Quality Improvement as the Basis for Judging the Success of an LIS

I have made reference in a previous note (see: President of eClinicalWorks Discusses PHRs and Patient Portals) to an interview by Mr. HIStalk of Girish Kumar Navani, president of eClinicalWorks (see: HIStalk Interviews Girish Kumar Navani, President of eClinicalWorks). In this same interview, I was struck by another passage in which Navani discusses the quality of health information systems. Below is an excerpt from the interview (boldface emphasis mine):

I recall an incident sitting with the assistant commissioner of New York City at a dinner table, with five eCW folks and him and his team....The commissioner asked us a question: "Tell me what you would consider to be the success and failure of this project?" I said, "I think if physicians don’t adopt the EMR and use it every day, I’d classify that as a failure." ...He said, "I disagree. If at the end of this project we cannot demonstrate that we improved the quality of care, i.e. we did not improve hypertension or control blood pressure and get diabetes under control and look a those 10 different values that the city measures themselves on, we will have a failure." That statement was an eye-opener to me and to many in that room. The vision of that project was not just get it implemented. It was, "After the implementation, prove to me it’s going to improve quality."

This notion of judging the success of a health information system on the basis of quality improvement got me thinking about success criteria relating to LIS deployments. I have been working with such systems for 26 years and I can say with certainty that most pathology departments define a successful LIS deployment using mainly what I will call "laboratory metrics." By this I mean that they are generally seeking improvements in lab operations, often relating to billing and efficient use of personnel. However, one departmental goal that is also very important for clinicians is improved test-turnaround-time (TAT).

Given that lab testing is critical for all clinical care, it seems to me that some of the success criteria for an LIS deployment should focus on the efficiency and effectiveness of the clinicians in their use of lab tests. Admittedly, TAT would fall into this category. However, let's pose another question. To what extent does the LIS-enabled test ordering process contribute to the appropriate use of the laboratory and lab testing? The answer to this question is probably very little and there is also little hope for change, given that most lab tests are now ordered via the hospital EMR with the order then transferred to the LIS.