College of American Pathologists
Printable Version






November 2011

Raymond D. Aller, MD
Hal Weiner

Using cloud-based reference lab network, Cerner clients get more from less Using cloud-based reference lab network, Cerner clients get more from less

Cloud-based technology isn’t new, but what Cerner is doing with it is worthy of note.

Cerner has created a reference lab network that uses one electronic connection via “the cloud” to transmit test orders and results between reference labs and hospitals, instead of using separate point-to-point connections to each lab.

The cloud-based approach offers near- and long-term benefits for hospitals, says John David Larkin Nolen, MD, PhD, Cerner’s director of laboratory strategy. Of particular benefit is that the network streamlines the process of managing connections between hospitals and reference labs. Some larger hospitals and health care systems that use other networks may have as many as 30 connections, Dr. Nolen says. “Those are 30 separate point-to-point interfaces somebody has to manage.”

The network also provides instant connectivity to a lab, no matter the volume of transactions generated by that lab, and scales the cost of the interface to that volume. In a traditional arrangement, a reference lab typically pays a lump-sum fee for the software interface between the hospital and reference lab information systems. With the cloud, the cost is transaction based. The client is charged a nominal one-time fee to connect the hospital and reference lab to the network via a traditional HL7 interface and a cost per test that the reference lab pays to Cerner, Dr. Nolen explains. The higher the reference lab’s total volume, the lower its transaction costs, he says.

Because costs are aligned with volume, hospitals and reference labs that use paper-based test ordering because their low ordering volume doesn’t justify the expense of an electronic interface can now use the network to communicate electronically, Dr. Nolen says.

Reference labs pay a one-time fee to be on the network, Dr. Nolen continues, meaning that if a lab is already using the network to connect with one Cerner hospital client, it can send data electronically to other Cerner hospital clients without incurring additional charges.

Cerner had already been using cloud-based technology to connect users of its electronic medical record system, so it made sense to offer labs the same technology for sending diagnostic data, Dr. Nolen says.

Cerner is now working on technology to send component data, such as images and tables, via the network. Reference labs typically send integrated data through packaged reports in PDF files, which means hospitals must dissect the data and copy and paste images and text to customize reports for clinicians, Dr. Nolen says. By sending component data in lieu of integrated data, hospitals can more easily create customized reports, he adds.

Cerner is also developing other functionality for the network, such as the ability to update test catalogs for each reference lab through the cloud. “I remember when I was a resident,” says Dr. Nolen, “when you’d wait for the big catalog to come from all the reference labs to look up: What’s the reference range? What kind of tube do I draw it in? That can all be electronically delivered now.”

Cerner introduced its reference lab network approximately one year ago, but only recently has it seen an uptick in adoption by reference labs. As of October, the network included 13 reference labs, which are designated as partner labs, meaning any organization on the network can create a connection to these labs at no additional cost, Dr. Nolen says.

An additional 10 reference labs are on the network solely to support specific clients. Because those labs are not partners with Cerner, meaning they have not negotiated a business agreement with the company, each of them has one interface to one Cerner client, Dr. Nolen explains.

Cerner is now automatically linking its hospital clients to the network as the hospitals upgrade their information systems to meet federally mandated meaningful use requirements, which offer financial incentives for labs that send orders and receive results electronically. Between 50 percent and 75 percent of Cerner clients should be connected by the end of 2012, Dr. Nolen says.

Adoption by larger reference labs initially may be slow because those labs already use interfaces to link with their hospital customers, and they might not want to change that connection for fear of losing influence with their customers, Dr. Nolen says.

But reference labs that conduct esoteric testing, such as genotyping, and other specialized assays that typically generate a lower volume of orders are beginning to understand how the network can make their tests available to a greater number of potential customers, Dr. Nolen continues.

“We see this as one of the ways to get the latest and greatest molecular test—which is where a lot of the next new developments are happening in the lab space—into the hands of our clients,” he says.

North Kansas City Hospital, North Kansas City, Mo., became an alpha test site for the reference lab network when it replaced its primary reference lab in March 2010. The hospital chose the network rather than a traditional point-to-point interface because of the simplicity of managing a single connection to multiple laboratories, says Trula Myers, laboratory administrative supervisor for the 451-bed hospital. “We chose to look toward the future and have that single connection in place.”

Because the hospital was already using Cerner systems, learning how to use the new interface was easy, Myers says, adding that using the network is like flipping a switch for electricity. “It just works.”

It would be ideal, Myers says, if all of the approximately 20 reference labs the hospital has used joined the network. “But even if Cerner just gets the major players, we’ll be ahead,” she notes.

The greater the number of reference labs on the network, the greater the amount of data that will be generated, which can benefit hospitals in the long term, Dr. Nolen says. Cerner can then mine the data to obtain metrics for such areas as pricing and turnaround time for test results, allowing hospitals to better determine which tests and which labs best meet their needs.

“With this connectivity engine—this cloud—our clients can look at all the reference labs connected and they can pick and choose the best test for them,” Dr. Nolen says. “So it really starts to flatten the landscape of reference lab testing.”

Sunquest purchases PowerPath AP system from Elekta Sunquest purchases PowerPath AP system from Elekta

Sunquest Information Systems has acquired the PowerPath anatomic pathology information systems business of Sweden-based Elekta AB for approximately $33 million.

Sunquest will market PowerPath with its Sunquest Lab laboratory information system and CoPath Plus anatomic pathology system product lines.

