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A Scenario for Lab Computing in the Post-Classic-LIS Era

Posted Oct 05 2009 10:02pm

I think that we may now be working our way through what might be called the post-classic-LIS era. The classic LISs were designed to meet most of the computing needs of the major hospital-based clinical labs such as chemistry, hematology, microbiology, and blood bank. These multipurpose systems dominated the market for about three decades. The first crack in the facade of their functionality and invincibility was the emergence in the market of so-called middleware. These niche applications were supported and promoted by the IVD vendors and smaller software companies, installed as "black boxes" between analyzers and the LISs, and provided additional functionality not always available in the LISs. A second blow was struck when many of the LISs available in the market were unable to adequately support molecular diagnostics. In response, a small group of the LIS vendors finally developed molecular diagnostics modules. The third blow consisted of the digital pathology systems that have been been supplied largely by a new set of vendors, manufacturing both the requisite scanners and software. The fourth blow, now in its very earliest developmental stage, has been integrated diagnostics which may ultimately result in the emergence of blended diagnostic information system (DIS).

A similar pattern is occurring in the hospital EMR market. Successful vendors such as Epic Systems have been unable to provide EMRs that adequately accommodate to the increasingly complex data and images generated in the major diagnostic departments such as pathology, clinical labs, radiology, cardiology, and gastroenterology. The inadequacy of these nominally "global EMRs" has not raised any alarms because the purchasers of EMRs, hospital CEOs and CIOs, rarely if ever use them on a daily basis for their own work. To explain away this EMR functionality problem. the advocates for these systems declare that they have not been designed to store and report all of this burgeoning diagnostic information and, most particularly, diagnostic images.

In contrast, the daily users of the "ancillary" diagnostic systems continue to insist that they function at a very high level in order to accomplish their daily work. In my opinion, the classic LISs, in a manner similar to the hospital EMRs, will gradually evolve into front-end viewers for the complex molecular test results and images that will be managed by back-end modules and linked under a federated architectural model (see: The Value of a Federated Architecture in Pathology ). HL7 will be inadequate as an standard for these modules due to the length of time and cost required to develop interfaces. The solution to this need for an on-the-fly interoperability solution will be LITS-Interop which is web-based, flexible, and inexpensive. Increasingly complex versions of this software were demonstrated at the Lab InfoTech Summit last March in Las Vegas and the just completed APIII conference in Pittsburgh.

I believe that lab computing of the future will resemble something like the following: the classic LISs will remain in-situ, primarily as viewers for the specialized back-end federated modules with LITS-Interop serving as the interoperability solution. These hospital lab mini-networks will be linked into larger regional or national lab networks with scattered reference lab nodes and with participation of panels of pathology and lab medicine consultants. The manner in which the hospital EMRs evolve will become largely irrelevant to lab professionals. The federated hospital lab mini-network will continue to pass to the hospital EMRs those top-level diagnoses that the EMRs can digest. If the hospital clinicians need to view detailed lab information or surgical pathology images, they will link to the web-based federated lab network described above. A similar situation obtains today if the clinicians want to view radiology images -- they sign on to the specialized radiology PACS, usually managed by the radiology department.

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