Connect Labs via an Agnostic Cloud-based Network

March 2022 - Vol.11 No. 3 - Page #2
Category: Laboratory Information Systems

The interconnected nature of the human body often enables disease diagnosis by the ways in which various parts of the body respond to said condition, and this concept can be fortunate. Unfortunately, this concept does not apply as easily to the idea of interconnecting disparate laboratories. As with the human body, something that may sound relatively simple can in fact be highly complex.

A common question I encounter is: How do you connect various laboratories to exchange important information when those labs operate using different laboratory information systems (LIS)? Continuing this line of questioning, how do test orders sent between requesting and, often multiple performing labs reconcile differing test codes and reference ranges to assure a comprehensive and accurate results report? As we know, sharing information among laboratory operations can be highly beneficial to all parties, but doing so remains a challenge. The following discusses a laboratory information system network developed and utilized in the United Kingdom. However, similar networks are being adopted in the US and there is much to learn from the UK’s experiences.

Benefits of Interconnection

In the United States, heath systems often operate or interact with various laboratory entities and facilities. Some of these lab facilities may be owned by the health system, whereas others are external and independent. Perhaps unsurprisingly, many of these laboratories may have different LIS that require interconnection in order to permit communications to and from the health system. Naturally, this requirement generates a need for a ubiquitous and agnostic network that could enable these diverse lab entities to seamlessly interconnect and share information automatically and in a standardized manner.

One potential solution involves the use of a digital hub through which any diagnostic laboratory, using any system, can digitally exchange diagnostic test referrals and results with any other laboratory. The system is entirely interoperable and connects all users, via the Cloud, to a full network of other users through a single connection. Such a system would enable laboratories to access wider testing options for referrals, offer a space to market their services more easily, and achieve capacity or faster turnaround times across a network of connected laboratories.

An example of such a network has been in operation in the UK for approximately 15 years as the National Pathology Exchange network (NPEx),1 now known as Labgnostic.2 Originally developed at the University of Leeds in 2006, this network interconnects multiple health-system hospital laboratories and private hospital laboratories in the UK to a national network. However, it is a unique international product that could enable any diagnostic laboratory to electronically refer test requests or results to any other laboratory on the network.

Current Uses

In the UK, the network is a national service enabling pathology managers to connect their labs with others through a single exchange hub so that test requests and pathology results are sent digitally from lab to lab in near-real time. This hub enables any diagnostic laboratory employing any system with an HL7 or FHIR interface to digitally exchange diagnostic test referrals and results with any other laboratory or arm of a diagnostic organization.

This network—in use since 2007—is the solution of choice for the UK’s National Health Service and is used by public health organizations, private laboratories, proficiency testing providers, and specialist diagnostics organizations in the UK, Ireland, and France. The network is also extensive, with over 150 laboratory-to-hospital connections. At present, 138 health systems and 12 private hospitals are interconnected, with hospital bed sizes ranging from under 200 to over 1,000.3

Network Expectations

One of the foremost aims and benefits of this network comes in the form of increased efficiencies and shorter turnaround times (TATs) for lab-to-lab testing. These common laboratory goals can be quantified via metrics produced by the network on how a lab is performing in terms of quality, timeliness, and cost effectiveness.

Connected laboratories recognized the high cost and difficult sustainability of disparate point-to-point interfaces and archaic paper-based processes and sought to minimize these methods by connecting digitally to the national exchange, which has helped modernize the ways in which patients obtain their results, cut costs, raised quality, and improved clinical care through expedited information interchange and diagnosis.

Impact and System Methodology

Laboratories in the UK have experienced a range of practice benefits through use of the service either as a performing or referring laboratory, including the following:3,4

  • Reduced number of manual processes (eg, information/data entry)
  • Fewer administrative burdens on clinical laboratory staff
  • Improved results TAT
  • Mitigation of transcription errors
  • Results returned directly into LIS
  • Automated sample tracking and audit trail
  • Improved quality of test information
  • Improved time to diagnosis
  • Digital return of proficiency testing
  • Ease of interoperability between systems, including global list of performing labs

The network utilizes a messaging engine that translates local data sets and codes from senders into a standard messaging format, mapped against SNOMED-CT coding standards within the central hub. These messages are translated once more into the local format and context of the receiving lab system. Thus, users can send and receive requests and results regardless of the LIS involved.

Message types include information on order entry, results (including reflex and follow up), labels, specimen manifests and tracking, and proficiency testing. Further, the statuses of patient samples are visible throughout the entire workflow with audit trails and time stamps enabling safe and secure access for all users. To wit, all data is stored in an encrypted format and is compliant with standard cyber security, personal identifiable information, and data protection guidelines such as the Health Insurance Portability and Accountability Act (HIPAA). See the SIDEBAR for a list of currently interconnected LIS that embrace the agnostic nature of Labgnostic (NPEx) for exchanging order information, results, and other clinical messages.


The developers of the Labgnostic network are exploring global partnerships, including Europe, North America, and Australia, to deliver this type of LIS interconnectivity network to a wider market and further broaden the benefit to all users. A version of this network has been imported into the US with two US-based laboratories currently in the process of implementation and more to come.4


  1. The National Pathology Exchange. Accessed 2.10.22:
  2. X-Lab Limited. Labgnostic. Accessed 2.10.22:
  3. NHS. The Health Informatics Service. Our key partnership role in major enhancement of digital pathology and diagnostic services in UK and beyond. Case Study. Accessed 2.10.22:
  4. Labgnostic Information Pack. Accessed 2.10.22:

Dennis Winsten, MS, FHIMSS, FCLMA, is president of Dennis Winsten & Associates, a health care consulting firm specializing in laboratory information. With over 25 years’ experience in the application of computer systems to health care, his 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); and Clinical and Laboratory Standards Institute’s (CLSI) area committee on automation and informatics.

Laboratory Information Systems
For a full list of vendors offering Laboratory Information Systems, go to:
Key Laboratory Information Systems Suppliers
Agilent Technologies, Inc
CompuGroup Medical
Epic Systems Corporation
LigoLab Information Systems
NovoPath LLC


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