Stand-alone laboratory information systems might be entering their twilight years as more labs move to enterprise-wide systems like Epic and Cerner, writes Julie Kirkwood in the September issue of Clinical Laboratory News (CLN).
Kirkwood describes the experiences of two laboratories making the switch and highlights several best practices that may ease the transition.
The University of Arkansas for Medical Sciences (UAMS) in Little Rock took what chief medical information officer Thomas Powell, MD, called a “big bang” approach when it switched software 2 years ago as part of a hospital-wide conversion to Epic. With the transition, he told CLN, the UAMS laboratory became one of the first major institutions in the U.S. to use Epic Beaker, designed specifically for clinical laboratories.
There were some glitches, he admitted. One problem was that Beaker did not recognize duplicate orders, so staff ended up repeating tests that had already been completed. Things have since improved, Powell told CLN, but it’s hardly smooth sailing.
UAMS’s experience is typical, said Noah Hoffman, MD, PhD, an associate professor in the department of laboratory medicine at the University of Washington in Seattle. Because the system is typically configured by information technology (IT) staff who have little, if any, knowledge of laboratory practices, “The lab has to compete with the general pool of requests, so it’s difficult to prioritize the lab’s work,” he said.
Labs also have to wait with all other customers for functionality, and are unlikely to be able to fire the vendor if things don’t work out because the entire healthcare system is involved in what is often a multimillion-dollar contract.
Laboratories often don’t have a choice regarding integration, Hoffman said. “If your enterprise is, for example, purchasing Epic and gets Epic Beaker for free, the substantial expense of a standalone lab system may be out of the question,” he said.
Despite some challenges, there are benefits to an enterprise-wide system. These include the ability to use analytics to improve outcomes and reports and provide information beyond pathology. “If (we) can show that what happens in pathology has a positive impact outside of pathology, I think that that will be very beneficial,” said James Harrison, MD, PhD, associate professor of pathology and public health science at the University of Virginia (UVA) in Charlottesville.
To reduce the risk of problems, the experts Kirkwood spoke with recommended the following:
- Design the system around the laboratory’s existing workflow.
- Ensure laboratory representation on all committees involved with the system design and implementation.
- Try, if possible, to retain your own IT team. That’s what UVA intends to do when it switches from Sunquest to Epic Beaker in 2017, Harrison told CLN. “One of the very first conditions we put on this move was that we would be able to maintain our IT team,” he said.
- Be open-minded. When the UVA hospital first switched to EPIC 6 years ago, Hoffman decided Epic Beaker was not robust enough for the laboratory’s needs. When the hospital recently asked him to reconsider, he saw it had certain advantages over Sunquest, making it “best in breed.” In addition, he said, “Beaker is one of the relatively few lab systems that is being actively developed.”
Enterprise-wide systems such as Epic and Cerner are not, of course, the only choices available to labs. Some labs are turning to laboratory information management systems (LIMS), Kirkwood learned. Brian Brunner, associate partner at the informatics-consulting firm LabAnswer in Sugar Land, Texas, attributed the growing popularity of LIMS to its broad set of capabilities that can be used to manage many aspects of the laboratory and beyond. In addition, he said, many LIMS companies are small and eager to work in the clinical market, so they are responsive to customers.
For more details, pick up the September issue of CLN.