Survival of the Fittest: Is Your IT in Shape?

Cover Story

Hulking laboratory information systems may need to slim down to run a marathon of contemporary healthcare requirements. New market drivers are forcing labs to seek new technologies impacting information systems.

“Most laboratory systems today are overweight,” said Dennis Winsten, Dennis Winsten & Associates, a 30-year veteran in the application of computer systems to healthcare. “Capabilities-like order entry-within laboratory information systems (LIS) are rarely being used anymore because they have been usurped by electronic medical records (EMRs).”

Winsten made the point that slimmer, more focused applications directed at the work of specific lab specialties are the best way for systems to morph.

Hal Weiner, president of Weiner Consulting Services with 40 years’ experience in healthcare information systems, agreed that LIS will be more inwardly focused, “. evolving much more like work area managers, very specialized in supporting laboratory work flows, specialized to specific benches. The scope of LIS will contract over the years to come.”

Weiner and Winsten both commented that the drive to molecular testing, companion diagnostics and pharmacogenetics testing has inspired a “new industry” with a new range of industry drivers.

Suren Avunjian, co-founder and CEO of LigoLab Information Systems, agreed, noting that labs face extraordinary new pressures and responsibilities-ranging from new molecular genetic testing, quality control automation and regulatory requirements to falling per-transaction reimbursements in the face of increasing volumes.

“Laboratories must select flexible LIS systems that quickly adapt to the dynamic, constantly changing laboratory ecosystem,” he stressed. “Systems also must be highly integrated to cover all workflows and departments of the lab to drive maximum efficiency.”

Avunjian also made the point that, while lab managers know their own lab environments best and should stick with what is working for them, they “must continue to investigate other options and be open to continual improvement of workflow and processes. Accept that IT/LIS has a big role in the success of the lab; stop thinking of LIS as a product, but rather as a vital platform.”

Emerging Strengths

Emerging lab responsibilities-and exciting new capabilities-call for IT that can embrace what Rob Atlas called the “golden age of diagnostics.” Atlas, senior vice president at Sunquest, told ADVANCE, “Evolving genomics, proteomics, our understanding of the microbiome and more will enable diagnostics to positively affect patient outcomes and overall population health-all while reducing the overall healthcare spend.” He noted that, while lab spending likely will increase marginally, the growth curve for overall healthcare costs may be reduced dramatically, “. making labs valuable as independent entities and considered valuable within health system C-suites-maybe for the first time.”

Unlocking this newfound power will require the right IT approach; however, Atlas cautioned, “The enterprise EHR, although very useful, will not be sufficient. High-performing, successful labs of the future will require a patient-centric infrastructure to support a community-wide approach with highly interoperable pre-analytical and post-analytical modules that can seamlessly integrate with multiple core LIS analytical platforms. Patient records must contain relevant details from the community, not just the health system.”

It all must be tied together with seamless connectivity. “Labs must be able to connect with physicians, nursing homes, referring labs and other collection centers to allow for the processing of clean, electronic orders,” said Atlas, “and all results must be integrated with a patient’s enterprise record to maintain a holistic view of the patient.”

It’s a tall order, but one that Atlas believes is achievable. “Smartly-deployed clinical decision support applications and utilization optimization rules engines at the front end within the community (pre-analytical modules) and powerful genetic analysis and interpretation and integrated reporting capabilities at the back end (post-analytical modules) will be used to leverage diagnostics and fulfill the promise of precision medicine.”

In the Cloud

Joseph Nollar, vice president of product development at XIFIN, believes that much medical information will continue to move to the cloud to provide efficient and scalable solutions for laboratories. “Cloud-based laboratory information systems are best equipped for rapid development and deployment,” he claimed. “This is critical as labs consolidate and diversify to meet market demands.”

He identified some of those hefty demands, stating that labs must contribute to the overall value-based healthcare model through ðanalytics-both financial and clinical-that lead to comprehensive population health management; move away from single modality systems toward multi-modality systems for clinical pathology, anatomic pathology and complex molecular testing; heighten efficiency to reduce costs and maximize margins; integrate digital pathology for primary diagnosis and secondary opinions (pending FDA approval); and allow for access to records for consultation and collaboration across the entire healthcare team.

It is all included in a conceptual model XIFIN has pursued under the assigned name “connected health.” “Connected health uses healthcare information to facilitate accessing, sharing and analyzing healthcare-related information,” said Nollar. “It is more than acquiring data or managing and analyzing patient data, though. Connected health also encompasses the communication and collaboration that needs to occur between everyone involved in a patient’s treatment.”

Mining Data

However a lab collects data and wherever it stores it, that data must ultimately be handled as the valuable property it is. “In order for labs to survive coming changes along with significant reimbursement reductions, they must have a handle on their information,” warned Weiner. “Labs must become educated about ordering patterns, about testing that may be inappropriate or unnecessary and about ðproductivity. Laboratories will need tools to help them decipher that kind of information quickly because a lag in understanding is costly. Without business intelligence and business analytics, a lab would have a hard time surviving over the next five to 10 years.”

A shrinking bottom line, said Weiner, is a wake-up call to turn tests into a cost advantage-with better test utilization and improved productivity. “Without information capability to do that” he said. “Lab managers will be pulling their hair out and praying someone can provide a solution for them. Fortunately, plenty of vendors stand ready to answer their prayers.”

Newitt is on staff at ADVANCE. Contact: [email protected].