CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
December 2019—IT as it relates to laboratory consolidation and the labor supply for lab IT were some of what came up when CAP TODAY publisher Bob McGonnagle convened a panel in September to talk about laboratory information systems. Part one of the discussion is in the November issue (with the LIS product guide); part two begins here.
On the panel were J. Mark Tuthill, MD, of Henry Ford Health System, Curt Johnson of Orchard Software, Wally Soufi of NovoPath, Michelle Del Guercio of Sunquest Information Systems, Nick Trentadue of Epic, Sepehr Seyedzadeh of Siemens Healthineers, and Tony Barresi of Beckman Coulter.
We recently read a news release about the continuing consolidation of important laboratory systems within not-for-profit systems. South Bend Medical Foundation decided to sell its clinical laboratory operation to LabCorp. This is one of a number of large deals announced within the past year or so.
I mention this to underscore how much consolidation we’re seeing of laboratories and of systems. We know already we have a lot of consolidation in instrument vendors, and we’ve seen a fair amount of consolidation among the IT vendors, particularly lab information system vendors. Michelle, how does this consolidation look from the perspective of Sunquest? If three or four hospitals decide to join in a system in a large geographical area, for example, certainly not all of them share the same LIS platform. I’m sure you get calls and questions about how to deal with multiple LISs in the various laboratories of the newly consolidated enterprises. Is that a typical question, and is there a typical, or in fact a not typical, response or action that you recommend?
Michelle Del Guercio, vice president of marketing, Sunquest Information Systems: To answer your first question, yes, it is something we see as the merger and acquisition trend continues. My response sounds like the same answer each time but it offers a very different result and outcome, and that is we do meet the customer where they are.
Sometimes it’s a Sunquest LIS; sometimes it’s not and instead it is ancillary components of what Sunquest offers. We meet the customer where they are and provide them with the tools with which they can continue to provide service to their physician community, either the internal affiliated physicians or the external outreach physicians, by getting those orders into the appropriate laboratory for testing. Whether the multiple different labs are sharing different test strategies and test dictionaries or if they’re not, it’s about allowing them to get those orders in without the chaos that might otherwise occur.
That’s one of the key areas that seems to be a pain point for many of these organizations as they go through mergers and acquisitions. Not only are they dealing with the combining of various cultures from the different hospitals, but they have to deal with the different systems and the different processes associated with that. So we try to provide them with ways in which they can reduce the disruption from the interoperability of the systems.
Wally, what is your experience at NovoPath in this environment of consolidation of laboratories and the changes in pathology groups, most of which would be getting bigger and consolidating in ever greater geographic areas? How are you meeting that, and do you have a single answer or does it depend on the individual case you encounter?
Wally Soufi, chief executive officer, NovoPath: It is case by case. What typically drives the consolidation decision are the vision and priorities articulated by the combined entity. Unfortunately, lab needs don’t usually figure prominently on the priorities list. That enterprisewide consolidation is going to continue for a while. However, lab leaders will realize soon enough that their workflow and business objectives are not a primary focus of the enterprisewide vendor. At that point, lab leaders will want to partner with LIS vendors that help them achieve their departmental goals.
Curt, you’ve spoken many times about the consolidation. Do you find the rate is increasing, and is that putting additional pressure on customers that then have a desire to standardize but in some cases may not have the capital or the cultural deftness to be able to do that across a consolidated system?
Curt Johnson, chief operating officer, Orchard Software: I’m not seeing consolidation pick up speed. What we are seeing is consolidation across broader areas of laboratory medicine. What I mean by that is large hospital organizations are merging, but they are also either merging or purchasing smaller hospital groups or they’re buying physician practices. Consolidation across the laboratory medicine spectrum, I believe, is increasing. It does create opportunities. The workflow of a 500-bed hospital may not be the same as that of a 25-bed critical-access hospital. Looking at what might be best for a large organization takes time, and you have to be invested in understanding the clients to understand how you can integrate with other systems and what’s best for the overall organization from an IT and a laboratory perspective. If it’s hospital to hospital, it’s typically going to be a full consolidation unless one is a very large academic center and one’s a rural critical-access hospital. Then flexibility is needed.
When hospitals purchase physician groups, integration is a different issue because now you’re talking about ambulatory care and different billing issues. If the clinics have laboratories and are doing their own testing, the workflow there is not the same as that of a hospital.
So where does that fall in the picture and how do you account for that? In any of these scenarios, point-of-care testing also has to play a role in where that testing is going to be done and what kind of systems are needed to integrate with it.
So communication is needed between the C-level suites of these organizations and the leaders of the laboratory—in consultation with the IT vendors and the personnel at the sites—to figure out what is going to have the greatest positive impact, not only on patient care but on the organization. When you figure that out, when the path forward is pretty straight and everyone seems to agree on it, you can proceed.
Do you find yourself at Orchard spending a lot of time helping to organize those discussions and set directions for those futures?
Curt Johnson (Orchard): Not as much as we would like. If you’re not having conversations above the lab level, by the time you find out a consolidation or a merger is taking place, it’s late. So you have to educate your clients within the laboratory to get involved with their executives and administration to understand where that health care system is headed and how the lab can benefit the whole organization. When those conversations take place and you’re at the forefront of an organization, then you have a role and you’re able to participate in a more positive manner.
When you find out after a consolidation has taken place, and they’re contemplating changing to one system, and it may not be the one your lab is using, it’s late at that point to try to get involved and make an impact. So it’s critical for all laboratorians to understand their role within the ecosystem of their organization and how to work with executives to make sure they understand the value the laboratory is bringing and ask to provide input in those decisions.
Michelle, I’m sure you’re largely in agreement with what Curt said. Would you care to add something in terms of how important it is for the laboratory to be at the table early?
Michelle Del Guercio (Sunquest): I definitely agree with what Curt has said. Often, historically, LIS vendor relationships have been within the laboratory. Our customers are asking us for help in how to get the lab into more of a strategic position within the organization and elevate it to a level of being involved in those discussions at the C-suite level. Lab leaders are looking for ways to do that. Historically they have not had the business training; they’ve very much been in the lab. Often, they don’t know what to do, and so we are providing them guidance to get them to have those discussions, to collaborate with other departments, using lab data to show support for the enterprise. We’re starting to see that shift and helping them get through those discussions.
It’s all very well for us to talk about these great plans, but we know we have great constraints in terms of a labor supply. In addition, we increasingly find that the laboratory itself has more limited IT staff time, money, and capability than it had in some years past because there’s so much central IT that goes on in these large systems. Dr. Tuthill, can you comment on the state of play at Henry Ford of both topics: central IT control versus lab, and the impact of labor on anybody’s desired lab operations?