LIS niche modules flourish amid IT consolidation

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Dr. Friedman

Hospital data, wherever it is stored, will need to be normalized—put into a format where it can be analyzed by analytics software. “This anticipates the greater use of these databases for a better understanding of clinical flows and processes or the necessary financial studies to reduce the cost of care,” Dr. Friedman says. Sophisticated analytics also requires natural language processing so that textual entries in the clinical records can be studied. “All of this will require sophisticated population health software. This may be developed by LIS vendors, EHR vendors, or new entrants into this market, which is a lucrative one because health care is such a major industry.”

Other developments with consumers as customers can’t be ignored, he says. These include “wearables,” home lab testing devices, and the transformation of retail drug stores as health centers with walk-in clinics, phlebotomy services for national reference labs, and even point-of-care testing. Lab testing performed outside of hospitals will require integration into the various hospital databases. “The increasing deployment of telemedicine services will also pose a challenge to pathologists,” Dr. Friedman says, “because patients will no longer be a ‘captive audience’ of hospital phlebotomy services and hospital-based lab testing.”

At Ochsner Health System in New Orleans, the laboratory moved in 2013 to Soft Computer for its LIS and the various modules required, says Greg Sossaman, MD, system chair for pathology and laboratory medicine. SoftLab is the generic LIS that includes general laboratory and microbiology, and Soft’s newest version has been used as the backbone to build the company’s molecular modules. “We’re on that now and on their blood bank system. We’re not currently on their AP system, although we plan to be.” Ochsner opted not to purchase some other Soft modules including biochemistry and cytogenetics.

Dr. Sossaman

Before Soft, Ochsner had had a legacy LIS for at least 20 years, even purchasing the code from the software company that originated the LIS and having in-house programmers to maintain the system. During that time the laboratory also maintained separate modules for blood bank, HLA, and AP. “Our desire was to try to bring as many things as possible under one vendor’s software,” Dr. Sossaman says.

Ochsner uses an Abbott track system for its chemistry along with Data Innovations’ Instrument Manager. “But we only had that for a couple of years before we implemented Soft. We’d already made the investment in Instrument Manager, so for the core lab we kept those rules. Soft gave us the ability to write autoverification for hematology and for chemistry for the rest of our hospitals.”

Adding to Ochsner’s motivation to go with Soft was the laboratory’s continuing expansion. “Part of the strategy in IT here is when we purchase or manage a new facility, they migrate to our IT systems. So we were putting our hospital information system into the new facilities and also putting in our lab systems, and it became very difficult to maintain the degree of integration we wanted when we only had internal resources.”

Now, Ochsner is using Epic for its EMR and Soft for its LIS, relying on an interface engine to handle communication between Soft and Epic. “It’s helped to have a vendor partner to be able to support all the new facilities,” Dr. Sossaman says. One reason consistency is needed is that the laboratory has complicated rules for how it ships specimens around the system and how it operates.

“After Hurricane Katrina in 2006, we bought three hospitals in the area in one year, then another the year after that and another the next year, all eventually moving to Epic and Soft.” Ochsner has seen similar adoption of its IT by some of the other hospitals in the state with which it has forged partnerships or affiliations. “We also made a deal where about half a dozen urgent care centers all migrated to our information systems this year.”

The primary use for the modules is for clinical support rather than operational support. “Ochsner is interested in analytics through Epic and its data warehouse, but has so far done less with the laboratory.” The health system adopted decision support tools over the past two years but “bolted them onto Epic” rather than make them part of the LIS, he adds. In addition, “we use Soft’s A/R system primarily for outreach clients but most of our billing for Ochsner is done through Epic.”

Dr. Sossaman believes the degree of IT customization necessary and the kind of LIS needed depend quite a bit on the individual laboratory and how it is set up. “I don’t think one LIS is able to handle everything at this point.” The same is true of the EMR: “If you look at our hospitals, we have probably every Epic module you can buy except lab, but we’re still buying a number of other subsystems—for example, for infection control.”

“I could see an independent reference lab able to have a standalone LIS where they have an Atlas-type product to connect with a lot of physician office labs.” On the other hand, “a smaller independent lab or smaller hospital might have Epic plus Beaker and work perfectly with that, versus places like ours that may need flexibility with Soft, which continues to develop new modules.” He understands the argument of many hospital executives that an enterprisewide solution for IT is preferable. “It’s more efficient, and actually that’s one reason we wanted to go with Soft—because we wanted the same degree of integration.”

One of Dr. Sossaman’s challenges is making sure laboratory data get factored into clinical analytics. “We’re very involved with Epic in looking at order sets, not just to avoid duplicate testing but also to find other ways to reduce the amount of testing, by creating care pathways for procedures like joint replacement or laryngectomy.” Mapping out all the steps in that care ensures the most efficient and best practices, he says: “We try to be part of that from the lab side and make sure laboratory data gets into the data warehouse.”

Dr. Sossaman is interested in the Mayo Clinic’s new CareSelect Lab module to provide laboratory decision support, the first such commercial product he’s heard of. “It’s very new, it’s integrating with the EMR and helping guide physicians to order the best tests from a clinical guidelines standpoint. It’s kind of ‘at the elbow’ help for them.”

As new modules like these roll out, Splitz of S&P Consultants says, many laboratories are asking the same questions: “Are we looking at best of breed? Should we be looking at integrated systems that are all the same vendor? How should they be set up? Do the modules integrate with each other?” Splitz tries to stress that “modules are very expensive and very complex to implement,” and in many cases laboratories don’t need the modules they think they need. But he believes modules will continue to reshape the competitive IT market that is offering laboratories so many choices, and so many dilemmas.
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Anne Paxton is a writer and attorney in Seattle.