In my note yesterday, I began my personal interpretation of some of the most significant ideas that were discussed during the recent API Strategic Summit (see: Lessons from the API Strategic Summit: Beaker LIS Is Not "Free"). The conference was convened to discuss the future of the LIS and pathology informatics in the era of powerful EMRs. For today's note, I would like to discuss the term best-of-breed LIS. This topic was prompted by a question posed to me at the Strategic Summit by the president of the API, Ray Aller. He asked: why is is only now that we are beginning to grapple with a formal defintion for a best-of-breed (BOB) LIS? The answer is that for approximately four decades, there was no need to define a BOB LIS because everyone thought that they understood the term. In other words, there was a general consensus about the definition. This consensus now seems to be growing weaker.
Simply put, a BOB LIS is a system supplied by a single vendor with a broad range of modules and functionalities, each of which was deemed to be superior, or at least equal, to the competing systems in the market. It was also commonly understood that the LIS market was segmented by hospital/lab size so the return-on-investment (ROI) needed to be factored into this equation. An LIS designed for a large, complex lab might deliver too big and expensive a "payload" for a smaller lab so a different LIS might be considered BOB for that smaller lab segment.
It was axiomatic in the LIS world that the founders of LIS companies had emerged from the clinical lab industry or that the LIS vendors would always hire lab professionals to help design their software and serve as liaisons to lab clients. It was also axiomatic that there was an active "conveyor belt" for ideas about new lab functions between the hospital lab professionals and the LIS vendors. The goal was to continually enhance the LIS software as the overarching lab mission evolved and changed.
The definition for a BOB began to unravel when some vendors began to focus on the requirements of individual labs/functions such as blood bank, surgical pathology, or lab outreach. Some of these specialized vendors began to outshine the "classic LIS vendors" at their own game. In other words, they developed expertise in smaller and more specialized lab niches. An example today is whole-slide-imaging for which specialized vendors provide both hardware (i.e, slide scanners) and the requisite support software. Lab professionals responded by retaining their "classic LIS" but also purchasing these new systems and interfaced them to their classic LISs.
A new, competing model is now rapidly coming to the forefront -- the enterprise-wide-solution (EWS) such as that provided by Epic. Epic views the electronic medical record (EMR), the major software tool used by clinicians, as the epicenter of the hospital computing universe and the functionality requirements of diagnostic departments as subservient. In this Epic model, the company conceptually supplies "shrink-wrap" integration of all modules so that hospital CIO's don't have to deal with the previous "Tower of Babel." An EWS vendor like Epic need not strive to develop a BOB LIS. Beaker only needs to be "good enough" because of the overall appeal of the value proposition of the Epic EMR to CIOs. In response, the hospital lab leadership needs to patch the lab functionality gaps opened by Beaker by deploying "specialized" lab systems or retain their BOB LISs. This is optimistically viewed as a stopgap measure until Epic delivers all the required software solutions.
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