"Technology Report"

Lab Information Systems Meeting Highlights Innovation, Ideas

CEO SUMMARY: Managed care’s pressure to create clinically integrated healthcare delivery systems changes the way laboratories report, use and warehouse clinical data. Dr. Bruce Friedman’s annual laboratory information systems conference in Ann Arbor provided graphic evidence that technology and LIS products are evolving at distressingly rapid rates. This complicates any decision to upgrade LIS.

CUTTING EDGE would be an apt description of the 15th annual symposium on clinical laboratory information systems held last week in Ann Arbor, Michigan.

Sponsored by the Department of Pathology at the University of Michigan Medical School, this year’s program, titled Automated Information Management In The Clinical Laboratory, was a hotbed of progressive and innovative technology affecting laboratory information systems.

Succinctly highlighting the direction of the industry was Robert De Crese, M.D., Director of Clinical Laboratories at Rush-Presbyterian-St. Luke’s Medical Center in Chicago. He defined the healthcare trends now influencing the design and operation of laboratory information systems.

Clinical Integration Impeded

In particular, Dr. De Crese noted that, although managed care is pushing integration of clinical delivery systems, a contrary trend is impeding it. Scattered contracting of services by managed care plans contributes to a “fractured” healthcare system. Year-to-year churning of employees between health plans complicates the picture. Because clinical data is inaccessible between providers, money and time is spent on duplicate testing and unnecessary studies.

“For this reason,” stated Dr. De Crese, “both clinical and economic pressure will encourage integrated clinical information systems. Regionalization of service is required for true integration of clinical data to succeed.”

Regionalization Of Services

De Crese noted that radiology is leading this regionalization. Digital transmission of images and data is growing. Other candidates to help lead this trend are anatomic pathology and the clinical laboratory. Commercial laboratories already demonstrate the capability of regional laboratory networks. Technology of laboratory information systems must evolve to support the needs of regional pathology, laboratory networks and the clinicians they serve.

Dennis Winston, President of Dennis Winston and Associates, echoed De Crese’s theme, noting that no software product exists today which can properly support the demands of those regional laboratory networks which are now operating.

“I will use the term LNIS, or laboratory Network Information System, to describe the type of software which is required by regional laboratory networks,” stated Winston. “Unfortunately, no such LNIS exists today. Existing laboratory networks are forced to take a ‘shake and bake’ approach to solving their problems.”

Need For Network Software

Winston pointed out that any LIS vendor which gave serious effort to developing a product to meet this market need would be actually taking the first steps to develop end-stage integrated clinical information systems. Winston’s consulting firm wants to support the design of an LNIS product.

For pathology, fascinating developments are under way at the University of Pittsburgh Medical Center (UPMC). In conjunction with a hospital in eastern Pennsylvania, UPMC is developing a working model of a “virtual pathology practice.”

“Virtual pathology departments will emerge due to pressures for increased specialization, higher productivity and diminished teaching budgets.”
-Bruce A. Friedman, M.D.

“We have the capability to offer electronic pathology reporting. We are already moving text and images within UPMC and with our ‘virtual’ pathology partner,” noted Michael J. Becich, M.D., Ph.D., Director of Genitourinary Pathology at the University of Pittsburgh Medical School. “To make this a practical sys- tem, however, we must continue to refine the capture of pathology images, how this information is ware- housed and how information is retrieved and transmitted. Another problem we are working to solve is how a pathologist properly certifies electronic pathology reports.”

Using a laptop, Becich demonstrated the report formats, data retrieval capabilities and ease of access for the systems already in operation at UPMC. In front of the audience, he used the internet to access text and graphics of anatomic pathology reports in real time.

“As you can see, we already have a workable system,” commented Becich. “Our challenges in creating telepathology systems are the speed with which new imaging and computer technology is introduced and how to continually adapt such technology to our system.”

Dynamic Telepathology

“The other impediment is cost. A dynamic telepathology station starts at a minimum of $150,000. Until prices come down further, I don’t believe that pathologists will use this technology on a widespread basis.”

Pathologists will be interested to know that Dr. Friedman predicts increased employment for pathologists and laboratory managers who take an interest in clinical information management. “Healthcare is recognizing that information is the key to improving clinical services. I see every segment of the healthcare industry defining their product as information.

“For example, in-vitro diagnostic manufacturers now view themselves as in the information business,” explained Dr. Friedman. “For them to develop and execute this business strategy, they need pathologists and laboratorians who understand clinical practices as well as the information technology used to manage this data.

“I believe that the creation of virtual laboratories will fuel demand for pathologists with the ability to manage new technology and outsourcing relationships. Pathologists with such skills will find themselves in high demand.”

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