College of American Pathologists
Printable Version

  In EHR world, LPL software still has its place


CAP Today




April 2013
Feature Story

Karen Krause

As hospitals and eligible providers work to meet the government’s 2015 deadline for implementing electronic health record systems to comply with the HITECH Act of 2009, are laboratory-provider links (LPL) software companies being left out in the cold?

No, they say. In fact, they’re adding new products and services to meet new demand

Brian Keefe, director of laboratory software solutions marketing for Psyche Systems, says the complexity of most lab testing will leave EHRs struggling to support the type of information lab reporting requires. “EMR companies are not set up or designed to handle the influx of integration requirements to begin to meet the demand of laboratory EMRs,” he says.

In fact, Keefe adds, “Some LPL companies are developing advanced analytical functionality for customized tests that standard EMRs could never hope to support.” It’s an expanding area of the laboratory market where LPLs will be needed.

Keefe says EHR vendors rely heavily on HL7 technology for interconnectivity, whereas the market will dictate support for better technologies such as XML and Web services.

Richard Callahan, vice president of sales and marketing for NovoPath, agrees. “While the industry is addressing the increased need for EMR connectivity, we do not see an enterprisewide vendor offering a unique solution across the varied health care market sub-segments.” That, he says, would negatively affect standalone LPL vendors.

Economics also plays a role, William Seay, CEO of Lifepoint Informatics, says. He calls LPL offerings from lab information system companies “rudimentary at best,” and he doesn’t expect that to change anytime soon. “LPL vendors compete aggressively, pushing the price down to the point that it’s not economically viable for LIS vendors to compete at our level of sophistication for the prices we charge. All of this is great for labs—they have access to robust functionality at an affordable price point,” Seay says.

Opportunities are already being realized. There is a large functionality gap between LIS offerings, whether new or existing, and the roughly 800 disparate EMR systems. “Current lab customers, prospective lab customers, and EMR vendors are all asking us to fill this space,” Seay says.

Lifepoint offers a product called CPOE Connect, which serves as a lab order-entry plug-in for EMR vendors and fulfills the needs of the sponsoring laboratory. “It can handle the complexity that’s inherent in lab order entry,” namely ask-at-order-entry questions, medical necessity screening, standing orders, order sets, specimen labeling, and instrument-ready bar codes, Seay says.

With the lab and EHR having to be integrated electronically, some LPL software has evolved from Web-based access to the lab to linking the lab and EHR electronically, says Kerry Foster, director of marketing for Orchard Software. He points to Orchard’s LPL, called Orchard Copia, which provides Web-based access and direct electronic lab-EHR integration. And, yes, some LPL software has functionality that an EHR may not have—advanced medical necessity screening, for example. In this case, “The user may still prefer the LPL software to place lab testing orders because of the added functionality,” Foster says. “But as EHRs improve upon this type of functionality, conventional LPL software is expected to go away.”

While some enterprisewide solutions offer an integrated LPL, they focus on market sub-segments, such as larger community hospitals and academic centers and the office-based physicians connected to them. NovoPath’s Callahan sees a market beyond this: “We believe that a combined LPL/anatomic pathology laboratory information system vendor such as NovoPath offers an alternative to clinicians and laboratories that are not affiliated or integrated with a hospital with an enterprisewide approach.”

NovoPath is partnering with an enterprisewide vendor to develop a seamless interface to its solution. “This offers the health care provider the best of both worlds—it can obtain a fully robust enterprisewide solution combined with a feature-rich AP system,” Callahan says. In addition to a client-hosted server approach to AP, NovoPath offers Web applications and interfaces to EHRs.

Lifepoint, too, has found success by teaming with LIS and EHR vendors. The vendors have found it makes sense to use Lifepoint’s applications, he says, for split requisitions, cumulative reporting, national and local coverage determinations, cascading ask-at-order-entry questions, custom AP/microbiology/cytology reports, patient service center workflow management, result validation automation, and more. “All of this ultimately benefits the lab with cleaner orders, lower claim rejection rates, and a more reliable result-delivery capability,” Seay says.

In some cases, the HITECH Act has generated business for LPL companies. Some EHR providers are overwhelmed with system installations and are asking LPLs to step in. “We’ve had a huge influx of these requests; they are a good deal of what we’re doing today,” says Bob Gregory, chief business officer at Atlas Medical. “LPLs that can’t provide a cost-effective and predictable way to deliver interfaces to EMRs will have a tough time competing with others that can. A number of EMRs think they can do it themselves, and some can. But others need lab expertise, which we can deliver.”

