Since the introduction of computers in health care laboratories in the mid-1960s, laboratory information systems (LIS) have largely fallen under the provision of specialized companies offering what has been commonly referred to as “best-of-breed” (BoB) systems, in that their functionality developed over time to be department specific and optimized to laboratory operations.
However, in recent years, the BoB LIS model has been challenged by the reality of fully integrated, primary vendor, enterprise-wide solutions. These enterprise-wide integrated information systems (EWS) provide electronic medical records, financial and administrative functions, and departmental modules, including an LIS. These EWS are becoming more prevalent as they consume BoB systems with a single vendor’s all encompassing system. Most EWS vendors promise to provide the functional equivalence of BoB LIS along with what they consider to be added benefits of an integrated information system, such as:
- Simplified enterprise communication
- Simplified deployment logistics
- Reduced total cost of ownership
- Simplified long-term stewardship of software, hardware, and data
- Enhanced patient safety
- Consistent and timely data production, analysis, and exchange
As hospitals and health systems replace BoB departmental systems with EWS applications, laboratories often feel pressure from facility administration to go along with replacing their LIS with an integrated lab module from the EWS vendor. Thus, the question of how to objectively evaluate the impact of implementing an EWS lab module on laboratory operations (and the hospital at large) comes to the forefront.
Definitions of the impact, benefits, and drawbacks of an EWS solution vary depending on the relative perspectives of the C-Suite, particularly the chief information officer (CIO), and laboratory management. CIOs generally favor an EWS solution based on the following factors:
- Fit with other institutional systems (eg, radiology, pharmacy, EMR, scheduling, etc)
- Support of hospital’s financial and service level initiatives
- Ability to achieve a greater level of integration
- Facility-wide homogeneous applications
- Use of common standards (eg, communications, data exchange, information nomenclature)
- Seamless data flow among hospital administrative, clinical, and financial systems
- Unified access for business and clinical analytics
- Focus on needs of physicians/clients
- Ease of access and of use
- Uniformity of data presentation to all staff (clinical and IT)
- Avoid bridging/interfacing different systems, which can be unreliable and costly
- Bridging can create data disparities between interfaced systems (eg, completeness, consistency, presentation, timing)
- For disparate systems, software upgrades may require interface upgrades
- Number of interfaces is minimized
- Promise of total, enterprise-wide decision support and business intelligence
Alternatively, laboratory managers tend to have a somewhat different perspective with a more laboratory-centric focus. Yet, these initiatives also benefit the facility as a whole. In either a BoB or EWS, lab management seeks the following factors in an information system:
- Support laboratory’s financial and service level initiatives
- Emphasize and facilitate laboratory outreach business as an important revenue generator
- Maintain and/or grow outreach revenue
- Focus on needs of physicians/clients and value over cost
- Optimize data display for caregiver interpretation
- Ease of access and use for laboratory staff and management
- Functionality above and beyond the sufficiency’s of the current system
- Proven interface and interoperability that can be supported without full integration
- Availability of support for advanced automation (pre-analytical, analytical, and/or post-analytical)
- Facilitates a mature laboratory workflow with well-defined and straightforward interface transactions
A common concern among laboratories that may consider their current, stand-alone LIS to be sufficient is that an integrated, single-vendor system may not be nimble enough to adapt to changing business conditions. Further, lab leadership might argue that integrated systems do not necessarily work well in a multi-entity business model and that the system’s component modules (eg, lab, pharmacy) cannot be easily modified to adapt to required business or regulatory changes without affecting the entire integrated system. This argument may conclude that loosely coupled systems can be advantageous in remaining flexible to change.
Ultimately, the question is: How can these differences be resolved in an analytical, rational way to assure the interests of both the lab and the organization are protected to the greatest extent possible? To examine this, first compare the generic differences between an EWS and a BoB LIS (see TABLE 1).
A primary decision point is determining the value of integration to your hospital. In particular, attention must be paid to the importance of clinical data presentation, completeness, continuity, consistency, and timeliness, as well as the broader application of expert rules and enterprise-wide business intelligence. As always, cost is a factor and the facility must consider the overall cost of ownership in the short and long term.
Given the importance and omnipresence of information systems in the lab, there is great value in arranging for onsite demonstrations of EWS LIS and BoB candidates. Likewise, perform a gap analysis to objectively determine the relative impact and importance of gaps in functionality, such as those affecting financials, operations, quality, service levels, patient safety, etc. The basic format of this analysis is as follows:
Step 1. Identify EWS gaps in functions and features:
- From demo as noted by lab staff
- From CAP Today guides (eg, LIS, AP, etc)
Step 2. Prioritize gaps (eg, critical, high, moderate, low)
Step 3. Quantify impact of gaps on lab and hospital to establish whether the gaps are significant enough to impact the system decision. For example, determine the impact on:
- Staff requirements/workload
- Quality assurance
- Outreach (growth, revenue, profitability)
- Results timeliness/turnaround
- Consistency and timeliness of data
- Service levels
- Patient safety
Both EWS LIS and BoB LIS have intrinsic advantages and disadvantages and it is important to determine the impact of both on your laboratory and hospital operations. An evidence-based assessment and gap analysis can be performed to best determine the tradeoffs and relative qualitative and quantitative advantages and disadvantages for your lab and hospital. See TABLE 2 for a list of essential factors to keep in mind during the decision process.
Depending on the laboratory’s environment and the schedule deemed necessary to achieve its operational, quality, performance, and business requirements, an EWS LIS may prove to be a suitable choice as part of an enterprise solution.
Although some vendors’ EWS LIS are presently less mature than many legacy LIS, they have made significant progress. These systems are still evolving and implementing new developments along a specified timeline. Thus, current functionality may not be a key decision point in determining the best system fit.
Ultimately, performing an objective, evidence-based analysis can establish the practical feasibility or infeasibility of any enterprise-wide LIS for your laboratory relative to a contemporary best-of-breed LIS.
Dennis Winsten, MS, FHIMSS, FCLMA, has over 30 years’ experience in health care computer applications, including all aspects of enterprise-wide and best-of-breed laboratory information systems. His background includes in-depth knowledge of laboratory and hospital operations as well as the capabilities and constraints of today’s computer and communications systems technology. Dennis’s professional affiliations include: Fellow, Healthcare Information and Management Systems Society (HIMSS); Fellow, Clinical Laboratory Management Association (CLMA), CLMA Board of Directors, 2011–2013 and 1990-1993; Association for Pathology Informatics (API); Clinical and Laboratory Standards Institute (CLSI) - Area Committee on Automation and Informatics.