I have posted a number of previous notes about Beaker, Epic's LIS. We now learn that Allina Health, with one of the largest and most complex hospital and lab operations in the country, is entering a phased rollout of the Beaker LIS over the next 18 months (see: Epic Beaker Laboratory Information System (LIS)). Below are snippets from the Allina web page discussing the project and designed primarily for internal and client consumption:
Earlier this year, Allina Hospitals & Clinics changed its name to Allina Health to better define who we are and what we do for patients and communities. Along with this name change, we're implementing the Epic Beaker Laboratory Information System (LIS) in a phased rollout approach over the next 18 months. The first phase occurs Saturday, July 14, 2012 at select Allina Health hospitals and clinics. We'll continue to offer consolidated laboratory services from each of our ten Allina Health hospitals.
What is Beaker: Beaker is a laboratory module that is fully integrated with our electronic health record (EHR), Excellian. It supports inpatient and ambulatory laboratory workflows, combining best-of-breed LIS functionality with the benefits of enterprise-wide integration for all Allina Health clinics and hospitals.
What to Expect: As this is will be a phased rollout, some Allina Health sites will remain on our current system, which is GE Ultra, while others will migrate to Beaker. Our Central Laboratory is scheduled to go live with Beaker in fall 2013. If some of your reference laboratory work is performed at a site that is using Beaker, and some testing sent to the Central Laboratory for testing, you will see multiple report types (from Beaker and Ultra) until the full Beaker implementation is completed in 2013.
Interim State: Term used for the time after first Beaker go-live until the final Beaker go-live.
The next 18 months will be a "do or die" period for the labs at Allina Health and Epic as far as the future of Beaker goes. In essence, it's their "Kaiser" moment, referring back to the time some six years ago when Kaiser began to go live on the Epic EMR in multiple facilities with lots of major problems (see: Kaiser & Epic Respond to Justen Deal's E-Criticism). Some of the problems were reported by an internal IT whistle-blower named Justen Deal. Justen ultimately departed from Kaiser as a result of his indiscretions. Allina has been put into its state of LIS-disequilibrium by the GE withdrawal of support for its Ultra LIS, formerly a Triple G product. Beaker apparently seemed like a reasonable choice of LISs for the Allina and lab executives given the the Allina hospitals were running the Epic EMR.
Note the quote above from the Allina web page that Beaker combines "best-of-breed LIS functionality with the benefits of enterprise-wide integration for all Allina Health clinics and hospitals." A best-of- breed LIS is a product that shows optimal performance across all multiple lab modules (e.g., chemistry, hematology, microbiology, HLA/transplantation, blood bank, surgical pathology) when compared to competitors in the market. Generally speaking, we are talking here about Cerner, Sunquest, and SCC Soft for larger hospitals. It would be unreasonable to use this term to refer to Beaker which, by the company's own admission, lacks some of these modules or has them under development (see: Details about Epic's Beaker LIS, Supplied by the Company). Dennis Winsten, an LIS consultant with more than three decades of experience referred to Beaker at last June's API Strategic Summit as a work-in-process (left; ENTERPRISE-WIDE INTEGRATED LIS OR BEST-OF-BREED LIS?; slide #3). However, it does occur to me that if Allina can successfully deploy Beaker in ten hospitals and a large outreach business, it, and Epic, could declare that the LIS has been tested and is suitable for most hospitals. This is a very big deal for both Allina and Epic.
The major question at hand is whether Allina Health can succeed in the next 18 months in deploying Beaker and successfully meeting its lab computing requirements. For me, the question boils down to the following questions:
- What range of functionality will be expected from Beaker? It sounds like there is pressure within Allina to completely leave the now unsupported Ultra LIS. I am assuming that Epic will never deploy a blood bank module so some ancillary, supported LIS products other than Beaker will be required.
- Unlike LIS vendors like Sunquest, Epic did not arise out of a lab milieu and lacks some of the internal lab expertise that is necessary to build a robust, best-of-breed LIS. I will therefore assume that Epic will tap into Allina's lab experience to better understand lab workflow and the more esoteric lab issues. This will drain Allina's lab leadership and productivity over the next couple of years at least.
- How about the money to support this very ambitious project? This is "do or die" for Allina so I will assume that they have given Epic a blank check for Beaker development. This project will be the "super-beta" for Beaker and will thus cost tens of millions of dollars in the final accounting. Money will probably not be the limiting factor in this project because Allina has so much at stake.
- How about Epic mindshare? Lab computing has been mainly a side-show for Epic in the past. My February, 2011, notes cites 51 employees out of some 4,000 working on Beaker (see: Details about Epic's Beaker LIS, Supplied by the Company). The company head-count now exceeds 5,000. Nevertheless, the company continues to close most of the EMR deals in U.S. hospitals greater than 500 beds and is now active in England. How badly does it want a best-of-breed LIS when a good-enough LIS will suffice for many of its hospital clients? How many balls can it keep in the air at one time?
- During a difficult transition to a new LIS, hospital executives can usually suppress internal employee revolts for a year or two at the most. However, this same logic does not apply to outreach lab clients who can turn to reference lab competitors in the market. Will Allina get hit hard on this side of the business that goes right to the bottom line? When, and for long, will Allina clinicians tolerate this "interim state" for lab computing and force the hospital executives to scream enough? Unfortunately for Allina, Epic carries a big stick and probably would not allow this project to be abandoned. This would force Allina to throw FTEs at an inadequate LIS which is not easy in a more cost-sensitive environment.
My prediction is the following: After about two years, Allina will be limping along on a still inadequate Beaker plus ancillary software products. It will then declare victory. Total lab operations will take much longer to recover from this trauma.