Despite the saturated marketplace for laboratory information systems (LIS) in the country, KLAS Enterprises continues to find itself with ever more to consider and review.

io01.jpg (15622 bytes)For seven years, KLAS has been evaluating healthcare information technology, including LIS vendors and products. Twice a year, the research and consulting firm issues rankings that represent feedback from more than 4,000 hospitals about 300 vendors and nearly 500 products.

Despite its maturity, the LIS market has room to expand, especially for those targeting smaller hospitals, said Ralph Reyes Jr., MT and KLAS senior vice president.

“The market remains attractive to foreign companies such as Molis from France and NetLIMS, an Israeli company,” Reyes said. Another growth area is in hybrid LIS operations. Hybrids include a laboratory operation in support of an acute care facility that also offers commercial outreach and serves its physicians and surrounding communities.
Reyes said LIS systems that can address both areas successfully have a promising future. Consider the East Texas Medical Center Regional Healthcare System in Tyler. The center operates a Siemens Open Lab LIS application. Through its ambitious outreach program — to the region’s doctors offices and clinics — the lab has evolved into a multi-million dollar operation, Reyes said.

McKesson’s Horizon Lab received the highest marks in the most recent KLAS ratings of LIS products. Jeff Watson, McKesson’s director of marketing, said Horizon Lab generates lab data that also drives clinical decision support programs — another lucrative market for McKesson.

The company’s Horizon Expert Orders offers clinical support and computerized order entry for use by doctors. Other McKesson products involve web-based communications and give mobile physician access to patient information.

Expert Orders, said Watson, was seven years in development. It marked a joint venture by McKesson and the Vanderbilt University Medical Center. The medical center’s staff conducted many trials and provided feedback on the software’s content and ease of use. Today, more than 80 percent of Vanderbilt’s physicians use Orders; nearly 11,000 medical center orders are processed electronically every day.

By providing physicians with alternative drug selections, Expert Orders saved the medical center more than $5 million during 2001, said Vanderbilt officials. Each day, the system issues an average 500 alerts — warning physicians of potential problems with their decisions. As a result, about one of every four orders is modified.

“From the clinical lab standpoint, the key is that McKesson LIS products were developed from the ground up,” said Watson. “It has both hospital-based and web-based outreach services integrated into the same system. The integration with pharmacy also enhances patient safety.”

The McKesson Web Outreach uses web technology to link to physician customers and provide an intuitive system for ordering tests and confirming medical necessity. This workflow-based system receives, reviews and stores lab results processed through Horizon Lab.

Another recent product addition — Horizon MobileCare Phlebotomy — is a hand-held device offering real-time wireless data exchange from the patient bedside. The device scans in the patient ID, collects vital data for blood specimen analysis then transmits it to the Horizon Lab in real-time for entry to an analyzer. “It helps labs eliminate the leading cause of lab errors — patient and specimen misidentification,” Watson said.

Cerner Corporation
This year opened well for the laboratory medicine business at Cerner Corporation. “In the first quarter alone, we had more than 30 hospitals sign to convert from a competitive LIS to Cerner Millennium PathNet,” said J.P. Fingado, enterprise vice president of laboratory medicine.

PathNet software automates lab clinical and management processes. Also, doctors can order tests from their provider office location, review results immediately as they are verified by the lab then track a patient’s resulting treatment via the Web using the Cerner ePathLink solution.

New products are boosting Cerner’s business. Its Synoptic Reporting program offers advanced pathology reporting. The tool captures discrete data points and provides for transmitting of the data to cancer reporting centers automatically using standard protocols.

Cerner has developed HealthSentry to improve the reporting of disease outbreaks that occur naturally or from a bioterrorism attack. Manual disease reporting is too often incomplete and time-consuming, according to Fingado. HealthSentry collects diagnostic information during patient treatment then transmits it electronically to a public reporting center. That helps agencies identify, monitor and respond to possible outbreaks. The software is already being used by Kansas City and the state of Missouri.

Interpretive reporting, said Fingado, gains in importance as tests grow more complex. “LIS solutions must be able orchestrate complex workflows where the results of multiple different testing modalities converge into a final interpretive reporting pathway,” he said.

