Lab information systems can follow specimens, update test status, manage business, and direct robots.

Because rapid access to test results has such a clear and profound effect on diagnosis, treatment decisions, and overall patient care, laboratories were among the first areas in health care to become computerized. In many institutions, bringing laboratory information online was accomplished decades ago, as soon as billing and admission-discharge-transfer systems were in place. Nevertheless, many of these early systems were simply distribution mechanisms for test results; too often, those results were laboriously typed into the system by clerks reading stacks of results on paper. Clearly, anything this labor intensive and error prone was a prime area for innovation in information technology.

Many software companies responded to this need for a genuine laboratory information system (LIS), offering everything from relatively inexpensive turnkey packages, to which the laboratory was expected to adapt itself, to higher-end, custom installations that adapted themselves to the laboratory. Academic institutions sometimes built their own systems, cobbling together best-of-breed technologies to form an LIS that might suit the laboratory perfectly, but might also require a basement full of technically minded tinkerers to maintain.

Over time, these proprietary, custom, and homegrown LIS types both merged and branched, making it possible to obtain nearly any combination of features for almost any size or type of laboratory. The range of functions handled by an LIS is also broad, and capabilities can often be purchased piece by piece to suit the testing types and volumes, budgets, and staff preferences of the facility.

The core functions of the LIS are the steps involved in following a specimen from acquisition through final report distribution, with test status updated at every stage. The LIS can also manage business functions such as billing and accounts receivable, workload balancing, staff scheduling, cost and revenue reporting, and efficiency analysis. In the fully automated laboratory, the LIS can direct robotic transport systems and instruments that complete tests from start to finish (while directing unusual results and problems to the appropriate human for attention). The LIS can distribute results throughout a hospital, a multisite enterprise, a network of referral sources, or a Web-based system permitting global access.

The LIS Today

Misys Laboratory, an LIS from Misys Healthcare Systems, Raleigh, NC, has been used for more than 25 years to manage specimen data. From initial requisition to specimen tracking to final reporting, the system can be customized to meet specific work-flow needs. Business intelligence tools incorporated in the LIS permit analysis of patient data and tracking of client problems. For referral sources, output can be personalized. The LIS works with information systems on both departmental and enterprise levels, as well as with major instruments and hospital information systems.

SchuyLab is a product of Schuyler House, Valencia, Calif. This inexpensive, Windows-based LIS monitors quality control, prints consolidated reports, compiles daily logs and worksheets, and interfaces with laboratory instruments through an icon-based program. Using Health Level 7, the system communicates with office and hospital information systems. Internet and direct Medicare billing modules are available, along with modules for dial-in results, medical necessity, remote printing, and automatic fax transmission. The system connects to 230 instruments, and custom interfaces are available for those not yet on that list.

FFlex eSuite from Fletcher-Flora Health Care Systems Inc, Anaheim, Calif, is an unusually flexible way of acquiring LIS capabilities under circumstances where this might not otherwise be possible due to technological incompatibility or budgetary problems. The system’s functions, all Web-based, are modular and can be implemented individually as funding allows. They can also be acquired using a fixed-cost plan that stays within the facility’s predetermined budget. They are compatible with both Windows and Unix/Linux operating systems, and they work with Unify, Oracle, Microsoft SQL, and other databases.

The LabDAQ LIS from Antek HealthWare LLC, Reisterstown, Md, is a widely used system that permits expansion as the laboratory’s growth (in physical size and in testing range and volume) requires. It is adaptable for use in hospitals, clinics, physicians’ office laboratories, and reference laboratories, and it employs Web-based ordering and reporting. It also interfaces with the laboratory’s other information systems, including hospital information systems, practice-management systems, and electronic medical records, for easy data access. National and regional reference laboratories are accessible using its bidirectional interfaces.

Cerner Corp, Kansas City, Mo, makes the PathNet LIS, which the company describes as the only system that automates both operations and management for the laboratory. Using Millennium architecture, it also provides a seamless information link with the electronic medical record. Clinical-laboratory, anatomic-pathology, genomics, and laboratory-outreach functions are managed by the system, which is based on more than 20 years of work in laboratory information technology.

SCC Soft Computer, Clearwater, Fla, offers SoftLab, a suite of products linking all clinical laboratory departments and functions enterprise wide. From the system, results can be distributed seamlessly throughout the integrated delivery network, with multisite integration. Although this LIS was initially developed for commercial and reference laboratories, its rules-based system has allowed it to expand to all types of settings, and it is fully Internet enabled. Because it is robotics ready, it can manage total laboratory automation.

Impac Medical Systems Inc, Mountain View, Calif, offers the IntelliLab full-featured LIS for reference laboratories, hospitals, and multispecialty clinics. The system produces barcode labels, manages orders, interfaces with instruments, and provides reporting and quality-control tools. Maximum reimbursement is ensured because the system’s advanced ordering features make sure that the correct test is ordered from the right laboratory (internal or external) for the patient’s insurer/payor. Medicare medical necessity logic is used to ensure test coverage, and charge summaries help the laboratory manage revenues.

