Cover Story
The features and functions of the laboratory information system (LIS) continue to improve; many now offer similar capabilities as a result of new and evolving demands on the clinical laboratory. If similar functions are offered for each system, have they become commodities? If so, what does it mean to you, the laboratory manager? Accordingly, have LIS evaluation and selection criteria changed? What factors make a big difference now and what's most important?
Consider Wikipedia's definition of commodity: "A good for which there is demand, but which is supplied without differentiation across a market." The quality of a given commodity may differ slightly, but it is essentially uniform across producers. The basic idea here is that there is little differentiation between a commodity coming from one producer and the same commodity from another producer-a barrel of oil is basically the same product regardless of the producer. If this is true for the LIS, what does this mean for laboratories seeking to select and acquire a replacement LIS?
The Capable LIS
More than 30 LISs are on the market today to support laboratory operations of various sizes and complexity. Virtually all have very similar functionality. Specific features may vary somewhat, but essentially, at their specific market targets, they are all competent and capable. If, at the functional level, most LISs are so similar, is it reasonable to state that today LISs are commodities?
If so, it means that the evaluation and selection process will probably rely on criteria other than functionality and features. That is not to say that function and feature are unimportant; rather, it has become more difficult to differentiate among vendors on a function or feature basis.
Of course, some particular feature may prove appealing to your laboratory and influence the decision, but the likelihood of that is diminishing relative to other important factors. Additional important selection factors could include, for example, market/corporate image, service/support, EMR integration, compatibility with other institutional systems, client base focus, future directions, financial strength, life cycle of the LIS, selective site visit(s), onsite corporate visit, pricing, the sales process and the quality of the company's salespersons.
Let's consider each of these factors and how they could influence an LIS evaluation and selection in today's marketplace.
Market/Corporate Image
Very often vendors are invited to participate based on buyers' perception of the company and its products. A company that has good visibility in the marketplace, has been seen at trade shows, advertises and/or writes for industry publications and has a good reputation will most likely be selected as a candidate, as users are most familiar with the name and product.
Service/Support
In recent surveys, service and support are noted as being key customer satisfiers. The vendor's capability and desire to maintain, as a goal, a 100% satisfied user base will be reflected in strong positive references and positive "word-of-mouth" advertising. Obtaining existing user satisfaction ratings of the vendor's track record for service and support is very useful information in the evaluation process.
EMR Integration
LISs that are part of an integrated electronic medical record system can offer value-added opportunities compared with interfaced systems. An integrated LIS under a common architecture, for example, allows for more consistent information presentation, more flexible and broader "rules" processes and the advantage of dealing with a single vendor. With the recent governmental emphasis promoting adoption of EMRs across the spectrum of healthcare providers, laboratories can expect that the LIS relationship with EMRs will become even more important.
Compatibility With Other Systems
Compatibility with other existing or planned information systems in your hospital and/or laboratory can be quite important. A new LIS that is incompatible with systems already in use would require maintaining an additional knowledge base for the new LIS and possibly different hardware, operating system and database software suppliers with which to deal. Such a situation adds to the complexity of the overall systems environment.
Client Base Focus
The market focus of the vendor can be an important consideration. For example, if the preponderance of the vendor's existing clients and prospects are medium-size hospitals and you are a small reference laboratory, features that are important to you but not the majority of the clients will rarely have priority for development. It is important for future enhancements that your laboratory fits within the majority of the vendor's existing user base. If not, consider a vendor whose user base most closely resembles the nature of your laboratory.
As well, understanding the future strategic and business directions of the vendor can help you determine if their corporate direction is consistent with the strategic and business directions of your laboratory. If not, over time, the support and enhancements that are needed by your laboratory may not have priority with the vendor.
Financial Strength
Many LIS vendor corporations are privately held. Whether public or private, obtaining financial statements of the last three years is important to help assure the financial viability of the firm going forward. Is the vendor a strong candidate to be acquired? The answer may impact your purchasing decision.