Pathologist Dr. Arthur Hauck, physician executive at Cerner, said the LIS industry is now working to address genomic testing. The efforts must address issues of patient consent and patient concerns about the security of their test results.

Orchard Software
Now in its 10th year providing LIS, Orchard Software continues to gain market share with its Orchard Harvest software. Gross revenues have been increasing an average 25 percent a year, said Curt Johnson, Orchard vice president for sales and marketing. Gross revenues at the privately held company are projected to increase nearly 50 percent this year.

While Johnson said Orchard’s customer base is primarily smaller hospitals (100 and fewer beds), regional reference labs and clinics of from 10 to 100 doctors, the company has signed up some larger clients, too. These include The Mayo Clinic in Rochester, Minnesota, and the World Bank, whose laboratory serves the needs of 18,000 employees and requires an LIS both extremely accurate and secure.

The hematology department at the Mayo Clinic averages nearly 2,500 CBCs a day, he said. Using rules defined by Mayo itself, Orchard’s software has enabled the department to cut its review rate down to about 18 percent.

An important benefit of Harvest, according to Johnson, is its broad flexibility. The software offers more than 200 standard instrument and host interfaces as well as customized connections. It uses the 4th Dimension database and runs on the Windows 2000 platform.

Instead of expanding into the electronic medical records field, Orchard continues to provide EMR companies with its clinical LIS. Orchard has worked with EMR specialists GE Medical, NextGen, Misys, Medical Manager, IDX, EPIC, A4 and others.

In addition to working with the EMR in clinics, Orchard serves the smaller hospital market. “Much of what that market does involves outpatient testing,” Johnson said. In May, the company introduced Orchard Copia, a lab portal for outreach software that includes lab ordering and results retrieval.

Data Innovations
An instrument-independent data management company, Data Innovations introduced its Instrument Manager Windows-based software in 1991. The company has developed nearly 400 interfaces to support about 600 diagnostic instruments and lab information systems.

Instrument Manager’s success has generated double-digit percentage increases in sales over recent years, said Greg Vail, company president. This year’s sales, through May, were up about 20 percent from the same period last year.

The software program ties together equipment from various instrument makers with larger-scale laboratory information systems (LIS) from many vendors. Customers most often request turnkey systems from the company, Vail said.

“We’re one of the few independent data management firms,” Vail said. “Our value as an independent is an ability to bring a standard look and feel to a lab full of different instrumentation, to enhance basic functionality.” Vail said that commonality results in easier cross-training of techs — an important issue at a time when labs are asked to provide faster turnaround of lab results despite shrinking lab staffs and budgets.

Vail said as LIS systems continually change in functionality, day to day operation of the lab can get left behind. “Our software addresses the instrument operation and coordination that is so necessary,” he said. Auto-verification based on user-defined rules, he said, remains the hottest issue for labs seeking better ways to manage data.

Dawning Technologies
Dawning Technologies has specialized in supplying lab instrument connectivity products since 1984, said company president John Selmyer. The Dawning distributed processing approach features hardware and software, a Linux/Java-based platform and industry standard HL7 and ASTM formats. “We have no desire to become a low-end LIS,” Selmyer said. “There continues to be a great need for good connectivity solutions.”

New products include the Dawning JavaLin clinical interface and JResultNet clinical router software. The JavaLin replaces terminal servers at remote connections. JresultNet software (embedded on the JavaLin) can also be run on a network PC workstation.

Several optional modules are available for JResultNet. These include a new Rules Module to automate additional front-end processing. The newest entry is an interface that tackles the challenges presented in microbiology by defining positions for all microbiology data elements within the HL7 and ASTM standard protocol framework. “A key area where we are expanding relates to system-to-system connectivity,” Selmyer said.

As the push continues among major vendors for hospital-wide solutions that include ancillary laboratory, radiology and pharmacy services not standard in HISs, other smaller vendors are offering scaled back solutions that meet more basic demands for better managed data and smoother workflow.

Nicholas Borgert is a freelance writer based in Charlotte, N.C.