College of American Pathologists
Printable Version






cap today

December 2005

bullet Think twice before leaning on LIMS

Software vendors are increasingly marketing laboratory information management systems, or LIMS, to clinical laboratories, and they aren’t always the best fit.

LIMS, which were developed for use in research and pharmaceutical laboratories, typically are designed to perform sophisticated data analysis of large batches of analytical specimens, rather than following diverse tests on a specimen through the laboratory on an individual basis.

Many LIMS acquire raw data from general-purpose analytical instruments and subject the data to sophisticated immunoassay curve fitting or other data-reduction al go rithms to obtain results. This approach differs from that of most clinical laboratory instruments, which directly produce a usable clinical result. Clinical laboratory information systems emphasize rapid turnaround time to the final report, while LIMS emphasize productivity in analyzing large numbers of specimens.

For these reasons, clinical labs should proceed cautiously when considering purchasing a LIMS. The lab should make sure the system can meet its specific needs instead of those of analytical, research, or pharmaceutical laboratories. Laboratorians should not blithely assume that a pharmaceutical LIMS, for example, will function well in a clinical laboratory environment.

LIMS may be more useful to public health laboratories than clinical labs because public health labs share characteristics with both clinical and analytical labs. Therefore, a typical clinical LIS and a LIMS may require considerable retooling to operate optimally in a public health lab.

If your institution is considering purchasing a LIMS, talk to numerous users of the system who run patient specimens in a clinical lab before making a purchasing decision.

bullet IBM partners with cancer centers to advance patient treatment

IBM recently announced that it is joining forces with Memorial Sloan-Kettering Cancer Center, the Molecular Profiling Institute, and the CHU Sainte-Justine Research Center-Mother and Child University Hospital Center under separate agreements to help accelerate cancer research, diagnosis, and treatment.

IBM and Memorial Sloan-Kettering are building a state-of-the-art integrated information management system to boost clinicians’ and researchers’ ability to study long-term cancer-related illnesses, identify disease trends, and determine success rates. Funded by a $3 million grant of technology and services from IBM, Memorial Sloan-Kettering will include a comprehensive system to integrate its hospital data with text mining and related analytical capabilities in a unified information management environment to facilitate predictive analysis and research.

Pathologists at Memorial Sloan-Kettering are also working with researchers at IBM to create a searchable database for pathology reports. Through the pathology report project, researchers are developing a system where information will automatically be extracted from thousands of pathology reports and mapped to a database. Past pathology reports at Memorial Sloan-Kettering are being mapped into standard formats. Information from the reports is extracted automatically and organized into databases so researchers can query the information more easily.

Under an unrelated agreement, IBM and the Molecular Profiling Institute, a specialty reference laboratory, are collaborating on new molecular profiling technologies to help physicians make molecular distinctions when diagnosing and treating cancer patients. Physicians eventually will receive a tailored report based on a patient’s complete molecular profile.

IBM touts the venture as a first step in eventually offering personalized diagnoses based on phenotype and genomic data.

IBM is also partnering with CHU Sainte-Justine Research Center- Mother and Child University Hospital Center, a university teaching hospital affiliated with the University of Montreal. Together they are developing an informatics infrastructure based on IBM’s Clinical Genomics Solution to better define the genetic markers for acute lymphoblastic leukemia.

Clinical data that was once manually extracted from the hospital’s patient file will now be transmitted electronically and merged with genomic data to create a medical information repository. This will reduce the query process from days to minutes and allow researchers to develop personalized therapies for patients and keep longitudinal records. All research projects will eventually be supported from a single database and integrated infrastructure.

bullet New EHR software in the works

Is the Centers for Medicare and Medicaid Services’ VistA-Office electronic health record software coming soon to a physician office near you? The federal government hopes so.

In September, the CMS released an evaluation version of VistA-Office, which is adapted from EHR software called VistA, which has been used by the Veterans Health Administration for about 20 years. By adapting the software to the needs of small physician offices, the CMS hopes to make one more EHR available to physician practices that want to use information technology to improve quality of care, says Cynthia Wark, deputy director of the information systems group in the CMS Office of Clinical Standards and Quality. VistA software is being used by 158 Veterans Affairs hospitals and about 1,300 other VA care facilities to maintain the records of more than five million veterans.

Only 15 percent to 20 percent of U.S. physician offices and 20 percent to 25 percent of hospitals use some kind of EHR system because of the expense and time associated with installing the software, according to a recent study by the Rand Corp., a nonprofit institution that conducts health care research and analysis.

Because implementing an EHR is not a simple process, the CMS first wants to evaluate the modified VistA software and determine how well it works in private physician offices. To do that, the CMS will choose five to 10 offices and clinics as beta sites for the adapted software. "We are looking for beta sites that are willing to make a commitment to provide our development contractors with feedback and to stay current with software updates," says Wark.

The VistA-Office software retains numerous functions of the original VistA software, such as order entry, documentation templates, and clinical reminders. New to the software are such functions as reporting of quality measures and printing/faxing of medication prescriptions. VistA-Office runs on the Windows operating system and uses a combined programming language and database management system called Caché.

Initial testing of the software has shown that users want more functionality, says Wark. One request is for more immediate access to laboratory information. The technology, Wark explains, includes a laboratory interface, but setting it up requires additional effort on the part of qualified vendors.

As of early October, the CMS had received between 300 and 400 inquiries about the program, which is targeted at small offices with one to five physicians. Those who express an initial interest in the software will work with qualified vendors who will determine whether the offices meet the criteria for the software and then help install the software at appropriate sites.

The CMS was expected to make its first beta site selections this month. Testing will take approximately six months to a year.

bullet Upcoming HIMSS meeting

The Healthcare Information and Management Systems Society will hold its 2006 Annual HIMSS Conference and Exhibition Feb. 12-16, in San Diego.

The meeting’s 2006 Interoperability Showcase will demonstrate the benefits of interoperable patient data exchange. Using leading technology, the showcase will demonstrate interoperability in existing electronic health record products, including cross-enterprise document exchange of laboratory results, radiology images, and medical summaries.

For more information, go to or call HIMSS at 312-664-4467.

bullet Contracts

The American Red Cross has implemented IDM’s Surround 4.3 laboratory information system at its national testing laboratories in Philadelphia and Detroit. The Red Cross’ national testing laboratories in Charlotte, NC, St. Louis, and Portland, Ore., are scheduled to implement Surround 4.3 by year-end.

Surround is an open laboratory system that provides sample management, instrument interfacing, decisionmaking, and a reporting module for centralized and free-standing laboratories in the blood and plasma sectors.

Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at Hal Weiner is president of Weiner Consult ing Services, LLC, Florence, Ore. He can be reached at hal@