In a recent note, I discussed how LIS's as components of EHR's were slowly gaining favor in the market over interfaced best-of-breed LIS's (see: Predicting the Future Functions of the LIS-Analytic (LIS-A)). Bill Grolly, a reader of the blog, submitted the following comment in response:
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.
Pathology departments thrived for decades by installing so-called best-of-breed LIS's that were interfaced to the HIS's (hospital information systems) and later EHR's. However and as emphasized in the comment above, it's become harder to compete with the "soup to nuts" solution offered by EHR vendors. Early in their development arc, EHR/LIS modules like Beaker suffered in terms of functionality compared to best-of-breed LIS's but that gap has decreased over the years. Many hospital executives now seem to prefer to work with a single hospital software vendor and pursue an enterprise-wide-solution.
Another point raised in the above comment by Bill Grolly is whether the leading EHR vendors could come up with an "analytics component" utilizing lab test data just as easily as the vendors of best-of-breed LIS's. This is certainly possible. Cerner was an LIS vendor in its initial software offering, PathNet, in 1984. The company later developed Cerner Command Language (CCL) which was similar to Structured Query Language (SQL) and was used to write LIS-based rules. These rules were an early incarnation of the more sophisticated algorithms that we deploy today based on deep learning and neural networks. As to which vendor would bring a broad set of diagnostic/predictive analytics to the hospital market, It could certainly be an EHR vendor like Cerner or Epic (see: Diagnostic and Predictive Analytics and Their Possible Link to the Future of the LIS).
We already know of one instance where researchers from Massachusetts General are developing a web site that will calculate a disease risk score after a consumer has uploaded his or her DNA analysis results (see: Upload Your DNA to a Web Site to Generate Risk Scores for Five Diseases). Such risk scores certainly fall into the family of diagnostic/predictive analytics. Look for more such projects from academic medical centers. On a longer term basis, I anticipate the development of a large number of diagnostic and predictive algorithms that will be licensed to run on hospital-based EHR's or LIS-A's. However, the FDA will certainly exercise regulatory oversight regarding the use of software like this. It's already active in regulating diagnostic algorithms for detecting wrist fracture in radiology by scanning images (see: FDA permits marketing of artificial intelligence algorithm for aiding providers in detecting wrist fractures). It therefore seems highly likely that the FDA will be very important in terms of the sale or license of imaging algorithms in digital pathology.
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