Vol. 22 • Issue 10 • Page 20
In many aspects of our lives, technology is pervasive; we have the ability to be connected with a borderless world at any place and any time. The mainstream application of smart phones, tablets, and many other advanced technology communication mechanisms keeps us connected to the Internet and widespread information distribution. At the center of all this connectivity is cloud-based computing and the Internet feeding a constant stream of current events directly to us via blogs, websites, social media, customized alerts and more directly to whatever device we may be holding at the time. For many, this constant stream of data can be overwhelming, but those who have embraced the information distribution can easily parse the content that is important to them.
Why not envision the same for the medical laboratory information technology infrastructure? Tomorrow’s medical laboratory will provide a full 360-degree view of a patient’s health. The laboratory information system (LIS) will be centered around a single database collecting information from multiple sources, including bar codes, scanners, instrumentation, other applications, physicians and trends from data sources. The LIS needs to have the ability to interface to multiple and disparate, sources to gather and aggregate the content. The LIS should be able to compile all the data in one location, perform a statistical analysis of this data to not only provide a full view of individual patients, but also trending based on factors such as test results, patient demographics, diagnosis, treatment plans, outcomes and historical data from selected segments of the data set – from any connected data source and share it with multiple destinations.
This is the logical progression of the technology-enabled smart LIS. What started as a basic data management system for clinical ðlaboratories almost 40 years ago has evolved into a full-featured smart hub for all laboratory automation. LISs, based on a central database capable of handling anatomic pathology, clinical pathology, cytogenetics, microbiology, molecular, toxicology and boutique testing ðworkflows defined by the laboratory are in an excellent position to meet current and future needs. The once predictable, basic system of generating reports has evolved to a highly customizable set of connectivity and database tools with limitless capabilities.
Historically, the LIS was developed for specific and disparate purposes – a clinical LIS to handle clinical cases, an anatomic pathology LIS to deal with anatomic pathology, etc. As advances in medical testing evolved, the need for the LIS to match the demand with technology became clear. The addition of molecular tests to the anatomic pathology information system was a logical advancement in LIS technology; the same holds true for other testing disciplines – clinical, anatomic, histology, cytology, GYN, dermatopathology – all housed in the same database. Looking forward, the LIS will need to be capable of supporting any kind of test as well as be built upon a foundation that is flexible enough to support future testing as it emerges.
The Patient’s Role
More frequently, we see medical laboratories serving more than just hospitals and physicians; for a growing list of tests, patients are the direct consumer. Boutique and predictive testing is often done with patients self servicing. The types of testing being performed continues to grow in more specialized areas such as microbiology, molecular testing, and cytogenetics, as well as boutique predictive testing through patented combinations of assays. All of these can be ordered through the lab and the patients can receive the result report directly.
As the volume of information available about any given patient grows, a centralized database from which reports can be generated is critical. An LIS with a flexible workflow tailored to the needs of the laboratory’s test offering coupled with robust EMR and outreach connectivity capabilities and instrument interfaces will be a requirement, not a luxury.
Communication is Key
In addition to the various kinds of testing performed in the laboratory, the LIS needs to be able to communicate directly with other applications. Support for outreach and EMR is key to building a patient centric information hub and a unified EHR. Hospitals and physicians need to be able to electronically transmit orders from their location to the laboratory without error and receive reports back securely containing all of the information available about a specific patient. There are systems that can do that today. Adding “smart”outreach and EMR capabilities to an existing LIS is a step in the right direction.
Smart connectivity solutions are ones that provide advanced technical capabilities such as cloud-based solutions able to leverage all of the functionality in your clients’ EMR without the need of a secondary tool such as a portal. Smart, technology-enabled solutions will provide supplemental requisition support and flexibility in delivering results in multiple formats and will provide the missing technical capabilities in your EMR as an advanced technology solution by being an extension to a limited functionality EMR.
As the central hub of information, the LIS will need to ðcommunicate with the various pieces of instrumentation in the laboratory, ðincluding spectrometers, liquid and gas chromatography devices and other specialized instruments like blood gas analyzers, test-specific auto ðsamplers and image capturing microscopes. Information exchanges between the LIS and laboratory instrumentation, either unidirectional or bidirectional, reduce the errors associated with manual entry of results, spees turnaround time and increase reimbursements.
