Director emphasized that laboratory leaders should begin their evaluation with an analysis of the LIS’s workflow, not features.

“Map how a case moves from accessioning to sign-out and billing, then test each vendor against that on your own cases in a live demo. Next, look at time to value: how long go-live takes, how much of the work falls on your staff, and whether upgrades arrive automatically or come as paid projects. Finally, check the vendor's architecture. A cloud-native system with artificial intelligence (AI) built into its core will get better every year. A legacy system with AI bolted on will fall further behind,” Gruner said.

Bull added, “After 26 years in laboratory operations, I have seen far more LIS projects struggle because the system did not fit how the lab actually works than because of a missing feature.” Once your current and future state workflows have been mapped and you’ve evaluated every system against them, she recommends focusing on four priorities. “First, look for a single unified platform across clinical, anatomic pathology, and molecular, so you’re not maintaining interfaces between your own departments. Second, look closely at how the LIS connects to billing. Nearly every data element captured at accessioning affects whether a claim gets paid, and labs that treat the LIS and revenue cycle as separate decisions leave money on the table. Third, scrutinize the vendor's implementation methodology and track record. Ask for references from labs of similar size and complexity and ask them candidly how their go-live went. Fourth, calculate the true total cost of ownership over five to seven years, including interfaces, upgrades, hosting, and the internal staff time the system will require.”

She concluded, “Finally, remember that you are choosing a partner, not just a product. You will likely live with this relationship for a decade or more, so responsiveness, transparency, and a shared commitment to your success matter as much as anything on the feature list.”

“The defining challenge right now is that laboratories are being asked to do more with fewer people and tighter margins at the same time,” Bull said. “Staffing constraints and reimbursement pressures leave laboratories less room for rework, including claims returned over documentation or medical necessity issues. In response, labs are expecting their LIS to absorb work that used to require manual effort: automating order entry, reducing touches in accessioning, and catching billing errors before a claim ever leaves the building.”

She continued, “We’re also seeing continued consolidation and growth in outreach programs, which means more multi-site operations and higher expectations for client-facing tools, such as provider portals and electronic ordering. At the same time, many labs are still running legacy systems that are approaching the end of support. I expect 2027 to be a significant replacement cycle, and labs that use that moment to rethink their workflows, rather than simply recreate the old system on new software, will come out well ahead.”

Gruner also pointed to the laboratory’s evolving LIS needs due to staffing shortages and increasing pressure on laboratory staff. “Labs face a mix of pathologist shortages, rising case volumes and pressure on reimbursement. The main question is no longer ‘which LIS tracks my specimens,’ but ‘which LIS gives my pathologists and staff back hours every day.’ Through 2027, we expect consolidation among multi-site groups, more labs leaving on-premise systems, and AI moving from pilots into daily routine work.”

Clifford said, “LIS applications will need to support digital pathology in more ways than just unidirectional or viewer launch as the technology continues to become standard.”

One of the biggest trends is the continued convergence of diagnostic disciplines, Folsom added. “Laboratories increasingly need to combine anatomic pathology, molecular diagnostics, genomics, digital pathology, and clinical laboratory data into cohesive workflows and reports. As precision medicine expands, laboratories will require an LIS capable of supporting highly specialized testing while facilitating collaboration across multidisciplinary care teams.

Another trend is the growing expectation that laboratory data be immediately available and actionable. Healthcare organizations are seeking faster turnaround times, greater automation, and stronger integration with enterprise systems. By 2027, laboratories will place even greater emphasis on cloud-based architecture, workflow orchestration, advanced analytics, and automation capabilities that help address workforce challenges while improving efficiency and quality.”

He continued, “At the same time, laboratories will face increasing complexity associated with cybersecurity, regulatory requirements, and growing data volumes generated by molecular and genomic testing. The LIS will play a critical role in helping organizations manage this complexity while maintaining operational performance.”

Cybersecurity and data protection considerations

Cybersecurity and data protection have long been an area of concern for clinical labs. “Protected health information remains a valuable target for cybercriminals, which means laboratories must evaluate an LIS not only on functionality but also on the strength of its security architecture,” Folsom emphasized.

“Cybersecurity belongs in the same conversation as turnaround time and quality,” Bull added. “I would evaluate an LIS on how well it protects information and how the laboratory will continue operating during a disruption. Ask for evidence behind the security claims: multifactor authentication, access based on job responsibilities, encryption, audit trails, vulnerability management, and tested backups. Be clear about who owns patching, monitoring, and incident response across the vendor, the hosting provider, and the laboratory. A cloud deployment still requires those responsibilities to be defined.”

Bull said labs should consider what happens when an outage occurs when evaluating an LIS. “How quickly can service be restored, how much recent work could be lost, and how will orders and results created during downtime be reconciled? Those answers should be demonstrated through recovery exercises that include laboratory staff. Security must also be designed into the implementation, supported by established controls and frameworks such as SOC 2. Access controls, downtime procedures, and recovery protocols should be tested before go-live and revisited regularly as the laboratory and its operational requirements evolve.”

Folsom concluded, “Security is no longer viewed as a feature. It is a foundational requirement that influences every stage of the selection, implementation, and ongoing management process. Laboratories are looking for LIS that combine strong security controls with high availability and reliable access to critical clinical information.”

Planning ahead

As laboratory leaders are planning for the next few years, Bull says one LIS technology opportunity to watch for is the LIS becoming a practical decision tool for running and growing the laboratory. “We already capture much of what happens to an order, a specimen, and a result. When that information is connected to staffing, service commitments, and the revenue cycle, it helps leaders understand why performance is changing and where to act.”

She continued, “I would want the LIS to help us learn from those patterns and measure whether the changes we make actually work. That gives laboratory leaders a stronger basis for conversations with clinicians and business partners. The question worth asking is how much better we could run the laboratory if we could use the information we already generate.”

Clifford said to plan for the ability to work seamlessly (and the willingness to) with IMS/digital platforms. “The speed at which adoption and technological advancements are happening are moving so far outside the LIS that they will need to be open and interoperable. That way, healthcare systems and labs will be able to integrate new and evolving technologies easily and expand their workflows at a pace that meets need, without having to make huge investments in redoing their IT infrastructure.”

Gruner highlighted that right now, an LIS is an "AI-native operating system" for the lab, where reporting, coding, case triage and quality checks are automated and the pathologist concentrates on diagnosis. “Labs choosing a platform now are effectively deciding whether they'll get these gains over the next five years or wait for a legacy vendor to retrofit them.”

Laboratories are generating more valuable information than ever before, but realizing that value depends on the ability to connect and operationalize the data, Folsom said. “The laboratories that gain the greatest advantage will be those that move beyond viewing the LIS as a transactional system and instead leverage it as a strategic platform for insights, collaboration, and growth. As precision medicine continues to expand, organizations that can efficiently connect diagnostic data, automate workflows, and deliver actionable information to care teams will be best positioned for success.”