If your healthcare organization (HCO) is looking to move to an “all-inclusive” EMR that includes replacing your best-of-breed laboratory information system (LIS), you should first think about several important considerations. The decision is not as simple as it seems on the surface. At a minimum, be well-informed and fully aware of the pros and cons of having a best-of-breed LIS or an LIS that is part of an “all-inclusive” EMR system.
Executive Summary
- A best-of-breed LIS solution refers to software that is developed specifically and exclusively for the laboratory; whereas an “all-inclusive” solution refers to an LIS that is part or a module of a suite of products from the EMR vendor.
- One option is to include your best-of-breed LIS alongside the EMR.
- When LIS replacement is the topic, the lab needs a seat at the table and an opportunity to communicate how this decision impacts their workflow, which in turn affects patient care.
- When making this decision, consider additional costs (e.g., integration, middleware, implementation, training, downtime, modules needed for lab specialties, etc.) that negate the EMR-LIS being “included” or “free.”
- Be aware of the functionality differences between the two LIS types and how losing your best-of-breed LIS functionality can affect revenue.
- Research and analyze your choices carefully to determine the best and most robust LIS that will provide your healthcare system quality results for your providers, patients, and laboratory team.
Best-of-breed Versus All-in-one Solutions
A best-of-breed solution refers to the leading software in a specialized category. The best-of-breed LIS is designed from the bottom up to manage laboratory operations. HCOs that choose to use best-of-breed LIS technology are savvy enough to realize that laboratory testing is incredibly complex and requires a focused approach to building the best technology stack. These organizations are in touch with the value of the laboratory and select tools that are solely focused on and designed to serve that specific purpose.
Conversely, in healthcare, an all-in-one or “all-inclusive” solution refers to a suite of related products from one vendor, the EMR vendor. HCOs that take an all-in-one approach are willing to address problems more generically, with less concern about the intricacies of the laboratory workflow managed by the LIS. This decision is typically made with a primary focus on cost as the EMR vendor describes the LIS as “included;” however, you must investigate the costs carefully to be sure you understand what you are giving up to replace your best-of-breed LIS.
From a logical stance, best-of-breed LIS solutions solve specific problems and manage multiple complex workflows that cannot be addressed by the general capability of all-in-one EMR solutions. All-in-one solutions typically meet minimum functionality requirements but do not include the level of sophistication found in a best-of-breed solution. Although all-in-one vendors offer many enterprise applications and claim that their system is a superior solution, modules in an all-inclusive EMR system are rarely best-of-breed.
Nevertheless, the allure of an all-in-one solution—dealing with only one vendor—persists for many.
Integrated Best-of-breed Approach
Implementing an EMR system that offers an LIS component does not mandate that your laboratory use the EMR’s LIS. Alternatively, the technology stack can include your best-of-breed LIS alongside the EMR all-in-one solution. Consider this analogy: You go to your primary care doctor for a common illness, but for a serious issue, you need a specialist with expertise in the area of your health concern. A hybrid approach of primary care doctors and specialists working together gives you the best overall outcome.
Lab & Administration Relationship
Unfortunately, the decision to replace a best-of-breed LIS is sometimes out of the laboratory’s control. This scenario is related to administrative leaders’ depth of knowledge about what the laboratory does, how it affects patients, and how important laboratory data is in patient care.
It is important for laboratory administration to have a strong relationship with organizational leaders. The lab needs a seat at the table and an opportunity to communicate how an all-inclusive EMR LIS purchase decision impacts the lab’s workflow, which in turn affects patient care.
The laboratory touches nearly every area in an HCO, yet its value is often overlooked and underappreciated. When decisions are made that dramatically impact the lab without the lab’s input, negative consequences such as employee turnover and low employee satisfaction can result.
Important Considerations
If you have a best-of-breed Orchard Software LIS, why would you replace it with an inferior system, particularly if there is little impact to providers? Below are some factors to consider if you are faced with this decision.
Middleware Integration & Elimination
An all-in-one EMR vendor may claim that one of the benefits of using their LIS module is that it is integrated. However, with a best-of-breed LIS vendor, the integration to the EMR system is seamless. With today’s technology, the ability of different systems to exchange information means “hybrid” solutions can easily deliver an all-in-one experience.
Your LIS sits in the middle of several other systems requiring complex integration. The LIS must connect to laboratory analyzers, reference labs, state health labs, other client EMRs, and more. Orchard Software has decades of integration expertise and can seamlessly connect to any EMR. Orchard also includes its proprietary device connection technology, Orchard Device Engine (ODE). The ODE provides a secure method of connecting diagnostic instruments and ancillary equipment to the LIS. It provides a central point of communication for all devices across all Orchard products regardless of physical location. The ODE enables rapid development and deployment of new interfaces for new devices, provides a means for documenting communications from the host to the device, and promotes easy migration of the components of the system.
Some EMR-LISs require a third-party middleware to interface the lab’s instrumentation, which requires a separate service independent of the EMR vendor. When there is a disruption to the middleware service, lab interfaces will be disrupted throughout the entire healthcare system. Orchard has experience interfacing its solutions with middleware if needed; however, the ODE can likely eliminate the need for those additional middleware solutions, saving significant costs and eliminating downtime associated with third-party middleware. With the ODE, if one lab is down it will not affect the other labs. ODE can be installed on numerous computers in each laboratory so that if one computer goes offline, the others act as a backup.
In addition, Orchard Software offers its customers training to implement their own HL7 interfaces, which saves labs time and money. “I did my interface training with Orchard, and I feel like—from a growth perspective—allowing me to build those interfaces with other EMRs really helps us grow in our communities and expand and connect Orchard with other EMRs at community hospitals and clinics,” said Lisa McCormick, MLS(ASCP), LSSGB, Laboratory Information System Analyst at Mary Lanning Healthcare. “I don’t think the [EMR-LIS] has the functionality to build interfaces with other EMRs. From my perspective, that’s huge for growth going forward.”
Peter Dysert, MD, and Chief of the Department of Pathology at Baylor Scott & White Health agrees. “The concept of software dependency and workflow is not the same in the EHR world from a clinical perspective as it is from a lab perspective,” said Dysert.
