We have just completed the API Strategic Summit, a gathering of pathology informaticians and lab professionals from across the country in Pittsburgh underwritten by Cerner, Sunquest, McKesson, and SCC Soft (see: Attend the Strategic Summit: Help Decide the Future of the LIS and Pathology Informatics). The conference consisted of a total of 12 lectures over an evening and a day. Its focus was an analysis of the future of the LIS and pathology informatics in the era of dominant EMRs. More detailed strategic questions that were addressed at the conference are available on the API web site.
The first lecture on the evening of June 7, 2012, was by Mike Becich who discussed the future of pathology and personalized medicine. The next day's schedule consisted of a total of 11 lectures, four by representatives of the corporate underwriters and seven others by faculty members selected on a competitive basis. A white paper is now under development that will provide a formal summary of the entire event. Meanwhile, I want to present, in a series of blog notes on Lab Soft News, what I personally consider the major take-away lessons from the conference.
Epic is rapidly becoming the most common EMR to in hospitals 500 beds or larger and grabbing most new contracts and installs. The company offers an LIS called Beaker as one of its modules as part of its business model of providing an "enterprise wide solution" (EWS). One commonly hears on the street that Beaker is free. This assertion requires significant qualification. If lab professionals accept this idea at face value, their future careers clould be in serious jeopardy. Beaker is "free" only in the sense that its software licensing fee is wrapped up in up-front price paid for the Epic EWS by hospitals. However and more importantly, there are significant installation costs involved in bringing Beaker live. Two LIS consultants present at the Strategic Summit estimated the current installation costs for Beaker at about $800,000 to $1,400,000, depending on hospital size. These are only estimates and may vary by deal and individual negotiations. By way of contrast, a fully-functional, best-of-breed LIS for a medium-sized hospital would cost roughly $2,000,000 for licensing fees and installation. However, the functionality of Beaker is significantly limited.
I was also told by faculty and attendees at the Strategic Summit that Beaker provides good functionality for chemistry and hematology and average or sub-average functionality for microbiology and surgical pathology. There are no blood bank or molecular pathology modules at this time or a lab-oriented outreach product (see: Details about Epic's Beaker LIS, Supplied by the Company). Lab rules capability is limited to what is offered by the Data Innovations "middleware" that is baked into Beaker with most of the rules focused on chemistry and hematology. Beaker plus the additional software that must be installed to achieve the necessary lab functionality may well end up costing the same or more than a best-of-breed system that begins with broad functionality. In addition and with the "Beaker plus" (i.e., hybrid) design approach, the lab is faced with a major system integration headache.
Given these circumstances, the question needs to be asked why would the lab leadership choose to install the immature Beaker product at all. From my perspective, there are two possible reasons. The first is to satisfy their hospital executives who may be laboring under the misapprehension that Beaker is free and also eager to please Epic with another Beaker install. The second reason is to provide lab professionals working in the hospital the "opportunity" to teach the Epic personnnel how to manage lab workflow and lab computing. As presented in a previous note posted in August 2011, the company reported that it had assigned about 50 employees out of more than 4,000 to LIS development, installation, and support (see: Here Comes Epic's Beaker LIS -- Ready or Not). This number may be larger now. I was told at the Strategic Summit that the company has almost no "lab experts" on the payroll as most of us would define the term. The commpany is going to need a lot of help to turn Beaker into a mature, best-of-breed LIS.