College of American Pathologists
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  Selecting an LIS? What to seek and what to skip






November 2007
Feature Story

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 bioterrorist attack.

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 chart components.

Vendors can no longer offer an LIS as an isolated application—it must be a component of the whole solution and integrate seamlessly with the EMR.

  • 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.


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