I have recently concluded that the term "best-of-breed LIS" has ceased to be useful as products like Epic's Beaker approach the functionality of competing LISs. Beaker still lacks a blood bank module which causes customers to seek one from another vendor. Epic has been assisted in its pursuit of BoB status in part by the publication of the LIS Functionality Assessment Toolkit (LIS-FAT) by the Association for Pathology Informatics (see: The laboratory information system functionality assessment tool: Ensuring optimal software support for your laboratory; Toolkit Components). This detailed list of both mission critical and desirable LIS functions has operated as a roadmap for vendors such as Epic that wanted to improve their LISs to satisfy the EHR market. I think that the best-of-breed label thus no longer provides the ability to differentiate between vendors specializing in the lab market and those that offer an LIS module as a component of a much broader hospital-wide enterprise-wide software suite. I also suggest here that a new label, specialized lab software (SLS) vendor, should he used to refer to the specialized lab software vendors.
I cite Sunquest Information Systems as the best example of a prominent SLS vendor in order to better understand the value that is provided by the company. In recent months, Sunquest and its parent company Roper Technologies have purchased three companies, Data Innovations, Atlas Medical, and GeneInsight, all of which offer highly specialized products. To better understand the degree of specialization offered by these firms, one need only look at Data Innovations (DI) as an example. It's the leading global supplier of instrument interfaces. Such interfaces are a mission-critical component for the Beaker LIS as well as for the instruments sold by the major in-vitro diagnostic companies. As a make-or-buy decision, Epic and the IVD companies have decided that the domain expertise to develop instrument interfaces is such that they turn to DI to supply interfaces to their customers. The IVD companies, of course, have complete mastery over the development of the software/firmware necessary to operate their analyzers. However, their interest, enthusiasm, and market success for middleware, the software that sits between instruments and the LIS inducing interfaces and rules engines, has been limited over the years.
There is no question that Beaker benefits from certain advantages in the LIS market, notably the desire of hospital executives to seek an "integrated" solution from Epic. On the other hand and as a major SLS vendor, Sunquest may seek to develop pathology and lab software products that may be too specialized or too market-limited for Epic to pursue. The following seven examples come quickly to mind:
- Physician portal and lab outreach software.
- Molecular pathology and cancer genomics software.
- Anatomic pathology automation software.
- Pathology consultation network software.
- Pathology and lab analytics software with emphasis on lab operations.
- Digital pathology software.
- Image analysis software.
What then is the take-home lesson from this discussion for lab professionals who may be in the process of considering the purchase of a new LIS? The pursuit of the maximum functionality from any software purchase is, as always, a key factor in such a process. Computers substitute for labor in in this era of value-based care and software is critical in the automation of most lab tasks. For an EHR/enterprise-wide solution deployment, many of the functionality and financial benefits may lie outside of pathology and the labs. In the final analysis, however, pathology departments will always need to develop a relationship with one or more SLS vendors, both large and small, to provide lab and pathology software and functionalities not offered by their EHR vendor.