Pathology and the LIS in the Era of the EHR

Pathology and the LIS in the Era of the EHR

The perspective of the

College of American Pathologists’ Diagnostic Intelligence and Health Information Technology (DIHIT) Committee

Traditionally…

LIS APLIS ADT ADT Results Results Orders EMR Patient Registration Medical Charting CPOE Pharmacy Scheduling LIS APLI S

The threat…

LIS and APLIS Integrated into EMR

• VERY appealing to Hospital Administration

•One stop shopping

•Single installed system

•One source for maintenance

•Promise of seamless integration •“No more interfaces”

• Facilitates Expansion

•Fewer IT issues to worry about as medical system acquires other hospitals/practices

Issues with EMR-Integrated LIS Modules

• Limited feature set vs stand-alone LIS/APLIS systems

• Less mature than other components of EMR

• Limited incentive to develop more than minimal functionality • Many features not present in integrated lab systems may be

mandated by regulations and still have to be done, even if that means doing them manually

• Myth of “no more interfaces”

• Genetics, blood-bank, send-out tests, molecular, tumor registry

• Encounter-centric vs Specimen-centric design

• Lab requests/issues must go into the hospital queue • Ability of labs to stay in business may depend on

keeping outreach clients happy; this may not be a priority for Hospital IT or the EMR vendor

The landscape is, in reality, more complex

APLIS LIS

DOCTOR’S OFFICE DOCTOR’S OFFICE

DOCTOR’S OFFICE

DOCTOR’S OFFICE

DOCTOR’S OFFICE

DOCTOR’S OFFICE

Unique Features/Needs of LIS/APLISs

• Not only manages the output of the laboratory, also controls the operations within the laboratory

• Specimen tracking and routing; asset status • Instrument interfaces

• Controls and quality assurance

• Numerous regulatory and patient safety features • Agility to adopt to emerging technologies and new

solutions/approaches • Outreach

Outreach and LIS/APLISs

• Catchment area of a laboratory can greatly exceed that of the hospital or even the health system

• Specimens can travel further than patients are likely to

• Outreach volume can justify resources which benefit the host institution

• Esoteric laboratory testing

• Wider range of antibodies and genetic tests • Subspecialty expertise

• Outreach operations require numerous interfaces into and out of the laboratory, carrying information on

LIS vs EMR

There’s enough work for everyone… Divide and Conquer!

• Laboratory Operations/Workflow

• Outreach Client Interfaces • Data Display Formats

• Decision Support at Order Entry • Data Integration

• Instrument Interfaces

• Support for Molecular/Genetic Testing • Patient Portals

• Digital Pathology

Roles for the Pathologist

• Manage own LIS

• Become a resource / advisor to the institutional EMR

• Experience with longitudinal records • Advise on data integration issues

• Harmonization of orders and results for EMR build • Data received from other labs, in-home testing, etc. • Understanding structure and content of laboratory data • Apples vs Oranges… but not all apples are alike

• Interfacing expertise: issues, process, vendor relations, regulation and compliance

Recommendations for EMR Vendors

• Don’t attempt to “reproduce” the functionality of an LIS and/or APLIS as a module in the EMR

• Focus on data integration – receiving and displaying data from multiple LISs and institutions and sources

• Other Hospitals • Commercial Labs

• In-Home testing (manual data entry)

• Focus on data displays which meet physician needs • In collaboration with pathologists, focus on decision

Recommendations for LIS/APLIS Vendors

• Keep ahead of the game with providing unique features important to laboratory operations

• Develop the ability for a single installed instance of the LIS to support multiple separate hospital labs

• Test selection • Staff selection

• Equipment integration

• “Open up” the data in the LIS to external uses, analytical tools, third party or custom developed solutions – give pathologists ability to demonstrate the value of their systems

Recommendations for Pathologists

• If you do not have management control of your LIS, get it • Become very familiar with the unique capabilities of your

LIS and their importance to your operations

• Understand the complex tasks which are part of daily lab operations and which are supported by the LIS, and be prepared to advocate for these

• Get involved in data management issues at your

institutions outside of your department and your LIS

• You have unique expertise in longitudinal data management • You understand that all apples are not alike

Diagnostic Intelligence and Health

Information Technology Committee

• Committee Members

• Projects

Raj Dash, Chair Raymond Aller Ramy Arnaout Bruce Beckwith George Birdsong David Booker James Brassel Victor Brodsky Bill Castellani Phil Chen Monica de Baca Frank Elevitch James Harrison Walter Henricks John Madden Gaurav Sharma John Sinard James Sorace Myra Wilkerson Ron Ranauro Mark Whitsitt

Framework for Empowering Pathology in the EMR Laboratory Clinician Communication IHE Profile Pathologist Led IT for Successful ACO’s

Laboratory Interoperability Best Practices Biorepository Best Practices