In a recent blog note, I stated that the LIS modules of EHRs such as Epic's Beaker are gaining traction in the market and thus performing the functions of the previously dominant best-of-breed LISs like Sunquest or SCC. I went on to suggest that the vendors of these latter systems should be aggressively working on a new type of LIS to protect their market share. Such a product would undoubtedly include support for lab-initiated diagnostic and predictive analytics (see: Diagnostic and Predictive Analytics and Their Possible Link to the Future of the LIS). In this and future blog notes about this topic, I will use my personal term to refer to such a future LIS -- the LIS-Analytic (LIS-A).
One of the first things that comes to mind regarding the functionality of the LIS-A of the future is that it will be both interdepartmental and collaborative. This is by way of contrast with the best-of-breed LIS's of today which are intra-departmental. Most lab test results are generated currently within the clinical labs without knowledge of the clinical findings of the patients being tested. These results are then been reported back to the clinicians without any feedback from them. I do not say this in any critical way -- the nature of the lab test transaction has always been that clinicians order lab tests and pathology responds to these orders. The clinicians are then responsible for interpreting the results in the context of a particular patient.
Diagnostic and predictive analytics, which I think will be one of the major functions of the LIS-A of the future, will need to take into consideration test results but will also require the monitoring patient outcomes subsequent to a testing episode (see: Appraising laboratory quality and value: What's missing?). This consideration of clinical outcomes is important in order to measure the value of lab testing. It is logical to assume that the acquisition of patient outcome data will be based on an interface with the EHR. I might also add that, in this era of precision medicine, the clinical labs will also be able to generate outcome data. One example would be the absence of circulating cancer DNA in a patient post treatment (see: Circulating tumor DNA).
My crystal ball is cloudy at this time as to how and when this interdepartmental and collaborative data will be collected and integrated into the LIS-A. I do understand, however, that the process will be highly automated and reliant on AI because for the following reasons: (1) test-ordering clinicians will be too preoccupied with patient care to provide such data to the LIS-A; and (2) there may be a substantial delay from the time that any particular test result is generated and the subsequent knowledge of outcome data for that same patient. As a result, I suspect that the LIS-A will be collecting and analyzing patient data for a period after the patient is discharged from the hospital.
A very interesting post. I think that the best of breed LIS's trying to find a way to move into this space is probably going to be very difficult for them. Why would the EMR vendors (Cerner, Epic), who have a built in lab system want to interface that data to a standalone LIS when they can provide the soup to nuts solution, including that analytics component? And why would an IT department want to spend the time/money to do that integration, given if the lab would just use the "built in" LIS, no integration would be needed, or since the lab results are sent back to the EMR, do the analytics there... I certainly think those best of breed systems do need to continually evolve and add better functionality, I'm just not sure this is a path they would want to tread in an attempt to add value.
Posted by: Bill Grolly | November 01, 2018 at 09:41 AM