The Complete Picture
At the end of the day, the LIS needs to be able to produce a report that shows a complete picture of a patient’s current health beginning with ordered tests from all sources. A comprehensive report will include clinical, anatomic and boutique test data; this might include molecular test results, cytology results, and/or other test results not typically associated with the standard clinical test menu. As the central hub of the laboratory, the LIS database needs to house all the information necessary to generate these reports. True lab automation – through the LIS – is what will make this report a reality.
The LIS database should employ current industry standard encryption methodologies to secure patient data. The data output, from its presentation to its delivery method and timing, should be based on the needs of the report requester.
In summary, the LIS of tomorrow will consist of a single, unified database capable of accepting test orders from multiple sources in multiple formats. The LIS will receive the patient demographics from the requisition – whether through electronic transmission, outreach ask-at-orders questions, barcode accessioning, etc. – and assign a unique patient record, or append the order to the patient’s existing record. The tests will be automatically routed according to the specific workflows for each test offered, be it clinical, anatomic, cytogenetic, dermatopathology, or another boutique or specialty test.
Instrumentation utilized to carry out the specific tests will send their results to the LIS database through instrument interfaces; slide location and other logged information will also be captured. The LIS will look at the results and automatically order any reflex testing based upon the predetermined criteria of the lab such as patient’s age and test result. Once all the tests have been run and results communicated back to the LIS, the report will be generated, showing a complete and accurate view of the patient’s history and results ready to capture any additional notes and signatures from the doctors. The report will then be transmitted to the ordering physician and any other parties as defined by the patient and her doctor. Additionally, the LIS will be able to point out trends in subsets of the data based upon criteria established by the lab or from the data set as a whole.
Lisa-Jean Clifford is chief executive officer, Psyche Systems.
Sidebar: Key Features, Functions For Tomorrow’s LIS
In light of healthcare reform, more payers are reimbursing hospitals and reference labs based on outcomes and not lab procedures. You may already be witnessing a reduction in your billable lab procedures. This means that you must carefully manage costs and reduce diagnostic errors.
Better quality means fewer recuts; fewer recuts means less cost and more time to diagnose and treat. LIS systems alone do not house all the information necessary to get that job done effectively. They are augmented by manual forms, spreadsheets, custom build one-off applications, etc.
Many labs have begun proactively addressing these issues to remain viable. Specifically, features must include:
• Peer review automation that identifies and assigns cases, gathering meaningful details while improving quality through automation. This enhances your ability to provide accurate and timely diagnoses in support of clinical management decisions, reducing risks while addressing costs by automating most or all of your administrate reports and dashboards.
• Professional, technical, administrative staff management and evaluation automation to proactively optimize lab staff effectively managing human resources, including support for mandated professional and technical evaluation process (OPPE/FPPE) leveraging peer-reviewed data. This automation should include your weighting and exclusions to eliminate extra calculation and paperwork. Features should support all the staff; physicians and technicians within one dashboard to reduce effort, thus further reducing costs.
• Process tracking should go beyond slides to better manage processes and labor to improve operations and minimize errors. It is becoming increasingly important to how well your processes are working and identifying constrains to improve operational efficiency.
• Lab equipment management and control is typically forms based. You are required to proactively track, validate, monitor and manage equipment, materials and reagents used in the lab. If you automate these tasks, your cost will go down. You will replace clipboards, spreadsheets, forms and logs, thereby improving productivity while automating compliance.
• Lab issues, when they impact patient safety, are typically logged into the hospital’s risk management system. However, day-to-day issues should be captured to track and manage lab-specific deviations and incidents. If this is not done in an automatic fashion, cost will not be easily identified and controlled.
In summary, lab reimbursements have started to impact your organization. Current and future LIS systems must be augmented with features that both carefully manage costs and reduce diagnostic errors without adding administrative overhead.
– P. Abrams, EVP of AccuCore Group LLC.