This past Friday, September 20, I delivered a lecture at the ASCP annual conference in Chicago entitled Preparing for Seismic Shifts in Pathology Informatics. The Association for Pathology Informatics (API) recently developed a collaborative relationship with ASCP so API members were asked to deliver 21 hours of content at this meeting (see: API and ASCP Forge Alliance). The major thrust of my presentation was that hospital executive officers have become increasing enamored with enterprise-wide IT solutions (EWS) such as Epic. With an EWS, the vendor supplies the EHR for a hospital plus a set of departmental systems including an LIS and an RIS.
In the case of Epic, their LIS is called Beaker. I have posted a number of previous notes about it. It has been described to me as "pretty good" or what I refer to in my lecture linked to above as "good enough." This is to say that it is immature but improving (see: Details about Epic's Beaker LIS, Supplied by the Company; A Pathologist Describes His Firsthand Experience with a Demo of Epic's Beaker LIS; Allina Health Begins a Phased Rollout of Epic's Beaker LIS; Here Comes Epic's Beaker LIS -- Ready or Not; Lessons from the API Strategic Summit: Beaker LIS Is Not "Free"). However, most lab IT observers agree that there are some functionality gaps with Beaker such as blood bank and lab outreach. I have been told that Epic is striving to improve Beaker functionality and has been adding FTEs to the Beaker business unit.
An EWS such as Epic holds great appeal for hospital executive officers, particularly CIOs, because the vendor takes responsibility for the integration of all modules. The downside is that the system is expensive (see: The Cost of Deploying an Epic EMR and the "Oreo Cookie" Analogy), many of the departmental modules do not achieve the status of best-of-breed, and the hospital deploying the product ends up with a monolithic system that can can sometimes lead to catastrophic system-wide computer failures. An example of this was the crash recently reported for the Sutter Epic EHR (see: Sutter Health System EHR Crash Reported by Nursing Union). It was recently suggested to me by a prominent hospital CIO that such EHR melt-downs, both acute and in slo-mo, may become more common.
On June 8, 2012, the API convened a strategic summit in Pittsburgh to address the question of how LISs and pathology informatics can continue to thrive in an era in which EHRs dominate the landscape. It was concluded that a set of tools was needed to measure the functionality of an existing LIS or one that was offered to pathology as a component of an EWS strategy. Last Friday and coincident with my lecture in Chicago, the API posted on its web site for download an LIS Functionality Assessment Toolkit (LIS-FAT). It consists of the following four components:
- A white paper that describes the strategic importance of installing/maintaing an LIS with maximum functionality and also discusses how to use the tools provide in the three appendices to it.
- Appendix I consisting of a list of 850 weighted functionality statements that can be used to evaluate an LIS and also identify functionality gaps.
- Appendix II consisting of ideas for scripted scenarios that can be used to guide an LIS vendor in an on-site live demo of the system.
- Appendix III with suggestions about how to develop a total-cost-of-ownership (TCO) worksheet in order to measure the true cost of an LIS plus the cost of plugging functionality gaps.
In this same context, you may also want to read an outstanding article that was published in the August issue of CAP Today that provided a detailed discussion of LIS functionality, anticipating the posting of the LIS-FAT on the API web site (see: Toolkit lets the lab make the case for the right LIS).