Orchard Looks to the Future for LIS Needs
Curt Johnson, Orchard Software’s COO, and Nancy Stoker, Director of Product Management, were interviewed by Robin Hocevar for the cover article featured in August’s Advance for Administrators of the Laboratory, “Critical Features of the LIS.”1 In the article, Johnson explains that at Orchard, we clearly understand we are at a crucial inflection point in healthcare where the U.S. delivery model is completely changing. As we transition from the fee-for-service (FFS) reimbursement model that rewards for volume to value-based systems, the entire focus in our healthcare system must shift. We begin to focus on population health management and other quality measures to improve patient outcomes and to determine healthcare reimbursements. The laboratory has a very important place in this new model.
With this in mind, what you need in today’s LIS is not what you need in tomorrow’s LIS. Johnson explains, “The example we use when we try to explain this is Polaroid instant cameras vs. digital photography. Are you trying to make Polaroid pictures better when the whole industry is moving to digital and they don’t know it yet? Or are we talking about digital photography? Any LIS company, if they are telling you how to make the instant picture better, they’re already done and they don’t know it.” At Orchard, we are concentrating on the future and on how an LIS needs to perform in the new healthcare arena to improve overall health and continue to support the laboratory’s needs through these changes.
1. Integration & Structured Data
The very basic, number one need is integrated LISs communicating with other healthcare information systems using discrete, structured data. To set the stage for performing advanced analytics and utilization analysis, your data must be structured in a way that supports these initiatives. To develop testing formularies and reflex algorithms, diagnostic protocols, or even combine data with other data sets within the healthcare organization to understand patient population needs, the critical starting point is accessible, interoperable, discrete, and structured data.
2. Utilization & Analytics
Prompt, accurate patient diagnosis is critical from the very beginning to improve the healthcare system. First, if you are trying to keep patients healthy, you need preventive diagnostic testing to alert you to outliers. Secondly, for unhealthy patients, you need a diagnosis as quickly as possible so treatment can be started. Thirdly, lab testing is performed to monitor treatment efficacy. Every scenario involves lab data. The ability to produce analytics that can help understand that data and create efficiencies in the system will be crucial. For example, we cannot continue to perform testing in the same manner we did in the FFS model. It becomes imperative to develop testing protocols and best order sets to promote appropriate testing and reduce unnecessary testing. You need the ability to perform utilization studies to determine if you are running the correct tests on the right patients and getting accurate diagnoses as quickly as possible. Instead of running a battery of tests because that is what will be paid for, you have to make decisions about the right testing based on specific symptoms to get an appropriate diagnosis. Your LIS should support algorithms, formularies, and advanced analytics that improve patient care.
Accurate analytics become vital to improving the healthcare system. From a laboratory standpoint, both internal laboratory analytics, such as TAT and staffing analyses, as well as external analytics that collaboratively combine data sets looking for patient outcome improvement opportunities, must be employed in the future. Internal analytics can be used to support Lean processes and improve efficiencies. Meanwhile, external analytics can add to the overall value the lab lends to the organization, uncovering ways lab results lend value beyond the results themselves (e.g., improving antibiotic stewardship or reducing unnecessary admissions). The LIS of the future should be able to support both of these analytic enterprises.
3. Eye on Efficiency & Costs
The future of healthcare depends on finding ways to improve efficiencies at reasonable costs; this certainly applies in the laboratory. Many labs, although already extremely efficient, are looking for new ways to address efficiency, such as using Lean principles to design workspaces and workflow, and adding in automation lines or autoverification. The LIS of the future will need to support these endeavors, not only by having software functionality that enhances workflow, but also by making upgrades and software enhancements available in a cost effective manner to benefit multiple users.
4. POCT & Home Health
Expect to continue to see groundbreaking advances in both point-of-care testing (POCT) and mobile health apps. As patient involvement becomes more important to the success of healthcare reform, lab testing will have to be available at the POC, wherever that may be. New ways of capturing and delivering lab results will have to be taken into consideration. Will patients communicate via tablets and smartphones? How will data from wireless devices at the patient’s home and from smartphone apps be collected and incorporated? As we move toward keeping patients more healthy and out of the hospital and we continue to see technological advances in this area, the LIS needs to be ready for involvement in monitoring patients at the POC, even if the POC is within their home.
5. More Molecular
Molecular testing is the big boon for the future of lab testing, and it is advancing so rapidly that reimbursement models and information systems can barely keep up. With an eye toward precision medicine and companion diagnostics, the LIS of the future will need a better handle on molecular testing.
Stoker points out that the workflow for molecular varies from the historical lab workload, specifically requiring the ability to handle batch management, as opposed to traditional sample- or patient-centric workflows. Johnson agrees: “The truth is, no one at this point knows exactly what molecular will look like, so for now, we need a three-pronged approach. First, there will be molecular analyzers, so from an LIS point of view, this workflow is familiar and has been designed. Secondly, there will be a molecular group that is assay-, therapeutic-, or disease-specific and is automated or semi-automated. Based on the degree of automation, the role of the LIS will be to handle that automation and make the workflow as efficient as possible to make up for any deficiencies. Also, reporting becomes critical. What is the output and how do we interpret the output? What can an LIS add to the output to make the diagnosis more beneficial to the end-user? Thirdly, there will be molecular testing that’s a bit like R&D—still outside of the box, very manual with multiple steps. In this case, the LIS has to determine how much influence it can have on the workflow. How can the LIS track, communicate, report, and interpret results, and store all of the data?”
Data storage becomes of utmost importance in that you need to consider big data storage when you get into molecular data. Even if we do not currently need all the data, we do not want to limit our storage capabilities, because as advancements are made, that data could become valuable down the road. “From a data storage point, you want to be able to store as much data as possible, even if you don’t use it today, to benefit patients years from now,” adds Johnson.
Laboratorians’ Role Will Evolve with the LIS
If you start with the premise that the lab is an integrated part of a value-based healthcare system, and FFS is going away, then the LIS of the future plays a critical role when it comes to management. As U.S. healthcare evolves, the lab is the cornerstone. The LIS of the future must be designed to support the lab and provide tools and information to support the whole organization in achieving the Triple Aim goals: improve patient experience, improve population health, and decrease costs.
The Future is Now: Orchard Sequoia
Orchard is well on the way to developing the LIS of the future based on brand new technology. Think about having all the foresight we just went over and starting from scratch to develop a new LIS, custom-tuned to the lab’s future needs and using all the latest and greatest technologies. That’s exactly what we are doing with Orchard® Sequoia™.
Orchard’s enterprise-class laboratory information system Sequoia, is built on the newest technology platforms and incorporates advanced tools to measure performance, improve productivity, and generate valuable business analytics. Orchard Sequoia’s unique architecture is designed to support high-volume, complex laboratories and incorporate diagnostics innovations concurrent with the changes taking place in healthcare.
Orchard is committed to keeping you informed and being a trusted resource that you can turn to for industry-related education. As always, we welcome your feedback. Follow us on Twitter at @orchardsoftware, and feel free to respond to this post by emailing us at firstname.lastname@example.org.
- Hocevar, R. (2015, August 1). Critical features of the LIS. Advance for Administrators of the Laboratory, 24(8), 14-16. Retrieved from http://laboratory-manager.advanceweb.com/SharedResources/EBook/2015/July/AL072715/pubData/source/AL072715_eMag.pdf
Kim Futrell, MT (ASCP)
Products Marketing Manager
Orchard Software Corporation