Vol. 23 • Issue 2 • Page 12
In recent years integrated laboratory information systems (LIS) offered as part of an integrated enterprise-wide solution have gained traction in hospitals, often replacing a more traditional “best-of-breed” LIS. Enterprise-wide systems (EWS) typically claim to offer integrated solutions while “best-of-breed” LIS must be interfaced with other hospital information systems.
Defining, Understanding Terms
To contrast the alternatives, these are some definitions for integration and interface:
Integration (from the Latin integer, meaning whole or entire) generally means combining parts so that they work together or form a whole. In information technology, there are several common usages: 1) Integration during product development is a process in which components or subsystems are combined and problems in their interactions are addressed; 2) The application modules were all designed together at the same time with a unifying purpose and/or architecture; 3) The application modules share a common operating system, programming language and database.
Interface means: 1) software and hardware that logically interconnects two computers or different application modules and allows them to interoperate; 2) The device or component that serves to physically and logically interconnect other devices or systems and enables their interoperation; 3) The actual connection between application modules or hardware devices that facilitates the exchange of data so that they can communicate or work together effectively.
The key difference is that with integration, the various modules are homogeneous in architecture, e.g., share common operating system, database and programming language; whereas, for interfaces they are usually heterogeneous and differ in software architecture. Either can, if properly done, provide interoperability within the LIS.
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Today many hospitals are moving to enterprise-wide information systems (EWS). In that transition, laboratories are often being asked to replace their existing “best-of-breed” LIS with the LIS offered by the EWS vendor. Typically, the change is being driven by the C-suite who envision an EWS as a benefit both operationally and financially to the hospital at-large. In such cases, laboratory management must consider the impact of such a change on laboratory operations. What will be the benefits to the hospital and the laboratory and what are the drawbacks in changing from a best-of-breed LIS to an LIS that is part of an EWS?
The figure “Polar Extremes of System Integration” humorously depicts the differing viewpoints. The various individual hospital departments, including the laboratory, see each specific breed as ideally suited to their needs. On the other hand, the C-suite envisions a single breed as being the best option to meet the hospital’s goals.
The most significant potential benefit of enterprise-wide information systems is the ability to provide true integration of all clinical components, including lab data. Billing and accounts receivable and some financial services may also be integrated into a single system. Such integration can offer caregivers more comprehensive views of patient data, incorporating data from multiple clinical sources. Further, since only one vendor is the overall system provider, instances of “finger-pointing” when problems occur are diminished or eliminated.
However, many claim that best-of-breed LISs offer enhanced functions and features that optimize laboratory operations, better support outreach and reduce labor costs. The optimal choice of enterprise-wide LIS solution or best-of-breed LIS requires careful consideration of the overall positives and negatives, as they affect both the enterprise and future laboratory operations. Doing this requires an impartial, unbiased, evidence-based analysis of the pros and cons of each alternative from the laboratory’s perspective and the impact on service levels, quality, productivity, staffing, revenue, functional gaps, automation line connectivity and patient safety.
How does integration differ from interfacing and are the differences important? Traditionally, interfacing has been used to interconnect the LIS to disparate information systems, including HIS, EMRs, billing systems and so forth. Interfacing does work but has some intrinsic issues, including the ongoing need to ensure that the interfaced systems maintain consistent and synchronized files, e.g., doctor files, test codes, etc. Changes in either system must be reflected in both. Further, downtimes in either system require re-synchronization after recovery. Maintenance of the interface can be a chore.
True integration will provide a single, unified database in which all clinical and financial information resides. Reports and displays of information to authorized users can combine elements from multiple modules and provide a more complete picture of patient diagnostic and therapeutic status.
However, laboratories need to assess whether a best-of-breed LIS provides superior functionality to justify its selection compared to the function and features offered by the “bundled” enterprise-wide LIS.
Key characteristics of integrated enterprise-wide solutions compared to interfaced best-of-breed LIS are identified in the Table.
Things to Consider
In line with the new Meaningful Use requirements, the drive for interoperability, and the standardization of communication protocols between systems, the need for one system to achieve interoperability becomes less of an issue. As we all conform to interoperability standards and systems are able to “talk” to each other, the focus becomes on meeting the specific needs of a department, while simultaneously enhancing their efforts to increase efficiency of the overall organization. As we move forward, the convergence of data from each department into useful analytics and business intelligence for the administrators of a healthcare organization becomes paramount to reducing cost. The LIS has to be able to analyze to a discrete level all data possible to ensure cost effectiveness. This can include testing algorithms, ordering patterns, and assisting with patient treatment plans – designed with the data from the laboratory.
A best-of-breed solution is probably better suited to large academic research facilities, independent reference and specialty labs, facilities with large outreach programs, and community hospitals that require functionality to improve the efficiency of their labs. By the same token, many small community hospitals may benefit from the functionality offered by a best-of-breed solution, but may lack the staff and/or expertise to implement and maintain a best-of-breed solution.
In any case, the optimal choice of an integrated enterprise-wide LIS solution or an interfaced best-of-breed LIS requires careful consideration of the overall positives and negatives, as they affect both the enterprise and future laboratory operations.
This is a complex analysis involving determining the true overall costs of system implementation and operations, impacts on access to clinical information by caregivers, ðefficiency of operations and impact on laboratory outreach revenue and business growth.
Dennis Winsten is president of Dennis Winsten & Associates, Inc. (DWA), a healthcare systems consulting firm specializing in laboratory information systems with headquarters in Tucson, Arizona (www.dwinsten.com, email@example.com). An ADVANCE editorial advisory board member, he has more than 30 years’ computer experience, including over 25 years in healthcare systems.