Uncovering the Hidden Holes Associated with EHR Laboratory Information Systems
In today’s electronic health records (EHR) market several companies dominate Epic, Cerner, and Meditech for example. Each of them offers enterprise-wide EHR solutions that include a laboratory information system (LIS). Typically, the LIS components of these EHRs are more geared for clinical laboratories and less so for anatomic pathology laboratories.
Other things being equal, CIOs prefer the simplicity of one vendor, one system, one bill, one database, one operating system, etc. However, in truth, other things are not equal. The problem for many laboratories, particularly anatomic pathology (AP) labs is the lack of functionality needed to efficiently run an anatomic pathology lab.
In addition, the EHR vendor may not provide focused support for the anatomic pathology practice. There may be well-thought-out reasons explaining why the AP lab is underserved by the enterprise vendors. However, these reasons don’t remedy the gap that AP labs experience especially when considering the revenue generated from AP labs.
The functional capabilities of the LIS will evolve over time, but you will be in a long-term partnership with this vendor—what level of support will it provide throughout the years to make your job easier? You would rather be working with a vendor who offers stellar support to a system that is still evolving, rather than an “integrated” system where you cannot get the vendor to repair or evolve an unsatisfactory aspect.
Hidden Holes
While the reasoning behind any new LIS is common, labs are consistently looking to:
- Lower labor costs in turn lower cost-per-test
- Optimizing workflows, which results in greater work efficiency, higher quality, and lower costs
- Fight the great fight around labor shortages
When evaluating LIS options for your anatomic pathology lab, especially in terms of evaluating an enterprise-wide EHR versus a best-of-breed LIS like NovoPath, one critical issue is the maximum total LIS functionality.
EHR LIS solutions have come a long way over the years, and they have all gone in their own direction regarding developing capabilities.
Another item that is critical is the level of attention and support the vendor is able to provide. But how does one assess the vendor’s culture of support? The most reliable is to get a list of at least a dozen or more current sites from that vendor, then call and talk to random employees at that lab. If the vendor refuses to provide a comprehensive list, and only provides “selected” or “representative” sites, the appropriate assumption is that they have something to hide, and you should look elsewhere.
Some concerns labs have expressed around an EHR LIS have been noted by Association for Pathology Informatics:
- Lab professionals want maximum computer functionality with system-wide integration as a secondary goal.
- Enterprise-wide systems typically do not have capabilities for outreach laboratory business, which is a significant revenue generator for both laboratory and the institution.
- An integrated, single-vendor system may not be flexible enough for the constantly changing business conditions associated with the anatomic pathology industry.
- Integrated systems aren’t easily adapted for a multi-entity business model, i.e., the various components such as laboratory, pharmacy, etc., are not easily modified when business or regulatory changes affect the integrated system.
Different Approaches to Consider
Some institutions solve these conflicts by investing in an enterprise-wide EHR with its integrated LIS and have the AP laboratory, blood bank, etc., make do or pay for additional customization work to be done.
As this is an option, a lot of the time, lab personnel draw great concerns around the:
- The level of support this is available for advanced automation and digital pathology
- The ability to configure workflows, UI’s, and roles to what is needed for their type of lab
- Support the lab’s outreach business
- The ability to focus on the needs of the techs and pathologists over costs
- Able to build and configure reports as needed
- Will it be a downgrade compared to the current system
The second approach is to purchase an enterprise-wide EHR and integrate a best-of-breed LIS that incorporates specific laboratory departments such as anatomic pathology.
Pros
- Mature, complete LIS with proven interfaces into the selected EHR
- High-priority applications are available immediately, and new or developing needs, such as outreach, can be met more swiftly than an enterprise-wide product, thus improving the pathology lab’s competitive position
- Least disruptive in terms of system transitions
In Conclusion
Although the argument against the best-of-breed cites problems with seamless dataflow, proven interfaces suggest that dataflow problems are minimal. Perhaps most important is to evaluate the value of a best-of-breed LIS, as compared to the “cost,” by looking at the impact on quality, productivity, improved competitiveness, service levels, and workflow maximization.
On this point, only rarely does a CIO want a monolithic EHR to balance all costs when compared to what it would cost to pursue a best-of-breed strategy for a LIS. Equally significant, seldom does the health system administration consider the additional costs to the hospital in circumstances where the choice of lesser performing APLIS means that the pathology laboratory may be less productive and have less-than-desired quality.
