Predicted Migration of "Some" LIS Functionality from Pathology to Central IT

In a note posted last week, I discussed some criticisms of hospital IT systems by lab professionals, notably excessive log-on security and unhelpful help-desk personnel (see: Criticism of Hospital IT Services by Lab Professionals). Steve A. submitted the following comment in response to the post:

This is right on. But the origin of the problem is that "LIS" has slipped out of control of the laboratory into the larger emr/IT sphere. Pathologists (with help of lab organizations) need to reassert their authority over the reporting of lab results, be it on paper or on computer. But it is probably already a lost battle...

I agree with Steve. Many of the problems raised in my previous note can be tracked to the EMR and the hospital central IT personnel who manage that system. Like Steve, I think that some of the battle has been lost but I believe that there is a favorable solution on the horizon. First, though, a little history. For about three decades starting in the 1970s, lab professionals exercised almost total control over the LIS. During this era, hospital executives were preoccupied with the financial and patient management systems. In the absence of any clinical systems to call their own, they gratefully ceded control of the LIS to pathology.

There was a major shift beginning about two decades ago. EMRs became more mature and hospitals added CIO and CMIO positions to their executive suites. In recent years, vendors like Epic have begun to promote an "enterprise-wide solution" encompassing an EMR plus numerous ancillary systems like an LIS (Beaker) and an RIS (Radiant) (see: Are You an Enterprise or Best-of-Breed CIO? Access to Cash May Make the Difference; The Feasibility of Using the Epic EMR as a "Platform" to Extend Its Functionality). Epic is now dominating the large-hospital market because of the high success rate of deploying the Epic EMR and also because an Epic contract shifts the system integration solution from the hospital CIO to Epic (see: Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion). CIOs are thus pressuring lab professionals to cooperate and install Beaker.

I expect little significant push-back from the majority of pathologists as a result of this power shift. For many of them, pathology informatics has always been a step-child that does not resonate with their core competencies. Beaker is currently a very immature LIS but the company will inexorably improve its basic lab modules (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). Some larger hospitals will undoubtedly install the system in upcoming years, functioning as beta sites. In collaboration with Epic, they will work to improve the core LIS modules and functions such as biochemistry and hematology. These core modules will then rest largely under the control of the hospital central IT group with periodic "advice" from lab professionals.

Despite this scenario, the battle for pathology informatics has not been lost and, in fact, is very favorable. In my opinion, the future of pathology and lab medicine lies with molecular diagnostics, including all of the -omics subdisciplines, and digital pathology. Epic will never be able to adequately  support these emerging disciplines. The science is just moving too quickly and the company will not squander its resources too far afield from basic clinical computing. Even most of the large, incumbent LIS vendors have had difficulty supporting molecular diagnostics and digital pathology. The future will thus lie with emerging vendors of -omics and digital pathology (DP) systems. These new systems will provide sophisticated support for imaging algorithms and also integrate imaging systems with current LIS functions like reporting and billing. These emerging -omics/DP systems will also serve as nodes on a national diagnostic laboratory network for referrals of esoteric testing and consultation. Because much of this processing and storage will be in the "cloud," lab personnel will again operate quasi-independently from central IT personnel.

In summary, I envision the following scenario: (1) some core lab computing functions will transfer to the central IT group in hospitals; (2) a set of new vendors will arise to support -omics and digital pathology; (3) these new systems will be selected, purchased, and installed by and in pathology; (4) these systems will have both an inward orientation, with reporting through the hospital EMR, and also an outward orientation as nodes on a national lab network; (5) this external network orientation will be critical for the survival of smaller hospitals because hospital labs will continue to receive -omics and tissue specimens but will be unable to perform many of the requested tests.

Comments

[Seattle IT Services]

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[Jesus Ellin]

This is a great question to see if the transition of the labs basic functionality is going to the EMR. This wouls require the EMR to be commitent in managing emergning lab workflows and intrumentation. Pathology is an insteresting animal indeed, I agree we are seeing a convergence of a future Tidil wave of APLIS/informatics/ technology coming our way. But what you have not indicated is the preparation needed by the staff inorder to make this successful deployment. I believe the biggest achillies hill to why the shift occured was the reluctancy of having strong IT foundations within the core laboratory. This in part as seen the LIS at the time a way of automation and efficincy and not know what the data ment for the future. If the Pathology community can grasp this concept at an early age we would be able to shift back ownership to where its intent is and that is the Anatomic Pathology Department. It is true shifting of testing within the pathology comnmunity is going to go to the larger more equiped laboratories, but the quality is going to have to be standardized from the outlying laboratories inorder to get this model to work. We already see huge disconnection with tissue bio banks and outside laboratories. But the future does rest with the Pathologist and their support staff

[Electronic Medical Records]

Once all of the doctors are able to get their information and techniques in order I really think that the EMR systems are going to help the economy and the health care field become more efficient.

[Adam Peters]

I can certainly see number 2, 'a set of new vendors will arise to support -omics and digital pathology' happening. Prior to or shortly after the start of number 3, 'these new systems will be selected, purchased, and installed by and in pathology;' will be a period of consolidation and acquisitions of these new vendors by the large suite/enterprise vendors. Many of these enterprise solutions were seperate succesful software products cobbled together and made to appear the same. If there is a market for the -omics and digital path products I'm sure the big EMR vendors are either working on a solution they can sell or watching to see what which new solutions work and will work well within thier suite.