Lab information systems—where the needs are greatest

Create PDF

This same problem holds in microbiology, where we’re looking at microbiology automation, and in parts of the laboratory like HLA testing and cytogenetics, where there’s a tremendous amount of information and little integration. What we see in the automated core lab and in automated anatomic pathology are islands of sophisticated data throughput. Many areas still lack this.

From the clinician side, it is determining the right orders to place and making the appropriate order selections without it having to be incredibly sophisticated. Finally, getting the reports back from the orders in a way that makes logical sense because the orders and the results should self-assemble into views that are useful versus people having to figure out what to pull together for which report.

Dr. Tuthill

We’re getting pushback on integrated reporting lately. People are asking us to create standalone reports because they don’t like having to scroll through pages of long reports. Molecular reporting is an interesting challenge because on one hand you have oncologists who want to see the 67-page SOPHiA Genetics report and on the other are family practitioners who want to see just the single line. How do you manage for those things?

As Dr. Becich alluded to, the ability to replay the tape and reanalyze without having to resequence is something we know is coming. There is a lack of sophistication at the report integration side and a lot of variability in terms of what customers want. Customers are not one size fits all. How do we handle this in the EMR or the laboratory information system?

In between all of this, how do we track this? How do we follow the materials that are moving around? Laboratory information system vendors have played a hands-off role in the materials-management or chain-of-custody problem. It is becoming more important as money has become tight because we don’t have time for rework. Samples are precious, and if they get lost, you’re in trouble. This is not well addressed by anybody now. You can buy third-party systems, but this should be an inherent part of laboratory information systems—a materials-management and tracking system so we can be assured that a critical sample is on the way, past the gate, in the door, and we returned results. Right now, this is all manual for the most part.

Ed Youssef, there seems to be a gap in terms of the demand versus what can be supplied to satisfy that demand. Are institutions able to invest? Is that a fair statement from an industry point of view?
Ed Youssef, chief strategy officer, NovoPath: To some extent, yes. Some of the items Mark alluded to, bringing a lot of factors together and vendors that need to play well together—if you’re talking about instrument vendors with all the different instrumentation, it’s hard to have a standard way to integrate with all the LISs, as each lab operates differently. With all the features and different capabilities of an LIS, it becomes an interesting challenge to supply a solution that can fit a limited budget. At NovoPath a lot of our clients have complex environments, and one way we overcome this challenge is by taking a phased approach. This provides our clients a way to understand what is being done, what needs to be done, and how we can get there in a way that makes everyone happy, even the finance department.

Lee, in many large systems, central IT controls the agenda, budgets, project lists, which means these great needs in the laboratory and in pathology are not necessarily floating to the top. Is that true?
Lee Webb (Clinisys): Yes. It’s not always getting to the top enough for the money to be spent on development.

Ross

Carol, what is your view?
Carol Ross (Clinisys): Especially with the growth of the integrated EHRs, the role of the chief information officer has changed in hospitals. They’re focused on the broad picture, so it can be challenging to get attention for these specific solutions. And with personnel challenges in the lab, it’s even harder to be able to dedicate IT staff to implement these features and functions.

Matt Modleski, we have a staffing shortage in health care, including health care IT. I talked to someone at a large institution who said they have more than 110 vacancies for critical IT people. Are we headed toward a perfect storm?
Matt Modleski (Orchard): We learned during the pandemic that many positions can work from home or somewhere else. In central Indiana we are competing globally for talent; throw in inflation and it’s hard to find good, talented people. And you hope you have a culture in which once they join, they want to stay. Every IT company in the country is battling it to some degree. It was crazy nine to 12 months ago, but we have seen it settling in the last quarter, so we’re hoping that trend continues.

Avunjian

Suren, do LigoLab customers have these same challenges?
Suren Avunjian (LigoLab): Yes, they do. It’s a pity that we still have to discuss interoperability issues. I have been in this industry for almost two decades, and it was top of mind early on in my career. More than a dozen years ago we decided to build our own middleware to attack this issue and resolve it to be able to connect to any kind of instrumentation or third party. As Matt Folsom mentioned, it’s not an engineering challenge—five to 10 percent of the effort is the technical component. The bureaucracy, meetings, and dealing with people is 80 to 90 percent of the effort. Interoperability with third parties or instruments should be addressed because it’s going to be a limiting factor for laboratories to scale when you’re talking about volume and manual steps. It will further hurt with ongoing staffing shortages and is an artificial barrier for laboratory growth.

Carlin

Dayna, NovoPath has been leading its product development and its customers to the cloud. It also makes good use of application programming interfaces for the interoperability that is desired. What has that journey been like, and is there still a ways to go to fulfill the maximum efficiency for operations?
Dayna Carlin (NovoPath): We’ve gone past just hosting your LIS in the cloud and into full-blown software-as-a-service LIS. We’ve taken this approach as it’s the way of life today. Applications like Gmail, Outlook, and even Salesforce are all SaaS applications in which the end users never have to worry about data centers, updates, et cetera, so we asked ourselves—why not LISs?

SaaS LIS applications like Novo­Path 360 combat staff and IT shortages because they take the responsibility out of the labs’ hands, giving labs time to focus on more pressing matters, like incorporating molecular diagnostics. However, because SaaS is a new way of operating, some labs are unsure or even scared of the cloud, and it also depends on bureaucracy. Do they think it’s secure enough? How do you get them there? With the interoperability—can it get there? We recommend working with an LIS partner that will guide you on your journey rather than just provide a platform.

Folsom

Matt Folsom, can you comment on where you think the market is and where your customers are heading as it relates to the cloud and ease of interoperability?
Matt Folsom (Xifin): Ten years ago the thought of going to the cloud for any lab was a flat-out no. That has shifted dramatically over the years.

You have to be flexible with what cloud platform you run the SaaS model in. We have customers who are fine with Amazon Web Services but say no to an Azure product, or vice versa. Having the ability to work across cloud platforms is make or break for some customers.

Organizations continue to push to have more things in the cloud. But not having an IT staff, or having a reduced one, makes it so the customer relies on the LIS vendor to provide the IT specialty—it has become critical to own that, as much as you’re able—as well as transparency to the user. A lot of these systems are used to IT people digging into the back ends. That doesn’t work in the cloud. So if you’re receiving an interface message, it has to be shown in your LIS; they have to know. I didn’t receive results from my instrument—what’s wrong with my instrument? My instrument isn’t connected—why isn’t it connected? Users need to be empowered in a user-friendly way so if they don’t understand the IT work behind it, they can glean from the LIS what the problem is and reach out to the LIS or instrument vendor to remedy the problem. Giving them tools to perform their own analysis has been tremendously beneficial to the end users.