The LIS: What is best-of-breed?
Lab Soft News published by Bruce Friedman provides an interesting and relevant source of thought leadership in the area of pathology informatics. His post –EHRs Pose a Major Threat to Fields of Pathology & Radiology Informatics – published on 8 April 2015, discusses the pros and cons of Enterprise EHRs versus best-of-breed lab and radiology information systems.
We asked Deborah Steele, Product Manager for the Health IT product suite at Sysmex, for her thoughts:
The use of laboratory data in the clinical setting has been quoted by multiple sources as providing 70% of the information required to make a clinical diagnosis of the patient. Therefore, given the value and importance of the information created in the lab, the underlying information systems that support the lab workflow should also carry high value when considering investment in information systems.
It is acknowledged that a vast majority of LIS / pathology informatics specialists and administrators, as well as designers of LIS solutions, are often ex-medical laboratory scientists. This often occurs as a natural career progression, resulting in experts that truly understand the complexity of pathology informatics and lab workflow. LIS suppliers with years of specialist experience aim to provide a dedicated service and support, so the lab is not lost in the void of an [HR vendor. And today, we see the availability of courses and training in pathology infomatics.
Private pathology providers are contracted as a separate service (to the hospital) to provide laboratory services to primary care and in some cases secondary care. Some private labs have developed their own LIS’s, usually on-developed from legacy source code. This can create a high risk situation if the pathology provider does not have the knowledge and resources to support the system for the long term. Best-of-breed LIS fill this niche; where legacy systems become obsolete due to ongoing support issues. Vendors are very much in demand to provide a service to these organisations.
Clinicians interact several times a day with electronic lab order entry forms and clinical systems for lab report viewing. In the past these have been managed using paper based systems, with the presentation of information controlled by the laboratory. Going electronic doesn’t eliminate the lab. Medical laboratory scientists and pathologists are the domain experts, and their involvement in the IT solution design outside the laboratory walls is of considerable value. Input from the lab is integral to ensuring the electronic request form captures the details and test codes required by the lab. Post-analytically, once reported to the clinical system, the lab approved reports need to accurately reflect the data and information that the lab released with the appropriate layout, reference ranges, interpretive comments etc. There should be absolutely no changes made by the clinical system/[HR – the clinical risk to the patient is too great. So, although an enterprise [HR may centralise the IT systems management, the informatics expertise still needs to be provided by the lab.
Many laboratories don’t work in isolation, i.e. the entire menu of clinical pathology testing is generally not available in a single lab. Labs refer work out and also receive referred work in for testing. Internationally and nationally approved reference labs process and report on tests that require specialist techniques. In some cases, there are several hundred tests referred each day and managing this workflow needs to be as streamlined as possible. A modern, best-of-breed LIS supports the electronic transfer of test requests within and between laboratories and the electronic receipt of the results back to the original laboratory for reporting. With an enterprise EHR lab system, these processes generally remain paper-based.
Standard capabilities are well accommodated in enterprise EHRs and it is easy to see some of the benefits on offer to the laboratory such as lower costs and centralised support. However, given the complexity of the lab and taking into account the critical nature of pathology and clinical laboratory information in the patient care paradigm, it is an area of high priority. Thus the investment in a laboratory information system and the experience of the company that provides the solution should be given high priority by healthcare organisations considering a new LIS.
Best-of-breed solutions have proven their ability to provide added value and manage extensive complexity and are an integral component of the laboratory service. Emerging disciplines such as molecular and genomics plus digital imaging technologies will increase the complexity and requirements for the LIS.
A best-of-breed LIS built from an in-depth knowledge of pathology workflow and medical laboratory science will continue to be an expert system providing functionality for the lab that is unlikely to be matched by an enterprise EHR with standard off-the-shelf capabilities.
Written by:Deborah Steele
Deborah Steele is the Health IT Product Manager at Sysmex and oversees the direction of the Sysmex IT product suite. Deborah’s experience includes 9 years as a Medical Laboratory Scientist working in both New Zealand and London, pharmaceutical industry product management, plus 12 years’ in product specialist and marketing roles at Sysmex.