In my last two notes, I have been discussing the potentially disruptive effect of the Theranos business model, particularly with reference to Quest Diagnostics and Lab Corp (see: Finally, Some Important New Details about the Theranos Business Model; Quest Diagnostics and Lab Corp Business Models Becoming Obsolete). In my analysis, I made mention that Theranos must deploy software to manage their test results and then transmit them to hospitals and physician offices. In other words, they will need some type of LIS, perhaps one analogous analogous to Quest's Care360. An important question, then, is what software will they will choose or perhaps what software are they already using in their small number of Walgreens pilot sites.
I now digress briefly to discuss hospital lab outreach programs. Under such programs, lab testing is performed in hospital-based labs for ambulatory patients who most often are under the care of physicians with a relationship to that hospital. Think of this as hospital-based labs operating as reference labs and competing with Quest and Lab Corp. If the patients being tested are admitted to the hospital, it's important that their test results are available in a hospital system to provide a longitudinal health record for them. Hospital labs commonly use outreach software to transfer the results from physician offices, most commonly to the hospital LIS database. However, I learned years ago that some hospitals were using such outreach software to transfer physician office test results to the hospital EHR and not to the LIS. This results in a fragmentation of lab database with the only complete record stored in the EHR and not in the LIS, the traditional repository of all test results.
If I were forced to predict what IT steps Theranos might take, I suspect that they would prefer to deploy a system such as Epic's LIS called Beaker which I have blogged about in the past (see: Here Comes Epic's Beaker LIS -- Ready or Not; Details about Epic's Beaker LIS, Supplied by the Company). A Walgreens competitor, CVS's MinuteClinic, has already been reported as using the Epic EHR (see: MinuteClinic taps Epic for EMR). By deploying Beaker as its LIS, Theranos would both acquire a LIS to manage its test results but also the ability to communicate test results to any hospital or health system with Epic. In a recent survey, 23% of physician respondents indicated that they used an Epic EHR. In 2011, it was claimed that 38 percent of all patients in the U.S. had records stored on Epic (see: ShandsHealth Goes Live with Epic; Company Penetration of the Hospital Market).
One additional point needs to be emphasized here. Epic's EHR has only one database. If the Beaker LIS is also installed in a hospital, there is no separate LIS database. If a hospital runs an Epic EHR and also runs an LIS from another vendor, that LIS will have a separate database interfaced to the Epic EHR database. Unfortunately, there is no "reverse feed" of test results transmitted only to the EHR database back to the LIS in such hospitals (see: "Reverse Feed" of Clinical Data from EHR to the LIS -- Will This Ever Happen?).