The title of this blog note may not make sense at first glance. Clearly, the mission of hospital-based labs is to serve the hospitals in which they are embedded. The problem, however, is that the future of diagnostic medicine lies in the emergence of so-called precision medicine and national diagnostic networks. This former term was defined in a previous note thusly (see: A Closer Look at a New Yale Pathology Outreach Venture):
The use of genomic, epigenomic, exposure, and other data to define individual patterns of disease, potentially leading to better individual treatment.
Here's an additional quote from this note that relates to diagnostic information networks:
[The NAS Report calls for the development of a] multi-layered [knowledge management] system [that] would collect a broad range of health data through a vast information network ...integrated into our current health care settings. Rather than considering research efforts as separate from health care, the report suggests we collect standardized molecular, exposure, and clinical data useful for research as part of routine health care.
Hold these ideas for a minute and stay with me. The pursuit of precision medicine and a multilayered, diagnostic information network does not currently align with the goals of most hospital executives. Their dominant, current IT goal is more inward-looking. It consists of the installation and management of hospital EMRs designed to aggregate and manage internally generated information. Moreover, most hospital executives view the clinical information that is created within the hospital as proprietary. They do not want their patients hospital shopping using portable clinical data.
The dominant EMR vendor currently for larger hospitals for new installs is Epic. The company shares the strategic views of hospital executives stated in the previous paragraph, which is no accident. The company does not encourage interoperability across hospitals except among its own clients (see: More on Epic's (Non)-Interoperability and the Recent NYT Puff Piece). Some commentators also view Epic as not being particularly innovative by and through its development of a closed EMR. It's a walled garden but ones very much unlike that developed by Apple (see: Epic Challenge: What The Emergence of an EMR Giant Means For the Future of Healthcare Innovation).
So what does the future look like for the pathology hospital labs, particularly the larger science and technology driven ones? The answer in my mind is a type of schizophrenic mindset. Such labs will certainly generate the routine lab results that are required by hospital clinicians to serve inpatients and outpatients, utilizing IT resources such as the Epic EMR. Some will be forced to convert to the Epic LIS, Beaker. However and, ironically, in order to serve hospital patients better, these same hospital labs will become nodes on the external information and diagnostic network described above. Such a strategic direction will be necessary in order to provide the precision medicine knowledge and thus serve the future needs of the hospital physicians and patients. Most labs will utilize their current best-of-breed LISs to function as network nodes.
I was headed in this same direction by my comments in a previous note (see: Predicted Migration of "Some" LIS Functionality from Pathology to Central IT). Here's my conclusion in that note:
....I envision the following scenario [for hospital-based pathology and the clinical labs]: (1) some core lab computing functions will transfer to the central IT group in hospitals; (2) a set of new vendors will arise to support -omics and digital pathology; (3) these new systems will be selected, purchased, and installed by and in pathology; (4) these systems will have both an inward orientation, with reporting through the hospital EMR, and also an outward orientation as nodes on a national lab network; (5) this external network orientation will be critical for the survival of smaller hospitals because hospital labs will continue to receive -omics and tissue specimens but will be unable to perform many of the requested tests.
By the way, both hospital executives and EMR vendors like Epic will always state that one of their major goals will be the pursuit of precision medicine. However, if your press them for the roadmap for this goal, their answers will be vague.
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