I raised the topic of Epic's LIS, Beaker, in a recent note (see: Introducing the Epic Laboratory Information System (LIS); It's Called Beaker). Now comes another unverified piece of news about the product from a comment in HIStalk (see: News 8/4/10), I present it in its entirety:
From LISales: “Re: Epic Beaker LIS. Word on the street is that they have one SMALL site using the system within the Wisconsin area, but nothing major yet. I’ve also heard that they are beefing up the development team while including the licensing right to the module within ALL of their enterprise licensing agreements. Also heard is that the functionality is being somewhat oversold compared to actual capability with no desire to develop certain aspects of a full-scale laboratory’s needs, Blood Bank to name but one.” Unverified [by HIStalk].
One word of caution here: this comment was submitted by someone with the nom de plume of LISsales, suggesting perhaps that he or she is involved with sales of a competing LIS product. However, the comment contains at least a grain of truth. It's a common practice for major EMR vendors such as Epic to shrink-wrap an inadequate LIS, or one early in development, with the sought-after EMR in the contract. This is probably even more prevalent these days with many CIOs seeking an enterprise rather than a best-of-breed solution (see: Are You an Enterprise or Best-of-Breed CIO? Access to Cash May Make the Difference.).
This EMR + LIS packaging may be offered for no additional licensing fees as a come-on. The company will then obtain their LIS margin "on the come" with the yearly support fees for the total system. Of course, there is also some padding in the up-front licensing fees. The net result of all of this is that pressure is applied on the lab leadership to join the crowd in the support of the "enterprise solution" from a single vendor. This is fine in theory but the pursuit of such a solution should not penalize the lab personnel who are required to work with a suboptimal LIS.
You may suggest at this point that the position of Epic with their immature Beaker LIS product is no different than any of the current best-of-breed LISs like SCC or Sunquest or Cerner. All of these products at one time or another had a small installed client base and worked with their beta clients to improve their product. Fair enough! In my mind, here's the difference with this Epic scenario. For Epic, their LIS will always be a subservient feeder system for their EMR and never a best-of-breed system. The LIS has always been more than a reporting system for the labs -- it optimizes lab workflows and also provide critical quality control functions. A "good enough" LIS will never suffice and that's why most lab professionals endorse the best-of-breed approach.
Another key point needs to be raised here. I believe that medical diagnostics, composed primarily of in-vitro diagnostics (IVD), pathology, and radiology, has been operating on a different IT development curve than hospital and office EMRs for a number of years. This will eventually result in two separate but inter-connected medical information networks: the clinical EMR and the diagnostic EMR. The reason for this dichotomy is that clinical EMRs (hospital plus physician office systems) will never be able to adequately manage, report, and store the increasingly complex data ( textual, numerical, and image) generated in the diagnostic services. Even the specialized LIS vendors are having trouble satisfying the information processing requirements of molecular diagnostics. Aa another example of this complexity, vendors are having difficult merging RISs and PACS systems. This clinical/diagnostic dichotomy will never be recognized, or even fully understood, by Epic executives.
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