A Dying Breed?

In recent years LIS offered as part of an enterprise-wide solution have gained traction in hospitals

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In recent years LIS offered as part of an enterprise-wide solution have gained traction in hospitals. often replacing a traditional "best-of-breed" LIS. A prime example is Epic Corporations's Beaker LIS.  Although there are other well known companies that offer an LIS as part of a more comprehensive hospital system, e.g. Cerner, McKesson. Meditech, Epic has been the "big dog" of late.

The most significant potential benefit of enterprise-wide information systems is the ability to provide true integration of all clinical components including laboratory data. Billing and accounts receivable and some financial services may also be integrated into a single system. How does "integration" differ from "interfacing" and are the differences important? Traditionally, interfacing has been used to interconnect the LIS to disparate information systems including H.I.S., EMRs, billing systems and so forth. Interfacing does work but has some intrinsic issues including the ongoing need to assure that the interfaced systems maintain consistent and synchronized files, e.g. doctor files, test codes, etc. Changes in either system must be reflected in both. Further, down times in either system require re-synchronization after recovery. Maintenance of the interface can be a chore.

True Integration will provide a single, unified database in which all clinical and financial information resides. Further, reports and displays of information to authorized users can combine relevant elements from multiple modules and thus provide a more complete "picture" of patient diagnostic and therapeutic status. However, laboratories need to assess whether a "best-of-breed LIS provides superior functionality to justify its selection compared to the function and features offered by the "bundled" enterprise-wide LIS.

What are the thoughts of various vendors -- both enterprise and best-of-breed on this issue?

  • NovoPath, Inc: A Best-of-Breed" LIS may or may not be better than an Enterprise-Based LIS for a particular facility.  It depends on two factors, the unique needs of the Enterprise Organization relative to the needs of the laboratory within and secondly, the functionality of the LIS. The Enterprise may not require a sophisticated LIS or, a sophisticated LIS  for Pathology may not have as high of a priority as perhaps more sophisticated software  solutions offered by the Enterprise Vendor for other departments such as Radiology, Billing, Nursing, and Pharmacy. If the Pathology Department has a need for only core functionality found in an Enterprise-Based Vendor and the Enterprise-Based Vendor can meet those basic needs, then other departments such as Pharmacy, Radiology, Billing, etc. may determine that the Enterprise - Based Vendor is a better approach for the Enterprise Organization as a whole.       Conversely, if the Pathology Department within the enterprise facility has complex software needs driven by high volume, demanding clinicians, exacting pathologists, and a complex test menu, it is likely that some of the Best-of-Breed Vendors will be a better solution f or the pathology lab over an Enterprise-Based Vendor that may not be as focused on the needs of the pathologist relative to the needs of other departments within the Enterprise.
  • Orchard Software: Currently, there is a significant convergence of factors in our healthcare system that is driving the need for a best-of-breed laboratory information system solution to the forefront. These factors include the rapid changes in healthcare as a whole, standards and interoperability mandated by the government, and the need to get an accurate diagnosis on the front end of patient care. The laboratory plays a pivotal role in these changes because getting the right diagnosis up front will reduce costs throughout the system. Also, because of the rapid advancement of technology, including molecular testing, combined with the need for all data to be in one consolidated database consisting of clinical, microbiology, molecular, genetic testing and anatomic pathology, a best-of-breed system becomes critical.

    In line with the new Meaningful Use requirements, the drive for interoperability, and the standardization of communication protocols between systems, the need for one system to achieve interoperability becomes less of an issue. As we all conform to interoperability standards and systems are able to "talk" to each other, the focus becomes on meeting the specific needs of a department, while simultaneously enhancing their efforts to increase efficiency of the overall organization. As we move forward, the convergence of data from each department into useful analytics and business intelligence for the administrators of a healthcare organization becomes paramount to reducing cost. The LIS has to be able to analyze to a discrete level all data possible to ensure cost effectiveness. This can include testing algorithms, ordering patterns, and assisting with patient treatment plans-designed with the data from the laboratory. All this combined makes it essential that a best-of-breed LIS is needed in healthcare today and in the future.
  • Psyche Systems: Whether a single-vendor solution or best-of-breed is better for a laboratory is an often asked question. The first thought that comes to mind about a single-vendor solution is "one size fits all", and a visual of clothing.  How does 'one size' really fit all?  It's a fit for a very small majority of the population, for the vast majority it is either shoe-horned, or forced, on and a very uncomfortable fit or hangs loosely and does nothing for you.  A best-of-breed LIS is one that focuses specifically on the unique needs and workflow of the laboratory. It's a solution for the lab and users within a lab - not to mention the testing focus or function of the lab - whether it is anatomic pathology, clinical, molecular, cytogenetics, microbiology, etc.  Labs are unique and with reimbursements being so closely scrutinized and under fire, the lab really needs to focus on how they - THEY - can be efficient, accurate and profitable.  A single vendor solution is geared more toward the entire facility and the lab is often an afterthought or such a small component that it gets the least amount of focus. 
  • McKesson: As both a provider of an integrated enterprise based laboratory information system (LIS) as well as a best-of-breed solution, McKesson believes that the best fit for any customer really depends upon the specific goals and objectives of that customer organization.  A best-of-breed solution is probably better suited to large academic research facilities, independent reference and specialty labs, facilities with large outreach programs, and community hospitals which require functionality to improve the efficiency of their labs.  By the same token, many small community hospitals may benefit from the functionality offered by a best-of-breed solution, but may lack the staff and/or expertise to implement and maintain a best-of-breed solution.  A prospect must also consider the financial viability of the vendor as well as support services that a vendor provides.  In this case, an enterprise based LIS may be the best alternative.

Factors Favoring Enterprise Factors Favoring "Best-of-Breed"
C-Suite commitment Strong laboratory commitment
Minimal or no interfaces to "foreign" information systems, e.g. other EMR, CPOE, HIS Interface connectivity to various EMR, CPOE, HIS systems required
Less complex Laboratory services with minimal outreach emphasis Complex laboratory services, e.g. molecular diagnostics, cytogenetics, other newer technologies with major outreach operations
High level of "true" integration across all system components Proven interfaces to existing or planned enterprise information systems
Possible lower cost if "bundled" with EMR and other enterprise applications Possible better ROI if demonstrable benefits for laboratory operations

So, generally speaking, what factors favor Enterprise-wide solutions vs. "best-of-Breed" LIS?

In any case, the optimal choice of enterprise-wide LIS solution or "best-of-breed" LIS requires careful consideration of the overall positives and negatives as they affect both the enterprise and future laboratory operations. This is a complex analysis involving determining the true overall costs of system implementation and operations, impacts on access to clinical information by caregivers, efficiency of operations and impact on laboratory outreach revenue and business growth.

Dennis Winsten is president of Dennis Winsten & Associates, Inc. (DWA). a health care systems consulting firm specializing in laboratory information systems with headquarters in Tucson, Arizona (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 health care systems.


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