The laboratory’s effectiveness in meeting patient care needs is closely supported by a laboratory information system (LIS) focused on laboratory workflow and the requirements of the organization the laboratory serves. As labs shift from being profit centers to becoming cost centers, it is beneficial to have an LIS suited to the lab’s goals. Lab leaders want to be partnered with an LIS vendor that understands the changes in healthcare, that is nimble enough to flex with those changes, and that continues to develop functionality that laboratories of today and tomorrow require for success.
In today’s laboratories, an LIS is not optional. Many laboratories today have complex workflows that require a sophisticated LIS. While often those who work outside of the lab see the LIS as a “black box” that receives orders and sends back results, today’s LIS involves intricate software that is vital to support laboratories and their role in patient care.1
Current functionality
Today’s mature LISs are complex and detailed. They include advanced features that promote clinical care and patient safety (e.g., patient match queue, duplicate testing alerts, outreach support, advanced decision-support rules, sophisticated analyzer interfaces, specimen tracking, quality control, quality assurance, etc.). The most sophisticated LISs will likely eliminate the need for middleware, as the functionality is included in the LIS. Many such features have been in the LIS for years and continue to be improved upon based on user input. For example:
Human computer interaction (HCI) improvements make LIS use more intuitive. These include such features as updated graphic properties that provide a cleaner, more sophisticated look, and larger button design to make it easier for users to see what is highlighted as they make selections.
Configurable decision-support rules continue to be developed with myriad options available that increase lab efficiency and productivity. These include, for example, auto-verification of results and advanced order-entry rules that are used for a variety of automated decision-making (e.g., the ability to fax and email invoices and requisitions, customized invoice and/or requisition layout templates based on ordering location or provider, etc.). Reflex testing cascades are another example of the use of automated decision-support rules to allow the laboratory to provide the most appropriate testing and readily support utilization management efforts.
Sample tracking allows each specimen to be tracked throughout its entire journey through the lab, from accession to disposal, with advanced filters and options to view specific items (e.g., disposed items, unassigned items, etc.). Specimen bar codes can be scanned to link the collection tubes to the patient encounter within the sample tracking system.
Advanced analytics and dashboard capabilities allow laboratories to track important metrics that can have organization-wide impact (e.g., antibiotic stewardship, turnaround times for bacterium ID related to hospital acquired infections, etc.) and view them in a real-time snapshot.
New focus of the LIS
Today’s LIS is a very complex software with numerous specialized capabilities dependent on each laboratory’s needs. The addition of niche functionality, such as voice recognition, scheduling, imaging, billing, pathology, and molecular, has shaped the LIS into an intricate clinical information system. There might not be a single LIS product that fulfills the complete needs of some laboratories, so additional modules or middleware must be added.
Additionally, as laboratories evolve in the value-based healthcare arena, emphasis is shifting to new areas, such as molecular and point-of-care testing (POCT). Labs have new analytics to track to support efficiency within the healthcare organization (HCO). Ideally, an LIS should be able to rapidly incorporate new functionalities to keep up with changes in the lab market. Here are some features that are important for the LIS to support:
Integration. The need for LIS interfaces to other systems (e.g., analyzers, reference laboratories, public health labs, tumor registries, billing systems, and EHRs) continues to be important. Regardless of the LIS, this need will persist as healthcare focuses on interoperable systems and laboratories update their test methodologies and make analyzer changes.
Outreach. Laboratory outreach is becoming another big focus as the healthcare system continues to experience multiple consolidations and mergers to develop Integrated Delivery Networks that have the economy of scale to succeed in value-based care models. Revenue-providing laboratory outreach activities require the LIS for detailed tracking of client needs.
POCT. The demand for POCT is increasing as the healthcare system strives to improve patient satisfaction and improve access and outcomes across the patient care continuum. Having the rapid turnaround time that POCT affords can speed diagnosis and subsequent treatment, and in many instances save downstream costs.
Analytic reports. Labs are expected to track internal analytics such as test utilization, staffing levels, and quality measures, and the LIS can be vital in providing these reports. Tracking of patients for certain disease states, such as diabetes or monitoring of anticoagulation, can support current healthcare metrics that demonstrate a quality focus.
Molecular and genetic testing. An increasing focus on personalized medicine and advances in technology are driving the demand for molecular and genetic testing. Laboratories that perform these tests need information systems that can support complex molecular testing workflows, algorithms, and large amounts of data storage and handling.
Stand-alone vs. EWS
In the past, decisions regarding LIS purchase and setup were handled by the laboratory staff and/or pathologists in charge of the lab. However, now that many EHRs include laboratory modules, decisions are being made at the administrative level based on the idea that it is less expensive and easier to implement an enterprise-wide solution (EWS). Today, it is becoming more common that EHR and LIS software are included in an EWS, or offered as a module within the EHR. Often the decision is made without input from the laboratory.
However, benefit is derived from the experience the stand-alone LIS vendor solutions offer because these LIS vendors have listened to their client base for decades and have developed a mature product based on actual client needs. Additionally, this process can occur more quickly with a stand-alone LIS vendor because the vendor focus is on the laboratory’s needs and is not diluted by the overall needs of the EWS. The EWS LIS might be integrated but does not focus solely on laboratory needs, and much of the detailed, specialized functionality is not readily available in the EWS LIS.
The LIS in value-based healthcare
An LIS requires specialized functionality that promotes efficient lab operations and patient safety, and it also supports the lab’s role in patient care. Labs need an LIS vendor that focuses its resources and development expertise on the lab’s specific needs, creating lab systems that benefit the entire HCO. As laboratories transition to become valuable cost centers, having a robust LIS can improve the lab’s efficiency and its ability to contribute to organization-wide savings and improvements in patient care. With continued change and uncertainty in healthcare’s future direction, laboratories need an LIS that is highly responsive to their needs and to the changing healthcare landscape.
REFERENCE
Sinard JH, Castellani WJ, Wilkerson ML, Henricks WH. Stand-alone laboratory information systems versus laboratory modules incorporated in the electronic health record. Arch Pathol Lab Med. 2015;139(3):311-318.
Kim Futrell, BS, MT(ASCP), currently serves as Products Marketing Manager for Orchard Software. Kim has more than 20 years of laboratory management experience. Prior to joining Orchard in 2012, her role was as Operations Manager of a multispecialty physician’s office in North Carolina.
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