College of American Pathologists
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  LPL software companies plug the gaps, hold their own


CAP Today




April 2012
Feature Story

Anne Ford

Call it the Battle of the Abbreviations—LPL vs. EMR. Ladies and gentlemen, in this corner: laboratory-provider links software, which electronically transmits test orders and results between a pathology laboratory and its clients. And in this corner: electronic medical record systems—specifically, their ability (in many cases) to offer LPL functionality, making it unnecessary for a physician office or hospital to invest in a separate LPL product.

Will this be a knock-down, drag-out fight? To hear LPL vendors tell it, they’ve got this battle in the bag. But that doesn’t mean they aren’t bringing their A games.

“There’s going to be a realization that these EMR companies are focused on the end-user physician, and the LPL companies are focused on their laboratory customer. LPL companies are putting the labs first,” says William Seay, founder and CEO of Lifepoint Informatics in Glen Rock, NJ, which offers LPI Web Provider Portal. “I think the labs will soon realize that not only is it very difficult to connect 50 or 100 different EMR companies with point-to-point interfaces, but also you really give up a lot of control. Laboratories are going to concede that they need a partner that is focused on their needs and helping them build their brand.”

If those sound like fighting words, well, maybe they are. The vendors in this month’s software product guide (pages 71–82) seem to be convinced that despite a number of challenges in the marketplace—including, but not limited to, the growing ability of EMRs to provide LPL functionality—LPL solutions aren’t going anywhere.

One of Seay’s main observations about EMRs: “Many have limited functionality, specifically with CPOE [computerized provider order entry],” he says. “Most EMR lab-order entry capability is not as comprehensive as that provided by LPL software companies, like ours.” That’s why, he says, Lifepoint has just launched a product called CPOE Connect. A lab-order entry plug-in, it “fills in the gaps in the EMR’s order-entry process, [providing] all the things that laboratories desire or need for clean requisitions.”

In the view of another LPL vendor, the limitations of many EMRs today can be traced to the failure on the part of early EMR vendors to fully understand the needs of the laboratory. “When EMRs first started emerging, they were a problem,” says Brian T. Jones, vice president of sales and marketing for CareEvolve, Elmwood Park, NJ. “They didn’t consider the fact that 80 percent of clinical decisions come from lab results. They had no lab expertise and no idea what constituted a clean order. The companies didn’t develop systems that could handle ordering or structured result reporting. The biggest vendors are starting to make real progress; many others are generations behind and will continue to rely on LPL vendors.”

Given these and other issues, says Steward Macis, “the independent LPL system will have a firm presence for many years to come.” Macis is product manager, Compu-Group Medical–Laboratory Division, Reisterstown, Md. Because “the EHR has only been able to manage data exchange to its own systems,” he says, “we see the need for an independent LPL solution to manage complex interoperability needs. A lab needs that central engine to get their data to all the EHR systems.”

Further, thanks to the 2009 HITECH Act and its financial incentivization of “meaningful use” of EMRs, EMR vendors have become overwhelmed by requests for customer interfaces, Macis says. “In my experience, because of meaningful use, these EMR companies have tremendous backlogs,” he says. “They just don’t have enough bandwidth to handle the influx of interfaces. They’ve got a staff of 20 and thousands of customers. When they say, ‘We’ll get the interface going, but we’ll have to wait 60 days before we can even get started,’ that affects the client.” In some cases, he adds, EMR vendors are even going to LPL companies to ask, “Hey, can we outsource interfaces through you to our product so we can get this moving quicker?”

In February Macis’ own company released LabNexus, a cloud-based LPL solution that connects laboratory data with multiple clinical systems. He calls it “easy to navigate, secure, and accessible,” saying, “We can provide customers with a Web portal to access their laboratory data, create lab orders, and retrieve lab results. LabNexus also provides the back-end connectivity by providing cloud-based HL7 interface technology to connect that same laboratory data to the practice management system, EHR, or HIS.”

In one area LPLs are likely to recede in importance over time, and that’s their capability to provide a Web portal for online test ordering and result viewing to physician practices, says Walter Henricks, MD, medical director of the Center for Pathology Informatics and a staff pathologist in the Pathology and Laboratory Medicine Institute, Cleveland Clinic. “The reason that LPL Web portal capability to offer online access to laboratory information has been useful is that not all physician offices have EMRs yet in which to interface results,” he says. Once a physician office practice implements an EMR, it is going to expect its results to be received electronically through an interface directly populating its own EMR. “They’re not going to go to a separate LPL portal system to view laboratory results or place test orders,” he says.

At the Cleveland Clinic, in-house patient results are communicated through interfaces from the laboratory information systems to the health system’s Epic EMR. But that doesn’t mean you won’t find an LPL on the premises: For external clients, an Atlas LPL solution is used. “What Atlas does is, it helps us route and translate interface messages between different EHR systems that our client offices may be using and our LISs,” Dr. Henricks says. “Atlas sits, if you will, in the architecture between our laboratory information systems and the client site EHRs and client site LISs. And it does provide a Web portal for sites wanting to use one.”

One trend to which the LPL market is having to respond: reporting laboratory test results directly to patients. “We offer our clients the ability to have a secure Web portal,” says Lisa-Jean Clifford, CEO of Psyche Systems, Milford, Mass. Laboratories can opt to establish a Web-based portal for patients as well as physicians. “The laboratories can do this based upon specific testing or types of tests. However, where we are primarily finding labs using this feature is with negative Pap results,” she says. “Several of our laboratory customers are allowing their gyn patients to be able to log in 72 hours post-Pap office visit to view their negative result.”

