While most laboratory directors come from clinical backgrounds with scientific education cores, the fact remains that clinical and anatomical operations are inexorably linked to finance and business operational performance. Thus, laboratory testing performance and related results transmission has substantial financial implications for the health of laboratory business. Much like missing specimens, missed revenue opportunities plague the laboratory director’s mind. Fortunately, there are readily available methods by which to avoid missed financial opportunities in the future.

Need for an Information Bridge

A range of laboratory information systems (LIS) have become widely utilized in hospital laboratories, but just as more instruments gain interoperability with computer systems to relay information, so has grown the number of financial instruments needing to relay information with an LIS in order to maximize benefit to the lab and the facility at large. Revenue cycle management (RCM) systems have become vital to the business aspects of the laboratory and have likewise grown in ability to interoperate and share data. However, not all systems engage each other seamlessly, and this connection is where disconnects are most likely to occur and where revenue is most likely to be lost. Examples of gaps at this point include:

• Incorrect or incomplete mapping for test or billing codes; codes do not match between the LIS and RCM system
• One of the two systems becomes temporarily inoperable (unscheduled or scheduled down time)
• Hardware changes or software updates in the operating system of either the LIS or RCM are not compatible with the other, or require internal debugging
• Technological or operational delays disrupt connection
• Time and resources (IT or human) are needed to re-synchronize the interface to assure all data is accurate and consistent within both information systems

Interface versus Integrate

It is important to differentiate between a system where an LIS is interfaced with an external RCM system, and an originally integrated LIS-RCM operating platform. These terms—interface and integrate—appear similar and are at times conflated. An interfaced system involves coupling via data bridge two platforms (in this case, LIS and RCM) from different companies/manufacturers that employ their own database and operating systems/hardware. Alternatively, an integrated LIS-RCM is when both systems are developed/manufactured by the same company, share the same hardware and software, and use a common database wherein necessary data for each system is stored. Given the common hardware/software and database, necessary data also do not need to be transmitted between differing systems via HL7, FHIR, or other communications protocol. With an integrated LIS-RCM system, rules engine logic and analytics often can be applied across both clinical and financial data.

The following will help clarify the important concepts behind the differences between an interfaced and an integrated LIS-RCM platform, as these differences can significantly affect the efficiency of laboratory operations, timeliness, accuracy, costs, and revenue.

System Interfacing

System interfacing connects disparate systems by exchanging data that are recognizable to both systems. This rarely involves changes to each system’s applications or operating systems; rather, each system adds a feature that enables data transfer while continuing to perform independently of each other. Communication between the associated applications is often limited to necessary data, which are stored in both system locations.

Interfaced systems do not share the same database, so the interface serves to maintain mappings between systems. With an interface, any changes made in either system precipitates a map update, such as when a new test or billing code is added into an automated instrument.

Optimizing these interfaces can involve continuous monitoring for variations to exchanged data characteristics, as changes may affect the interface and introduce either erroneous data transmission or interface malfunction. A substantial benefit of interfacing is that common communications protocols are mature and widespread. Presuming a well-defined interface specification analysis, these bridges are relatively easy to implement.

Benefits:

• Numerous proven interface communications protocols
• Most common methodology to connect LIS and external systems
• Software updates in one system do not affect applications in interfaced system(s)
• Ease of implementation using standard protocols

Challenges:

• Data maintained in multiple locations
• Changes in data type/size in either system requires interface re-testing/map updating
• Data transfer can be delayed by downtime on either system
• Business analytics limited by scope of data transmitted via interface

System Integration

Integration is significantly more complex to develop initially, as both (or all) systems must be related (ie, share same hardware/software), and the associated applications must utilize a common operating system, data language, and database. These platforms are designed and built to interact with one another on a fundamental level. Rather than having different systems communicate back and forth, as with interfacing, integration allows for a seamless transition of information with all data stored in a common database structure. Likewise, data definitions are unambiguous and there is only one data source to house all related information.

A fully integrated system eliminates the need for database synchronization, and this is a substantial benefit, as data transfer and system mapping are not required. All software updates apply automatically in each part of the integrated system and do not require the same level of compatibility testing as interfaced systems. If your laboratory employs a wide range of systems that need to be regularly updated, or complex real-time reporting requirements, then an integrated system of clinical and anatomical LIS with an RCM system may be the best choice.

Benefits:

• One comprehensive system, reducing silos
• Real-time data access and reporting throughout system
• Data is centralized, eliminating synchronization and inter-system data mapping
• Data type/size is consistent and unambiguous
• Business intelligence and analytics data encompass clinical and financial functions
• No need to reconcile data between LIS and RCM

Challenges:

• Specific application updates may affect other integrated applications requiring thorough regression testing
• System failure or downtime shuts down both LIS and RCM operations
• Adequate database backup is required and can be costly

Conclusion

Both system interfacing and system integration of LIS with RCM have been successful workflow improvements for laboratories. Each approach has benefits and drawbacks, with interfacing serving as the most common method, traditionally. However, declining reimbursements and shrinking profit margins are forcing pathology, clinical, and reference labs to consider changing the way they approach LIS and RCM functionalities. Lack of transparency and synchronization due to siloed systems can lead to data inconsistencies, increased denials, and a resulting loss of revenue. The proliferation of fully integrated EHR systems that natively combine LIS functions with RCM functions in hospital labs has set a trend toward integrated systems that has yet to be largely exploited by independent pathology groups and clinical laboratories. As various diagnostic laboratory operations adapt and acquire new technologies, the question of whether to interface or integrate related information systems will continue to require scrutiny in order to capture all available revenue opportunities in the laboratory.