Editors Note: The is the 11th installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, formerly called Computers in Healthcare. This article appeared in the September 1993 issue. At the time, Jack Darnell was senior product manager of laboratory information systems at Houston-based CHC Corp.

DarnellOperating a laboratory in the 1990s and beyond will require managers — and laboratory information systems — to closely consider four trends: quality outcomes measurement, patient view of clinical information, point-of-care testing and community health networks.

In the 1970s, a few forward-thinking healthcare institutions took a bold leap into the future by implementing a system to automate and track certain tests and procedures in their laboratories. Although these first laboratory information systems were a rudimentary precursor to today's LIS, the systems represented a new way to address the trends in laboratory use. Advances in patient care translated into a greater volume of tests processed through hospital laboratories. This, in turn, dictated the need for automation in the lab. Even then, laboratories were under pressure to handle more patients and process test results faster and more efficiently.

Automation not only achieved these goals, it enabled healthcare institutions to operate their labs more profitably and efficiently.

The healthcare landscape in the 1990s, however, reveals a much different picture. Although only two decades have passed, the pressures facing healthcare institutions center on the trend toward greater cost control and managed care. Laboratory information systems, in turn, are evolving to meet the new demands of the healthcare market. Hospital labs still are expected to process more results in a faster, more efficient and accurate manner. But processing, tracking and recording test results in only the first step. For an LIS to remain a competitive tool, it must also create and support a database of knowledge to assist physicians in analyzing data and solving management problems.

Four trends
Hospitals that were quick to adopt early laboratory information systems are beginning to consider features that are required for the 21st century. Other institutions are evaluating their existing systems. Both will need to consider key trends affecting their evolving information systems strategies. Four general trends will play the most prominent roles in utilizing laboratory information systems in the coming decade: quality outcome measurements, patient view of clinical information, point-of-care testing and community health networks.

The managed-care environment will place greater emphasis on hospital labs to help track quality outcome measurement. In a managed-care environment, healthcare providers will be forced to place a greater emphasis on measuring the quality of the care and cost-effectiveness they provide.

As a result, laboratory information systems must be able to store and analyze in-depth cost and clinical data to help measure patient outcomes. In doing so, the LIS can provide input to clinicians and administrators on protocols of care that target various cost and quality benchmarks. An advanced LIS enables an institution to more easily monitor the progress of a patient's treatment plan, ensuring appropriate tests are ordered and analyzed.

In addition, the lab system must correlate ordered tests to patient eligibility. Managed care reduces spending by eliminating unnecessary tests. The LIS must confirm that all tests will be approved for payment by the insurer. It must also ensure that these tests conform to the practice guidelines defined by the healthcare institution for that patient's diagnosis.

A “rules-based” laboratory information system enables healthcare institutions to achieve both these goals. These “rules” mimic the process of human logic by making “if-then” determinations at various stages in the order entry/result entry process. When an order for a test is entered into the lab system, for example, the rules determine if the patient is eligible for the protocol and that the ordered procedure is part of the treatment plan for the patient's diagnosis. Allowances will be a necessary component. The ability to track these variances can help users monitor utilization and adjust practice guidelines, if necessary.

Laboratory information systems are becoming the focal point for creating a “patient view” of clinical information. Medical information about each patient within the healthcare institution has traditionally been viewed on a departmental basis. Each department in the hospital — radiology, pharmacy and laboratory — has maintained its own separate database on the same patient. The information was not chronologically consolidated to show the outcomes of the treatment process, nor was it immediately accessible on an enterprise-wide basis.

With this type of comprehensive online patient profile, physicians can monitor the dates of specific treatments, procedures and lab results — as well as the cause and effect of each — and more effectively prescribe the next course of action.

Point-of-care testing will bring greater efficiencies and productivity to hospital labs. It will also result in improved patient care. The growth of point-of-care testing has resulted from the need to reduce the turn-around time of tests and integrate laboratory clinicians into patient-focused teams. The integration of POC technology with the laboratory information system must occur on a real-time basis. Because POC technology is still considered to be in the development stage, current users will play a critical role in determining the way this tool will be implemented in the future.

While POC technologies have been viewed as an expensive experiment by some hospitals, POC can actually contribute to an institution's cost-control efforts. Data entry at the bedside or within a clinic can help eliminate typical delays in the treatment process. The more quickly this data is entered and the results analyzed, the sooner the next phase of patient treatment can be ordered. This eliminates expensive downtime in the treatment protocol.

Integration of clinical patient data will require greater information sharing among multiple hospitals across an increasingly larger geographic area. Many hospitals have recognized the need to track patient-physician encounters and treatment patterns across multiple facilities in their networks or regional healthcare systems.

Under the managed-competition strategy, physicians, employers and insurers will enter into these types of community health networks with hospitals as a way to increase efficiencies of clinical data networks in providing services. Through HL7 and other attempts to standardize clinical data networks, laboratory testing information could be accessed by anyone (with the appropriate security) supporting these networks. This comprehensive level of data about a patient's medical history will enable these cooperative networks to better manage the patient's current and future treatment plans.

Maximizing technology
These four key trends can play a major role in balancing the need for advanced technology with the need to justify technology investment — all while proving technology's contribution to improved patient care. By addressing each of these trends — quality-outcome measurements, patient view of clinical information, point-of-care testing and community-health-information networks — when considering the effectiveness of a laboratory information system, a healthcare institution or network will ensure that it maximizes its investment in technology and human resources.

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