The LAB/HEX LIS has been developed by HEX Laboratory Systems, Encinitas, Calif, with the intention of pairing flexibility and stability. All types of laboratories can use the system, which is expandable through modules for medical necessity; for interfacing with practice-management systems, hospital information systems, and analyzers; for multisite service; and for billing/receivables. An application service provider (hosted) version is available, along with Internet order entry and results retrieval. The LIS supports user groups ranging in size from two to 50.

The CLS-2000 laboratory system from Computer Service and Support, Linwood, NJ, is an LIS with the ability to automate the laboratory completely. It handles chemistry, hematology, microbiology, mycology, serology, cytology, parasitology, and toxicology, in addition to the reporting and profitability functions of an LIS. Remote access and physician customization are available, along with billing integration, barcode generation, and rule-based order entry with medical-necessity functions.

Recent Introductions

As computing speed and storage capacity have increased while hardware prices have dropped steadily over the years, the LIS has used this new data-management power to expand into more ambitious areas. Even anatomic pathology, with its wealth of images and text-based reports, can now move out of the paper-based realm and gain the productivity associated with LIS use.

The Orchard Harvest LIS by Orchard Software Corp, Carmel, Ind, is now accompanied by a newly released anatomic pathology module. This fully integrated addition uses rules-based decision making to help anatomic pathology departments overcome the paper-based systems that they have continued to use for so long, even after their facilities converted to LIS use. Historical and current results are accessible as a single clinical history containing the patient’s cytology, pathology, and clinical laboratory findings. Direct integration also improves communication between departments, the company says, by permitting shared use of the patient database and all LIS features.

NovoPath is a Windows-based anatomic pathology LIS from Novovision Inc, Princeton, NJ. While it was created for independent pathology practices, it is readily integrated with hospital information systems. It handles label printing, image acquisition, reporting, electronic report signature, and archiving for all pathology cases.

ClinLab, Inc, Orange City, Fla, offers the turnkey ClinLab LIS for both clinical and business laboratory functions. Medical technologists designed this system, which uses client/server technology to provide fail-safe data storage and unlimited expansion capabilities. The system is intended for laboratories of small to medium size and can be interfaced with instruments and information systems of various kinds. Remote access and remote printing are supported. A major focus of the system is the reduction of clerical work by technologists; this may be especially valuable as workforce shortages continue.

Ongoing Expansion

Since an LIS is already capable of handling the laboratory’s internal needs, future developments are likely to focus on continuing expansion of its interoperability. Increasingly, the LIS is expected to communicate seamlessly with the enterprise and pathology picture archiving and communications systems, the hospital information system, the laboratory’s instruments, point-of-care testing equipment, Web systems for remote access, and the electronic medical record. These capabilities are critical to the ability of any LIS to meet the future needs of its users, especially as the electronic medical record gains broad use. Regulatory agencies, payors, and accreditation programs are also expected to require LIS-generated data on compliance and quality, perhaps in the near future.

Psyche Systems Corp, Milford, Mass, has announced a partnership with Boston Software Systems, Sherborn, Mass. This will allow the e.lixa Suite, Psyche’s hosted set of LIS extensions, to be accessed from the desktop using Boston WorkStation scripting technology. Using a Web browser and hosted applications, a laboratory can add new functions to its legacy LIS without spending as much as it would to buy its own new software module. Outreach and graphical analysis reporting are available in this form; using e.lixa’s relational database of all current and historical patient and specimen data, the laboratory can generate reports on any parameter that it tracks. Referring physicians can also use Web-based ordering and results retrieval.

In late February 2007, Thermo Fisher Scientific Inc, Chicago, announced its working relationship with Microsoft. Together, the companies will develop advanced laboratory systems using the Microsoft technology platform and Thermo Fisher’s informatics expertise. Secure, scalable, and flexible software to increase productivity will be the focus of this work. Darwin LIMS (a laboratory information management product for quality assurance, quality control, and research and development) has already been built on the .NET platform from Microsoft. In the interest of interoperability, open XML standards for data exchange will be supported by Thermo Fisher and the other members of the Microsoft Bio-IT Alliance.

Roche Diagnostics, Cambridge, Mass, is now developing the next version of its Omega 3000 LIS. The upcoming release is being built on CACHe 2007, a postrelational database that allows rich Web applications to be developed quickly in response to the needs of users. It also permits these applications to be made without depending on any particular platform. Significant reductions in Java development time have been announced, allowing Roche to meet future LIS needs quickly.

Acquisition Timing

Want to read more? Search for “lab information systems (LIS)” in our online archives.

For those laboratories still using paper-based information systems, the cost of lacking an LIS may, by now, exceed the cost of acquiring one. Vendors can often help with cost justification for an LIS purchase, although each laboratory’s circumstances will differ. The main areas of cost savings attributed to LIS use are elimination of lost and misidentified specimens (ending the need for repeat testing), higher specimen throughput, immediate problem detection and enhanced troubleshooting, complete charge capture, higher reimbursement rates through better compliance with payor requirements, and, especially, more efficient use of staff time.

It is harder to assign a dollar figure to the increased speed of diagnosis and the more informed treatment decisions that LIS-based access to laboratory results creates, but both clearly advance every laboratory’s underlying goal of improving patient care.

Kris Kyes is technical editor of CLP. For more information, contact .