Lab Information Systems_ Paradigm Shift in the Lab: The Solution-centric LIS

Paul Park is vice president of corporate strategy, Atlas Medical, Calabasas, Calif. Contact him at ppark@atlasdev.com.

Since the advent of the computer revolution, clinical laboratories have been early adopters of information technology. Computers, hardware and software have been integral to conducting and managing the testing process, as well as reporting and storing results. As stand-alone powerhouses of lab informatics, these legacy laboratory information systems (LISs) were originally deployed to be silos of information, with little need to interact with other systems, let alone the outside world. While this strategy was effective a few years ago, today’s lab operation requires much more.

Most hospital enterprises today recognize that lab operations are an integral component of the services they offer to the physician community. At the same time, the enterprise looks to the lab to deliver more revenue and to operate with positive margins. As a result of this paradigm shift, laboratory management must advance its operations from hospital-centric production facilities, focused solely on the needs of the internal enterprise, to entrepreneurial organizations looking to expand the size of their client base, and the scope and reach of their services, efficiently and profitably. This requires re-engineering key components of lab operations, including sales, customer service, billing and functions currently handled by the LIS, including order/specimen processing and results dissemination.

The New, Heterogeneous Face of Labs
The management team’s mission and strategy for the lab has dramatically changed over the last decade. The impact of mergers and acquisitions in the lab business has pushed lab management beyond the confines of its legacy infrastructure. Additionally, increasing competition from national lab service providers has driven competitive responses from regional and local players, including the formation of lab networks (whether formal or informal), and has changed the competitive landscape. These forces have changed the lab into a more complex, distributed and political environment with more complexity than before.

In the solution-centric paradigm, lab managers identify the business problems they want IT to solve, and they pursue the IT components that their operation requires for success.

Although the lab’s purview may have been a homogeneous organization in the past, today many labs are a heterogeneous mix of multiple organizations, processes and technology solutions. These changing forces present new IT challenges as lab operations now manage and interact with multiple lab information systems, oftentimes using competing technology platforms driving different workflows and addressing different service needs.

Two underlying principles should guide lab managers in their efforts to manage the new, heterogeneous nature of institutional labs and maximize revenue opportunities for the enterprise: 1) One size does not fit all; and 2) Connectivity and communication are critical components for laboratory success. As the lab reaches out, interacting with constituents beyond its original service area, its ability to provide superior customer service and remote access to lab information becomes a salient business driver, requiring IT to push the LIS beyond initial design.

Driven by the enterprise mission to maximize profits and the significant opportunity cost (in both time and money) of replacing the LIS, labs are looking for strategic approaches that maximize their current investment while enabling them to add the features and functions they want in the future. With the business driver centered on new investments in technology, operations must pay for themselves by reducing expenses or expanding the business.

For example, we work with lab management teams looking to expand their business via outreach. These customers view outreach as a profit opportunity, justifying their investment on the ROI of entering outreach, including the cost-benefit of investing in IT solutions to enable outreach.

The investment decision is justified by the projected ROI and is influenced by the impact these solutions will have on business. The right solution will deliver on these promises, and in many cases, the results can be dramatic. In today’s competitive healthcare market, a strong return on investment is essential for management success.

ROI is a critical success factor in all lab investments, and lab managers know that ROI has many facets. It’s more than getting your money back. Other tangible components and facets to consider include:

These are the new questions driving clinical labs that want to grow their business. This drive for bottom line growth is reaching beyond the early adopters. Labs looking for operational success are fueling the next wave of IT investment, moving away from the monolithic LIS to solutions. These labs are driving the market to produce sophisticated solutions that meet their individual needs and address the complexities of their individual markets. At the vanguard are IT solutions that enable specialized workflow, including multistage/multilab order processing, interfaces with multiple legacy systems such as disparate LIS platforms, and driving emerging technologies.

Labs looking for operational success are fueling the next wave of IT investment, moving away from the monolithic LIS to solutions.

The new questions in the lab are: Can one vendor provide me with all the solutions that I need to bring these diverse communities together? What is the “glue” that holds my IT investments together? Can I offer a next-generation solution without sacrificing the end-user’s experience or altering my existing workflow processes?

A Solution-centric Model
These questions are driving the next paradigm of lab excellence: solution-centric IT. In the solution-centric paradigm, lab managers identify the business problems they want IT to solve, and they pursue the IT components that their operation requires for success. They challenge the vendor to address their business goals and to work with them as a trusted advisor and partner. They are not limited to their LIS vendor; they look across the market for the right solutions. In this new world, lab managers look to augment their existing investments with best-of-breed solution sets that enable their business goals.

The solution-centric shift drives the IT decisions from the enterprise IT department into individual business units. In the old paradigm, the notion of efficiency driven by a mix of different technology components across disparate systems seemed counterintuitive and doomed to failure.

In the past, it was very difficult to integrate competing platforms; each solution was a proprietary “black box” designed to stand alone. Today, with the market-driven migration to standards-based technology, communication, storage and retrieval platforms for clinical information, HL7 and object-oriented programming paradigms, it is possible to deliver a best-of-breed solution that is better, faster, cheaper and tailored to the individual needs of the purchasing lab.

Beyond the LIS, nimbler, more flexible solution providers have entered the market that both provide some LIS features and augment existing LIS systems. The first wave optimized the user interface, enabling front ends that focused on remote order entry and results review. The second wave is driving a comprehensive evolution in workflow optimization, including optimization inside the lab, between the lab and its customers, between labs and across the enterprise.

The difficult challenge for vendors in this second wave of lab IT is addressing the lab’s need for a system that is effective out of the box, without limiting the lab’s ability to operate with its individualized workflow needs. An effective solution must be flexible; cookie-cutter style won’t work. Instead of delivering a hard-wired automated business process, next-generation developers elevate configurability to paramount importance, enabling platforms that can support multiple individualized workflows without sacrificing functionality, performance or ease of use.

These next-generation configurable systems enable labs and the LIS to thrive in a rapidly changing market by leveraging standards-based solutions that address each lab’s unique needs. Whether it is providing support for mobile PDAs that put information in the hands of physicians for ordering tests and reviewing information, or multistage ordering capability that drives orders to the patient service centers by optimizing workflow tasks, like collecting samples, signed ABNs (advance beneficiary notices) and electronic order entry and electronic transmission of the order to the lab, the solution-driven lab provides the features and functions its constituents need to be successful.

The lab’s reach must now extend across multiple systems via interfaces that allow disparate LIS systems to communicate and function together in a unified manner. Orders and results need to be synchronized and available with electronic health records and electronic medical records; connectivity is pervasive across the enterprise.

As markets become more mature, environments become too complex to be effectively serviced by one vendor. Savvy labs see the need to operate under the guise of a single integrated system, but approach IT offerings as an a la carte or cafeteria plan, utilizing features and functions from different vendors to build a system tailored to their individual needs. While not always straightforward, this is the new world of opportunity, which enables labs to evolve to higher service levels without stopping the business to overhaul the system.

Bringing it all together, the answer is solution-centric. Today’s clinical lab managers must ask themselves, Is the technology solution I’m adopting right for the enterprise and its customers? Armed with years of experience working with computers in the lab, they now can critically assess what solutions will work and can confidently leverage IT as a tool, a business driver to improve customer satisfaction, improve patient care, increase service levels, boost revenue and enhance their competitive advantage. In the bold new world of healthcare excellence, best-of-breed information technology solutions offer labs the choices they need to attain business excellence.

For more information about outreach solutions from Atlas Medical and Atlas Development Corp.,
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