Life Cycle of the LIS
Understanding the relative position of the LIS in its life cycle also can be an important factor. How old is the LIS technologically? Is it an older system not recently upgraded and based on older technologies? How many have been sold in the last two to three years? If there have been relatively few new sales, are there plans to discontinue ("sunset") the product?
Site and Corporate Visit(s)
Site visits may not be particularly useful in the selection process but may provide useful insights in pointing out potential issues in implementation and operations. The reason that site visits are of limited value in the LIS evaluation process is that for each vendor candidate only "happy" sites are visited and it is often very difficult to find a close match to your laboratory's size and operation. Telephone reference calls to many of the vendor's user sites can be more cost-effective.
A visit to the vendor's corporate headquarters is an extremely valuable source of information. At a corporate visit, all technical, operational and contractual questions can be answered by vendor top management. Further, it is an opportunity to meet the team that will be responsible for installing and supporting your system and to establish inter-personal relationships.
Pricing
Strangely enough, price rarely becomes a major differentiator. At any given level of LIS, e.g., large, medium and small systems, vendor prices tend to be clustered with relatively little difference among them. If large differences appear, it is generally due to a misunderstanding of the laboratory's requirements.
The Sales Process
Even the process of interaction with the vendor candidates can be an informative and useful selection factor. How responsive are they to your questions and requests? How frank and forthright are they in their dealings with you? Are their responses clear, complete and accurate? The vendor's actions during the sales process is often indicative of how they will act and respond after you become a customer.
The impact of knowledgeable sales persons also should be considered. A competent, personable, sales representative who understands laboratory operations, issues and needs and speaks "laboratorian" will have very significant impact on your acceptance of the vendor's LIS. Many more selection decisions are made on the basis of the sales person than you would imagine.
So while functions and features of an LIS continue to be keys to laboratory acceptance and utilization, they may be less useful in differentiating between various LIS candidates in a selection process. Other factors such as those discussed here may prove more useful in determining your LIS vendor of choice.
Dennis Winsten is president of Dennis Winsten & Associates Inc. (DWA)., a healthcare systems consulting firm specializing in laboratory information systems with headquarters in Tucson, AZ (www.dwinsten.com, dwinsten@msn.com). An ADVANCE editorial advisory board member, he has more than 30 years' computer experience, including over 25 years in healthcare systems.
AP LIS Features Supporting Patient Safety & Cost
By Rick Callahan
The processing of anatomic pathology (AP) specimens linked with correct patient information could pose challenges relative to workflow efficiency. In an effort to streamline the process and identify functional areas within the department that may have a higher probability of error, it is best to first understand your workflow and any inefficiencies. If necessary, you may need to embark on a program to redesign the workflow to eliminate potential for error and improve the overall process.
Software
Software is available to help you track your specimen and capture statistical data that could be analyzed via the Lean Six principals to identify areas needing attention and provide benchmarking baselines for periodic review.
Various software programs for specimen tracking are on the market today; some may be provided by your AP laboratory information system (LIS) vendor. However, with over 30 AP LIS vendors to choose from, it is safe for you to assume that not all AP information systems equally offer features that support patient safety and workflow improvements.
Having a discussion with your AP LIS vendor would be a logical place to start when investigating software that will support your initiative. If your vendor does not have a specimen tracking software program, third-party vendors in the pathology market segment may be able to provide a suitable middleware solution.
Specimen Tracking
Specimen tracking software optimizes use of patient information imported from the hospital information system, electronic medical record or practice management system into the AP LIS. Through the use of barcode technology, the specimen is labeled and clearly linked to the patient information in your AP LIS.
By properly and efficiently linking the specimen with the appropriate patient information, you eliminate the potential for errors in mislabeling requisitions, specimen containers, slides and cassettes.
In addition, use of barcode scanners at each work station enables capture of relevant information regarding processing of the specimen, as the software tracks the specimen through each step in the lab. This provides a wealth of information that can be analyzed to improve patient safety and enhance the process flow.
Labs that are seriously interested in reducing the probability of error while simultaneously improving processes should consider specimen tracking as a good first step.
Rick Callahan is vice president of Sales and Marketing for Novovision.