The integration of laboratory data with other departments in a hospital or clinic has undergone a major evolution in the last decade. It was not that long ago when all interaction between the lab and the outside world was performed on paper reports and requisitions. However, the financial demands on clinics and hospitals required them to become more efficient and productive. The first stage of this evolution, as it relates to the lab, was to automate all the functions within the laboratory itself.

Laboratory information systems (LIS) were being implemented at a rapid rate to primarily interface directly to the analyzers. By directly communicating with analyzers, labs immediately realized increases in efficiency and accuracy, and easier regulatory compliance. As clinics and hospitals have adopted or upgraded their hospital information system (HIS), billing, and electronic medical record (EMR) systems, the demands on laboratory systems have increased.

The second phase of the evolution occurred when administrators realized the cost of having separate islands of information that did not speak to one another. Valuable time was wasted in entering redundant patient information in different systems. Many wanted the lab to receive demographics and send charge information to the billing system.

A later trend was the request to receive orders and send laboratory results to the HIS or EMR. Finally, the LIS is expected to act as a central hub, to send orders to a reference laboratory if the tests are not performed in house, and to receive the results back from the reference lab. This allows the LIS to have virtually all patient results accessible for comprehensive analysis.

A New Standard
Fortunately, there was an industry standard that defined the format of data between multiple software systems to facilitate this dialogue. This specification, called HL7, was a boon to this evolution. However, like all things in life, the devil is in the details; while HL7 is a great start to this process, other questions of connectivity and HL7 interpretation must be worked out.

As the lab reaches out, interacting with systems beyond its normal course of business allows the lab to provide excellent customer service and remote access to lab information. This initiative has pushed the LIS beyond its initial design. The change to workflow and laboratory procedures is profound when implementing seamless interfaces to other systems. Issues that must be discussed during the planning stages include:

• Orders: Where will the orders be placed? Which system will bar code the specimen?
• Networking/Configuration: Is the LIS already part of the existing network? How will the file transfer occur on the network?
• Experience: Have the vendors successfully interfaced in the past?
• Implementation: Are the interfaces in sequence or combination? Is there a test environment?
• Procedure/Workflow: Will my current workflow be altered, and how?

On the Same Page
The successful implementation of an interface requires that all parties (lab manager, information technology staff, billing staff, clinicians, and software vendors) be on the same page before any work is commenced. The challenge for clinics and hospitals is finding vendors that will address the lab’s need for a system that is effective out of the box, without limiting the lab’s ability to operate efficiently. An effective solution must be flexible enough to accommodate slight variances that exist between vendors, and it must be easily configurable.

In order to complete this process, clinics and hospitals sometimes contract experts to help coordinate the network connectivity, software vendors, and workflow. Still others have in-house experts to work through the details. During this process, it is critical for the lab manager to remain involved in all stages of implementation, as there will most certainly be changes to the laboratory procedures and workflow.

The best way to get maximum benefit is to take the time to carefully plan, test, and implement. Your new workflow should further enhance efficiencies in the laboratory and minimize errors. The involvement of the laboratory administrator is key to the success of the project.

Andy Pollack is president and founder of Antek HealthWare, creators of the LabDAQ LIS. He has more than 20 years of experience in laboratory workflow consulting, computer hardware, software programming, networking, and database design.