CareEvolve’s Jones doubts the putative popularity among physicians of direct-to-patient lab result reporting, whether it takes place via an LPL or an EMR. “Physicians really don’t like the idea of patients getting technical lab data,” he says. “All of a sudden the patient has a lab report without a physician explaining anything to them, and they immediately start calling the practice over and over again and Googling WebMD and saying, ‘Oh my gosh, I have cancer.’” And will patients look at reference ranges to understand that a 10 result from lab A and a 100 from lab B are equivalent? “We just haven’t seen the demand,” Jones says, “even though it’s a feature that CareEvolve does provide.” Demand may increase in 2014 when direct-to-patient becomes a mandate under HITECH.

Patients don’t appear to be interested either. “People talk about patient portals, but look at Google Health,” he says. (Google Health, a personal online health record service, was discontinued in January due to low adoption rates.) “That’s what I would consider a major failure. Release-to-patient is a checkbox labs look at when they’re trying to select an LPL vendor, but really, hardly anybody’s logging on and saying, ‘I am Jane Smith; I want to see my Pap results.’ What they want is the phone call from the doctor saying, ‘Everything’s normal.’”

Another issue with which LPL vendors find themselves contending: AP resulting. Aside from the financial investment that LPL software represents—especially when weighed against the lower-volume contracts that AP laboratories typically have with physician offices—vendors find themselves going up against some technological challenges with this type of testing as well. For example, says Curt Johnson, chief operating officer of Orchard Software, Carmel, Ind., “AP data is not necessarily designed to be discrete. Images don’t necessarily port well from one system to an EMR. You have to have the tools to embed a PDF of the original report along with the discrete data, or you need to be able to provide a link back to the PDF report. The discrete data is invaluable, but from the patient point of view, the actual report may be more beneficial.”

Why does discrete data make a difference? Because, Johnson says, end users need it to qualify for financial incentives related to meaningful use. “Discrete data is usable, it’s mineable, you can run analytics on it,” he says. “As changes are coming in health care—the different compensation packages coming down the road—you need to be able to use those analytics. And we’ve designed our systems so that our information all outputs through one interface discretely.”

Rick Callahan, vice president of sales and marketing at AP systems provider NovoPath, sheds more light on the AP-related issues that vendors face: “A lot of AP LIS vendors have the ability to post a patient’s pathology report, in PDF format, on their lab’s Web site. The clinician will log on to the Web site and pull the report onto their computer. This is a pretty standard way for AP LIS systems to deliver reports. A more advanced way of delivering reports is to have an HL7 interface developed between the lab and the clinician’s EMR. The pathology lab could then transfer the report, embedded into the HL7 message, over to their client’s computer, enabling that message to be downloaded into the EMR.”

That, however, is a rather expensive proposition for a laboratory. “You have expenses at different points, one of which is associated with the AP LIS vendor charged to develop the interface,” Callahan explains. “And the other expense is associated with the EMR vendor for which the interface is developed. So the laboratory or the referring physician pays on both ends.”

Still, he says, it’s an effective way to get the PDF into an EMR. Having the PDF go over the Internet to the physician’s computer is also an effective way for Web-based AP LIS vendors to facilitate delivery of the report.

“Where the trick comes in,” Callahan says, “is for those client-hosted AP LIS vendors such as NovoPath to deliver the pathology report from a client-hosted server solution over the Web, onto a computer. This would require a Web-based application to a client-hosted system. There are not a whole lot of AP LIS vendors that can do that; we’re one of them. The idea is to generate a pathology report in the lab, sign it out, have it go back into the server for archiving, but also have it go over the Web and deposit itself onto an unattended computer or secure printer in the clinician’s office.” That’s probably the most effective, least costly way, he says. “Labs are gaining awareness of this as a relatively inexpensive technology that a lot of them are probably going to need to adopt to help their clients attest to meaningful-use criteria.”

AP report delivery is likely to become a less expensive investment for laboratories as the vendors become more experienced in interface development, he says. “More people will then be able to afford a point-to-point HL7 interface. Until such time, a combination solution of a client-hosted server and Web delivery application will help minimize the cost to the lab and satisfy the clinician’s requirements for a relatively effortless approach to depositing reports on a computer or in an EMR.”

What else will the future bring? “A blurring of the lines,” says Clifford of Psyche Systems. “In the past there were vendors who focused solely on functionality like the EMR, or on the AP LIS or the clinical LIS. We began 35-plus years ago as the developer of a clinical LIS, and then we expanded into developing an AP LIS. Then we developed our microbiology LIS, Outreach, EMR connectivity, et cetera. What we are seeing now is that to stay technologically current with the needs of laboratory facilities as well as physicians, it has become necessary for vendors to take all of that functionality and make it central to the LIS. Outreach, Web-based reporting, EMR connectivity—all of these applications are becoming components of the LIS, and vendors are able to provide connectivity so that access to the physician and the receiving application are one and the same.”

In terms of LPL-specific vendors, “the market’s becoming more competitive,” CompuGroup’s Macis says. “It used to be there was a handful of LPL vendors. Now there’s more. Customers have more of a choice; they’re not just tied to one or two.”

CAP TODAY’s guide to laboratory-provider links software includes systems from the aforementioned vendors as well as from several other companies. Vendors supplied the information listed. Readers interested in a particular LPL system should confirm it has the stated features and capabilities.

Anne Ford is a writer in Evanston, Ill.

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