College of American Pathologists
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It’s every which way for new LIS product

June 2001
Eric Skjei

Despite the hurdles posed by a mature but turbulent U.S. market, a new LIS product, Molis, was introduced here last year by Tucson, Ariz.-based SIA and is now installed in two laboratory sites.

Widely used in Europe, Molis offers competitive strengths—flexible technology, breadth of functionality, advanced outreach capabilities, integrated billing, and seasoned management. Developed in Belgium and owned by the Japanese firm Sysmex, Molis has a truly global pedigree, which may prove to be its most effective asset.

SIA (Sysmex Infosystems America) is headed by president Al DeStefano, who served as chief operating officer for Sunquest from 1985 to 1992, then managed a clinical care product for Motorola until the late 1990s.

Before DeStefano took on this latest challenge, he spent time studying the laboratory information systems market, and found that LIS users weren’t entirely happy. "There weren’t many users who would say they were interested in a new LIS," he says, "but they did have a common set of problems."

By and large, DeStefano reports, an appreciable portion of mainstream LIS users seem to feel disenfranchised, and much of their frustration is focused on the time it takes to adapt or upgrade their systems. Because LIS vendors issue major updates or new releases only every 12 to 18 months, their customers typically implement a new release only every three to five years. Moreover, even when new releases do become available, customizing them is complicated and expensive, DeStefano says.

But the marketplace and regulatory environment impose requirements for change much more frequently. "They are merging, unmerging, establishing core labs, breaking up core labs—all within an ever-changing regulatory landscape," says DeStefano. In short, laboratory users need LISs that are more elastic than ever, that can be tailored to fit specific situations, that can be installed quickly and changed on demand, within months, not years.

Molis offers adaptability, mainly because it is based largely on Uniface, a fourth-generation language, or 4GL. (See "What is a 4GL?") Among other things, this means Molis has within it the tools that allow it to be more easily upgraded than many of its mainstream competitors. Uniface gives Molis the ability to take advantage of the new technology as it evolves, DeStefano says, without requiring laborious rewrites. "Molis is based on a model everyone would like to adopt," he says. "Our developers can concentrate on LIS programming rather than writing software to deal with each new technology as it comes along."

Supported by a large U.S. software company, Compuware, Uniface also lets Molis function independently of specific database or hardware platforms. It can operate in an eclectic spectrum of laboratory environments, on databases ranging from Oracle to Sybase, from Windows to Unix, on client-server networks or within a Web browser. In short, a lab using Molis can decide to use the hardware and database software that fits its needs, rather than limit itself to a specific platform.

The product does have much to commend it, says Hal Weiner, president of Eugene, Ore.-based Weiner Consulting, which has no consulting arrangement with SIA. "What is different about Molis is that when it was created its designers knew they were going to be working in the international market, where you really have to have a product that can be rapidly adapted to different cultures and languages." This is not the case with many mainstream LISs, he points out, in which even such simple features as user prompts and error messages are hard-coded and thus not easily changed. "For many older LISs, even translation into another language is a major development effort," he says.

Molis incorporates a rules engine. "It has a very good rules-based engine for exception handling," Weiner reports, and "from what I see, the approach taken in Molis to creating and maintaining the rules will be much easier for the end user to handle than in many other LISs."

Labs implementing Molis may also find that their installation time is sharply reduced. In the typical installation process, the LIS vendor trains a customer trainer, who then trains everyone else in the client site. But this strategy has the potential to propagate errors, as someone new to the product introduces it to others who are even less familiar with it. Also, traditional installation imposes much of the burden on the client. "The customer has to build its own database, do its own customization, write its own rules," Weiner notes.

SIA’s strategy bypasses these problems. Once the customer has supplied the design requirements, SIAperforms the pre-installation work. Then, once Molis is installed, SIA trains its users. "Because we teach the client how to use the product after the fact, they get the value of using a new product without having to spend a lot of time on it beforehand and without disrupting the lab," says DeStefano. As a result, SIA predicts it will be able to complete a typical installation in about five or six months, half the time a typical LIS installation now takes.

The LIS market is being reshaped in other ways, says Bruce Friedman, MD, professor of pathology and director of clinical support information systems, University of Michigan Health System, Ann Arbor. In health care organizations, there is a new emphasis on enterprisewide medical records, one that tends to relegate LIS needs to more of a subsidiary position. "The buying decision for many large health systems tends to be focused on the integrated electronic medical records suite rather than the best-of-breed ancillary systems," Dr. Friedman says, "and is about tools that can integrate and present data to clinicians, helping them work smarter."

In this scenario, laboratory functions don’t carry much weight, don’t have a primary or even influential voice in the decision-making process, and risk being sidelined as decisions are made about what to buy and how much to invest in what kind of functionality. The upshot, Dr. Friedman suggests, is that labs may pull back from purchase decisions and adopt a more decentralized and specialized focus on "best of breed" LIS functionality, a trend that, if it materializes, would have important market implications for LIS vendors.

At the same time, some key laboratory functions are moving to the Web. "I think the first successful lab ASP [application service provider] suite will involve lab portals that perform order entry and result reporting," Dr. Friedman says. "If that happens, then other functions may follow, not only for lab but also for radiology and the electronic medical record suite." What functionality will remain as an integral part of the LIS, he asks, and what should users be looking for in an LIS product?

The answer, Dr. Friedman predicts, is that the entire LIS market may return to a previous mode in which users and vendors find themselves competing in, in effect, a specialized, niche market. This market would be driven almost exclusively by a concern with optimizing lab operations and mastering such specialized lab functions as streamlining the updating of test results replicated to the clinical data repository, specimen tracking, and phlebotomy draws.

Finally, all LIS vendors are likely to wake up to the fact that they are competing in a more global arena. The lesson for a company like SIA, Dr. Friedman says, is that this is a fast-moving and demanding international market. Its global experience may stand it in good stead, but that is only one piece of the puzzle. It also needs to be ready to compete on best-of-breed grounds on any number of lab-specific functions, and it needs to be more than ready to accommodate the move of laboratory functions to the Web.

It also needs to be thinking in terms of genuine partnerships with its customers. Perhaps overused, the term still means something powerful to DeStefano. "When I was at Sunquest, vendors and clients had great partnerships," he says. "I want to bring that back. I enjoy that relationship, and I think clients deserve vendors who provide products for them that really help them provide the kind of services they want and need to offer."

Eric Skjei is a freelance writer in Stinson Beach, Calif.