Keefe says business is up substantially for Psyche, and that’s the reason. “Many of our customers value the ability to provide their clients with an order-entry and result-reporting application within days, not months, of signing a contract,” he says.

Psyche’s aim is to integrate more seamlessly with EHRs. “When physicians or providers invest in an EMR, they want to use only that EMR,” Keefe notes. “Providers don’t want to incorporate more than one system into their practice. The lab should be able to leverage the EMR system so that the provider can solely use and focus on the EMR system while still benefiting from the robust technology and tight integration of the LPL.”

Orchard’s goal is to offer features for linking multiple laboratory sites, and to be a repository of lab data. “This fills a need the EHR cannot fulfill,” Foster says. Atlas’ Gregory has similar sentiments. “We don’t pretend to provide the broad range of functionality of an EMR,” he says. Even though EMRs will continue to be adopted, “from our perspective we still need to provide lab-specific workflow so weaknesses of the EMR don’t prevent clinicians and labs from doing what they need to do.”

Atlas augments what the EHR offers in a lab-specific way. “As an embedded solution, we ensure that the doctor and lab can continue to do their work without compromise,” Gregory says. “We can provide EMRs with order-entry functionality through our user interface and make them better by using our best-of-breed capabilities.” He says they’re partnering with EMRs to deliver this to their lab clients through the interoperability network iOn, which allows physicians using certified iOn EMRs to connect to the lab in as little as 48 hours.

Atlas platforms also allow EMRs to incorporate back-end capabilities into their software, he says. “We are supporting the use of EMRs and complementing them by offering multiple opportunities to clean up orders—in the physician’s office, at the patient service center, and at customer service within the lab operation.”

An LPL that complements the EMR is what customers want, LPL software vendors say. “The most common request from customers,” Keefe says, “is, ‘How can we get connections more quickly and more affordably?’” Psyche’s solution was to develop tools within its LPL to allow more efficient data mapping between the EHR and the LIS for test menus, billing codes, and insurance providers. It also provides tools to empower the lab to roll out its own interfaces with minimal reliance on vendors using Psyche next-generation wizards. Keefe foresees customers asking them to eliminate the bottleneck and wait times for adding provider EHR interfaces to the LPL.

NovoPath customers are seeking a client-hosted server AP LIS that is easy to use and cost-effective. “Some want a system that will provide the flexibility of an LPL [though they don’t specifically ask for this], and others have LPLs already in place, so they are seeking a vendor that can link to their EMR via HL7 interfaces,” Callahan says. “Others are seeking a cost-effective AP LIS that provides traditional fax, printing, and e-mail notifications to clients for the lab’s Path Report retrieval.” NovoPath can customize such solutions, he says.

Down the road, Callahan says clients will continue to ask LIS vendors to provide applications that help providers reduce the probability of patient error, streamline workflow, and improve efficiency while simultaneously being able to meet meaningful use criteria as the stages are defined.

Under the models of accountable and coordinated care, Foster foresees Orchard’s clients looking for easy access to laboratory data for real-time analysis. “We have clients that run advanced reports on provider-diagnosis-specific test utilization to analyze variation patterns and develop best-practice ordering protocols,” Foster says. Such analytics, and the ability for remote systems to use the data, will become more important.

Where Epic’s LIS is replacing an LIS that needed LPL software, Lifepoint has found a place. Its Web provider portal is used as a wraparound to control workflow and order entry at its hospital clients that use Epic. “There are more than 300 ambulatory EMR vendors whose customers have successfully attested to meaningful use and received their incentive checks,” Seay says. Epic has 25 percent of these attestations, but the other 75 percent of the market needs to connect back to the health system. This is where Lifepoint’s EMRHub helps with LIS-to-EMR interfacing, and its CPOE Connect, whether embedded or standalone, is in demand.

Orchard Software’s systems include a shared database for clinical and anatomic pathology as well as microbiology. Orchard Copia offers a structured-query, language-based lab-EHR integration engine designed for complex outreach, and Orchard Trellis is an order and result management software that incorporates point-of-care test results.

Atlas Medical also offers a broad range of capabilities across radiology, clinical pathology, and AP. “We can provide integrated reports in a sophisticated way across disciplines,” Gregory says. “In addition, by using our Enterprise Master Patient Index solution, labs can deliver a patient-centric view of a patient’s results for lab and ancillary services across multiple encounters, such as in a lab HIE.” This information can be used for clinical decision support, data analytics, and reporting to payers.

CAP TODAY’s product guide to LPL software is on pages 18–30 and includes profiles of LPLs from the aforementioned companies and from several other vendors. The companies themselves supplied all information in the tables.

Karen Krause is a writer in Lehigh Valley, Pa.

Related Links Related Links