“It was a product we respected,” Chris Callahan, vice president of product strategy at Sunquest, told CAP TODAY. “We’ve had to compete with them [Elekta] for several years. We think it’s a strong product that held its own in the marketplace. The deal made so much sense on so many different levels.”

“The PowerPath product line came to Elekta as part of the acquisition of Impac Medical Systems in 2005,” says Tomas Puusepp, president and CEO of Elekta. “PowerPath is clearly a leading brand in its sector with an impressive customer list of prestigious institutions. However, the synergies between PowerPath and Elekta have been limited, and we expect that PowerPath will have good prospects with Sunquest given their more complementary business.”

Sunquest began pursuing the purchase of PowerPath early this year and recently started marketing the product. Callahan emphasizes that Sunquest will continue to actively market CoPathPlus.

“Both products have their respective strengths and weaknesses,” he says. “We can apply the strengths of one to the other. ...They can mutually benefit each other.

“There will be certain types of labs where PowerPath will be more suitable and other types where CoPathPlus will be more suitable,” he continues. “What we’re going to do—equalizing for such factors as price—is let individual clients choose their preference. Once we get more experienced with the respective clients, then we will start recommending specific products to specific types of clients.”

Sunquest acquired all Elekta PowerPath sales and development staff with the acquisition, so “everyone that PowerPath clients talked to on the support desk are still there,” Callahan says.

PowerPath brings to Sunquest’s anatomic pathology client base about 250 North American clients, doubling the company’s AP systems market share to 24 percent.

“We find the AP marketplace to be rife with opportunity,” Callahan concludes. “We are going to look for ways to [further] expand our presence and leadership in the AP market space.”

Sunquest Information Systems
Phone: 800-748-0692

Clinical informatics recognized as medical subspecialty Clinical informatics recognized as medical subspecialty

Physicians can now become board-certified in the subspecialty of clinical informatics.

The American Board of Preventive Medicine has announced that it will administer a clinical informatics examination to interested physicians who have primary specialty certification through the American Board of Medical Specialties.

The ABPM has set a goal of offering the first exam in fall 2012 and awarding the first certificates in early 2013.

“Clinical informatics (CI) certification will be based on a rigorous set of core competencies, heavily influenced by publications on the subject that were developed by AMIA and its members, many of whom have pioneered the field and supported CI’s new status as an ABMS-recognized area of clinical expertise,” according to a statement released by the American Medical Informatics Association. AMIA is developing materials for online and in-person courses to help physicians prepare for the exam. The courses are expected to be available next spring.

The role of clinical informaticians, according to AMIA, is to use their combined knowledge of patient care and informatics concepts, methods, and tools to assess the information and knowledge-based needs of health care professionals and patients; characterize, evaluate, and refine clinical processes; develop, implement, and refine clinical decision support systems; and help procure, customize, develop, implement, manage, evaluate, and improve clinical information systems.

Siemens introduces system for data management Siemens introduces system for data management

Siemens Healthcare Diagnostics has released its Syngo Lab Data Manager data-management system.

Syngo can connect lab instruments to the lab information system, as well as to any automation system or Siemens’ remote-monitoring solution.

The product, which manages a range of pre- and post-analytic functions, includes autoverification; integrated quality control, which includes automated Westgard and customizable rules, as well as real-time patient median statistical analysis; and remote connectivity to Siemens’ data center.

Siemens Healthcare Diagnostics
Phone: 800-431-1970

4medica unveils application for smartphones and tablets 4medica unveils application for smartphones and tablets

4medica has introduced the first version of its 4medica Mobile application for smartphones and tablets.

The application gives physicians around-the-clock access to pathology and radiology results, patient demographics, notes, patient lists, and trending data from multiple sources via their iPhone, iPad, BlackBerry 6 or higher operating system, or Android smartphone or tablet.

4medica Mobile aggregates data through a cloud platform that links multiple sources, including commercial and hospital reference laboratories, electronic health record systems, ancillary systems, and radiology clinics. “This vast connectivity can support a hospital’s clinical data integration strategy to fulfill meaningful use gaps or accountable care organization requirements to qualify for federal funding and shared savings,” according to a release from 4medica.

Phone: 310-695-3300

ONC undertakes data query initiative ONC undertakes data query initiative

The Office of the National Coordinator for Health Information Technology has launched Query Health, an initiative to establish standards for querying widely distributed data sources, such as electronic health records.

The ONC is soliciting participation in the initiative from software vendors, provider organizations, and health information exchanges. Participants will be asked to join one of three workgroups, focusing on business, clinical, or technical issues.

The business workgroup will handle privacy, security, consent, sustainability, data-use arrangements, and best practices. The clinical workgroup will develop functional requirements and standards for vocabulary. The technical workgroup will implement standards and references and support pilot projects.

“In recent years, the use of distributed queries has become a growing focus of health information technology,” according to an ONC blog posting from Doug Fridsma, MD, director of the ONC’s Office of Standards and Interoperability. “Instead of relying on centralized databases, the distributed query approach provides access to aggregate data for specific analytical purposes without identifying individual information and allows the data to remain behind the health care organization’s firewalls, thus maintaining patient privacy and security.”

Among the vendors that have already committed to participate in Query Health are Cerner, McKesson, GE Healthcare, Siemens, Allscripts, NextGen, and Healthland.

Dr. Aller is director of informatics in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at