I am reconciled to the fact that many pathology departments will be running Epic's LIS, Beaker. Hospital executives continue to seek an enterprise wide solution to support their hospital IT needs. After perhaps selecting Epic's EHR, they will often gravitate to Beaker for their LIS. Beaker has added sufficient functionality such that it now can be described as a satisfactory choice in the face of pressure from the C-suite. Beaker can thus be described as a generic LIS. It will never achieve the status of a best-of-breed LIS because there is no need for Epic to improve it to the highest functionality level. Epic's core business is its EHR. It's not possible, nor even necessary, for the company to extensively develop its departmental modules.
Another reason why Beaker will never achieve all of the functionality required by sophisticated pathology departments is the rapidity of scientific discovery in the fields of molecular pathology, genomics, and digital pathology. In order to meet this LIS functionality vacuum, new specialized software companies will inevitably arise to meet the needs not supplied by Beaker. Pathology departments running Beaker will need to purchase a number of such specialized laboratory software products but will then require a system integrator on the lab side to knit together the information output of their installed specialized systems that will then be interfaced to Beaker and the EHR for reporting. There is currently no provider of such integration services fo pathology departments.
On the hospital-side, system integration requirements are being met by Epic. Specialized software companies must decide whether to participate in the Epic ecosystem. I have previously discussed this ecosystem in relation to the deployment of a lab rules product developed by Mayo and National Decision Support that is installed on the hospital side (see: Rule-Based Decision Support Tools Available on LISs for Decades; Lab Rules Firing at the Time of Test Order; Possible on the LIS?). The advantage of this ecosystem from Epic's perspective is that it has control over all of these specialized software companies and can also take contractual measures to avoid poaching of its employees by other companies.
I doubt whether Epic would have any interest in developing ecosystems in pathology similar to those on the hospital side because its culture is based on a centralized IT model. Another reason for lack of interest on the part of Epic in developing a pathology ecosystem is that it would be a tacit admission that Beaker lacked desired functionalities. However, Epic could theoretically be forced to allow interfaces of specialized pathology products to Beaker but only on the basis of extreme pressure from client hospital C-Suites. Therefore, the only way to force Epic to permit specialized software vendors on the pathology side is by such leveraging. Initial responsibility for this rests with leadership of the pathology departments.