In my note of two days ago, I discussed how Mayo Clinic has developed a decision support and report generation tool called CareSelect Lab in collaboration with a company called the National Decision Support. The system is deployed on the EHR side (see: Mayo Develops CareSelect Tool to Guide Best Lab Practices for Clinicians). I went on to point out that the tool performs functions such as flagging obsolete tests and clarifying confusing test names. It can also generate standardized reports of test utilization by hospital physicians. I went on to say the following: "Lab professionals have been trying to inform clinicians about duplicate testing and comparing physician test-ordering practices for decades with variable degrees of success in changing test ordering habits." I thought that it might be appropriate to provide more detail about this statement.
For perhaps thirty years, LIS vendors have provided the capability for lab professionals to create rules that could scan lab test orders and the lab database to generate if-then actions and reports very similar to the described capabilities of Mayo's CareSelect Lab. Cerner, which launched as an LIS vendor, even created a specific language called Cerner Command Language (CCL) that was used to create such rules (see: Cerner CCL). Here is a paragraph describing CCL from the Wikipedia:
Cerner CCL (Cerner Command Language) is the Cerner Corporation fourth-generation programming language, which is expressed in the Cerner Discern Explorer solution. CCL is patterned after the Structured Query Language (SQL). All Cerner Millennium health information technology solutions use CCL/Discern Explorer to select from, insert into, update into and delete from a Cerner Millennium database. CCL allows a programmer to fetch data from an Oracle database and display it as the user wants to see. With features like, Record Structure and subroutines, it allows us to get data from database and manipulate it by storing in a temporary structure; execute a particular section of the code, if required using a subroutine.
We are now entering an era when "lab modules" like Beaker from Epic are being adopted as replacements for classic LISs that lab professionals have installed and maintained for decades within pathology. Instead of having a rules engine that operates directly on the LIS, we now see, as in the case of the Mayo product, lab decision support installed on the EHR side. This makes sense in that the EHR is the system where clinicians order tests and review test results. However, in many ways this seems like retrograde movement in terms of the sophistication of healthcare IT. The benefits that are being claimed by the CareSelect Lab tool have been the norm for decades with LIS-based rules scrutinizing lab test ordering and resulting.