Augmenting Your LIS

See how hospitals are adding best-of-breed applications to their LIS in order to augment and extend the life cycle of their LIS instead of replacing them.

In 1990, there were over 700 LIS systems sold to hospitals by 76 LIS vendors. In 2004, there were less than 300 sold by less than 50 vendors. In 2014, there were less than 160 by 20 vendors. Why such a difference?

First, many companies have been acquired for their client base and the products sunsetted. Second, many of the sales were part of a total Enterprise Wide System (EWS), where one system is now serving many hospitals. And third, hospitals are keeping systems longer. It is not uncommon to see 15-year-old LISs still running, with perhaps some newer hardware and software upgrades. Except for the physician office laboratories and small hospitals, this is a replacement market.

One of the other reasons that sales are slow is that many vendors have failed to add significant new functionality to their products, so there is no impetus to change. Many hospitals are not replacing their best-of-breed LIS; rather, they’re adding best-of-breed supplemental applications to augment and extend the capabilities of their LIS as well as its life-cycle.

Supplemental Applications

For many organizations who have elected to utilize the less mature LIS provided by their EWS vendor, adding some of these supplemental
applications are necessary because the LIS does not have the capability at present.

These applications generally fall in five categories:

1. Physician and patient portals
2. Business intelligence
3. Outreach extensions
4. Quality additions
5. Productivity enhancements

Physician and Patient Portals

Physician portals can provide for physician order entry, barcode label printing, results review, supply orders and access to online test procedures. Patient portals can provide access to test results, interpretation information and secure Email communication; some portals allow patients to schedule testing at times convenient to the patient. Secure, internet-based portals can enhance communication between the laboratory, client physicians and patients and improve satisfaction with laboratory services. Portals have become a necessity to be competitive in outreach services business.

Business Intelligence

With reduced reimbursement, laboratories are under increasing pressure to optimize business practices, improve utilization and cut costs. Business intelligence (BI) is a set of computer-based tools that provide organized, well structured and understandable views of laboratory operational and financial data. BI, collectively, refers to analytic software that extracts data from your LIS and ­organizes, compiles, aggregates, analyzes statistically and presents information as readily understood “dashboards.” It refers to a variety of software applications used to analyze an organization’s raw data.

BI, as a discipline, is made up of several related activities, including data mining, online analytical processing, querying and reporting and is the set of techniques and tools for the transformation of raw data into meaningful and useful information for business analysis purposes. The goal of BI is to allow for the easy interpretation of large volumes of data, allowing for quicker and better management decisions. Some characteristics of BI include:

• Software that works with your LIS
• Extracts and organizes existing laboratory data and presents it in useful, actionable formats
• Provides snapshots of sorted and categorized data indicating comparisons and trends
• May provide alerts if limiting “criteria” met

BI systems may contain one or more of the following capabilities:

• Extraction and reformatting of laboratory data
• Multidimensional aggregation and allocation
• Normalization of disparate common data
• Real-time reporting with analytical alert
• Statistical inference and probabilistic simulation
• Key performance indicators monitoring
• Management dashboards

BI can greatly assist management to better understand their laboratory operations and make well founded, prudent decisions to meet laboratory objectives. BI can assist in creating value propositions for patients and MDs. It can help strengthen relationships, improve quality and monitor service levels.

BI applications can be acquired, in many cases, from your existing LIS vendor or from specialized business intelligence systems companies, many of whom specialize in the healthcare and/or laboratory marketplace.

Outreach Extensions

Outreach business has become a key element of laboratory financial success. Augmentation and/or extension of outreach software capabilities can add significant value to a lab’s information system. Examples of such supplemental modules include:

• Courier and fleet management
• Client Services (CRM)
• Sales and marketing monitoring and reporting
• Supply orders and inventory management
• Revenue cycle management
• Cost accounting and cost per test analysis
• Payroll and HR modules
• Asset management

These tools can enable a laboratory to improve customer satisfaction and profitability. Outreach reports that can monitor which clients only send you Medicaid work, or who orders more supplies than they order tests, are just a few tools that can assist in improving the financial status of an outreach operation. Outreach modules can be obtained from your existing LIS vendor or from other 3rd party specialist suppliers.

Quality Additions

There are various middleware and/or specialized software modules that can serve to enhance quality levels:

• Instrument data monitoring – validating instrument performance based on internal instrument parameters, result validity and dynamic quality control monitoring
• Instrument maintenance – providing online checklists and alerts to assure that required preventative maintenance is performed completely and at the proper intervals
• Proficiency testing and monitoring as required by regulatory standards or organizational guidelines
• Managing and documenting SOPs, validation documentation tools
• Instrument correlation

Productivity Enhancements

• Laboratories are under constant pressure to improve productivity. Again, this is an area where middleware and software applications can be of great assistance.
• Lab automation – the utilization of automation lines in pre-analytic, analytic and post-analytic settings with middleware to control automation line operations and interface to your LIS.
• Autoverification – usually part of a modern LIS but, if necessary, could be supplemented with a middleware adjunct associated with lab instrumentation or the existing LIS for autoverification of results.
• Expert rules – help eliminate unnecessary testing and assure that appropriate testing is performed; many of these rules are available with most LISs, as well as with middleware and stand-alone rules applications.