CAP TODAY asked laboratory information systems
vendors to share their thoughts on offering open-system standards, handling
surveillance data, and staying competitive. Here's what they had to say.
CAP TODAY: Are LIS vendors doing enough to incorporate
LOINC, SNOMED, or other open-system standards into their laboratory information
systems? And how, or to what degree, should vendors incorporate such standards?
- George Rugg,
senior vice president and general manager, laboratory systems, Impac
Medical Systems, Sunnyvale, Calif.: From an idealist's perspective,
I say vendors have not done enough. There obviously is greater potential
value in describing clinical observations using standardized language
and coding than not. Unfortunately, however, the demand to incorporate
these standards has not materialized across the U.S. health care system
to the extent it has in other countries. From a realist's perspective,
I would say vendors have done enough, as evidenced by the fact that
vendors can sell products without even incorporating such standards
as LOINC or SNOMED. Simply put, vendors must meet the demands required
by health care institutions or they will not survive. And until the
health care industry is required by regulation to adopt such standards,
or vendors can demonstrate how offering them provides clear benefits
to providers or themselves, it is unlikely that vendors will give high
priority to incorporating such standards.
- Mark Spencer, vice president
and solution line manager for Horizon Laboratory Solutions, McKesson
Provider Technologies, Louisville, Colo.: Laboratory information
systems vendors have allowed their clients to incorporate LOINC, SNOMED,
and other coding standards into their LISs for years. CAP workload codes
were the forerunners of these capabilities. However, laboratories have
had to build various tables with the coded data to make information
that was captured as a byproduct of system use available for reporting
purposes. Furthermore, it has been the customer's responsibility to
update these tables with new codes or values as they became available.
As data for these coding schemes become commercially
available, LIS vendors should provide the ability to upload information
to pre-populate maintenance tables that reference these values. As coding
standards become the common exchange links between various applications—for
example, connecting an LIS to a physician's electronic medical record—having
the coded values will allow vendors to provide standardized messages and
data exchanges to receiving systems. Consequently, connecting to third-party
systems will become easier for the customer, lower the total cost of ownership,
and provide interoperability.
Interfaces between LISs and other applications are
a reality. Therefore, vendors must provide an easy way for customers to
connect to other systems in a cost-effective and standardized manner.
CAP TODAY: How important is it for LISs to be able
to provide surveillance data to public health agencies in a standard format?
What is your company's strategy to ensure that its products can provide
surveillance data to such agencies?
- George Rugg (Impac Medical
Systems): Impac believes the value of public health agency databases
will increase significantly if detailed LIS data are reported since
many therapeutic protocols are prescribed based on results from pathology.
Data that are reported in a standardized format may be aggregated and
mined to reveal trends and correlations. Impac is involved with the
Centers for Disease Control and Prevention's Reporting Pathology Protocols,
or RPP2, project to improve standardized data reporting. Impac's PowerPath
anatomic pathology system can export discrete LIS data, including the
CAP's cancer protocol data, to cancer registry systems using the HL7
interface standard. Impac's MRS cancer registry system can also import
this detail, along with diagnostic, treatment, and followup information
directly from provider systems.
- Mark Spencer (McKesson Provider
Technologies): Providing surveillance data from the LIS to public
health agencies is critical in this post-Sept. 11 era. The threat of
bioterrorism increases the probability that an initial wave of pathogens
will be isolated in the laboratory setting. Being able to report these
data to public health agencies in a standardized manner expeditiously
and automatically could be the first line of defense in containing an
outbreak of a potentially fatal infectious disease. It is also necessary
to be able to send surveillance data to federal agencies, such as the
CDC, in a standardized format, especially in the event of a suspected
Hospitals have, for many years, used their LISs to
provide infectious disease information to public health agencies at the
state level. And standards for these data exchanges are rapidly evolving.
Standardizing the process for transmitting data obviously will make it
run more smoothly over time.
McKesson has worked with several clients in different
states to establish data exchanges from its LISs to state public health
agencies as those needs have been defined. And McKesson's LIS is positioned
to incorporate these standards as they are adopted by each state.
- Elaine Nordhues, vice
president, Clinical Software Solutions, Queen Creek, Ariz.: It
is important in today's environment of increased concern for public
safety, as well as for epidemiologic purposes, to provide surveillance
data to public health agencies in a standard format.
Clinical Software Solutions provides statistical and
reporting capability as a standard feature of its Clin1 laboratory system
and other clinical applications, including Clin1 nursing and pharmacy.
CAP TODAY: How does a vendor distinguish itself in
the LIS marketplace now that many lab information systems have the same
features and functionality?
- Mark Spencer (McKesson Provider
Technologies): Laboratorians are sophisticated buyers. As they
replace their LISs, their goal is to pursue vendors that have, at a
minimum, adequate and evolving functionality, the latest technology,
financial stability, and superior implementation and support services.
It is also imperative that the laboratory system be actively integrated
with pharmacy, nursing, and physician applications. By providing integrated
laboratory, pharmacy, nursing, and physician data and their associated
alerts, clinical users have the right information for the right patient
at the right time to make the right patient decision. This results in
higher quality patient care and better outcomes.
- Elaine Nordhues (Clinical Software
Solutions): Because many LIS features are now standard, vendors
have to distinguish themselves through their level of service, pricing,
flexibility, ease of system use, and industry innovation. Clinical Software
Solutions' Clin1 laboratory system has evolved to include a full complement
of communication tools and utilities, from faxing, remote printing,
PFD file generation, e-mail, and electronic signature technology to
integrating directly with the company's medical records and electronic
Vendors can no longer offer an LIS as an isolated application—it
must be a component of the whole solution and integrate seamlessly with
- George Rugg (Impac
Medical Systems): The presumption here is that all vendors design
features in the same manner, which is not correct. But besides setting
itself apart based on features and functionality, a vendor must distinguish
itself from its competitors based on such factors as product support,
upgrade procedures, research-and-development investment, staffing levels
and experience, users meetings, advanced training, system hardware requirements,
track record, data accessibility, and architecture type.