In the information technology domain, few activities rise to a higher level of "mission critical" status than the reliable and efficient integration of the laboratory information system (LIS) with the hospital information system (HIS). Clinicians send orders for laboratory examinations and base decisions on the results they receive. Patient lives may hang in the balance. And the healthcare facility owes its very mission and survival to the smooth flow of clinical and administrative data through the enterprise.
HIS/LIS integration has been enabled by the development and adoption of a variety of standards. Laboratories use HL7 to send electronic data results from their equipment as their systems rely on LOINC (Logical Observations, Identifiers, Names and Codes) as a clinical terminology suite based on SNOMED (Systematized Nomenclature of Medicine) Clinical Terms. This unified strategy serves as a foundation for a common computerized language used around the world.
"The bulk of laboratory results are highly structured digital data produced by blood analyzers," explains John Quinn, chief technology officer for healthcare practice and principal at Capgemini Health in New York City. "The LIS that sits between the blood analyzers and the HIS environment is specific to the workflow and organization of the laboratory, whether it is an internal hospital laboratory department or an outside reference lab."
Dennis Winsten, president of Dennis Winsten & Associates, Inc. in Tucson, Ariz., urges anyone involved in building the interface between systems from two different vendors to make sure that both vendors support the LOINC model as their means of exchanging information. "If it is not LOINC, make sure that what is being passed from one system to the other is what the other system expects."
The laboratory portion of LOINC contains a number of categories: chemistry, hematology, serology, microbiology and categories for drugs, such as antibiotic susceptibilities. Winsten describes expansions in LOINC include more clinical activities such as vital signs, intake and output data, EKGs, urologic imaging and other clinical parameters, including nursing functions.
INTEGRATED SYSTEM OR BEST OF BREED?
Health institutions begin the process of HIS/LIS integration with their initial IT purchase decisions. The primary controversy involves a "best of breed" vs. "integrated system" rationale.
Best of breed involves building a system that has the best laboratory system, best pharmacy system, best radiology system, including the best computerized physician order system (CPOE), and nursing entry system. This yields multiple systems to connect, which Winsten describes as a challenge even with all of the standards currently applied. An up-front integrated approach entails a system with a single architecture where everything is defined once in terms of meaning and it provides all of the components.
Proponents of best of breed argue that with an integrated system up front, the individual departmental effectiveness and efficiency are compromised, while the integrated system advocates maintain that effective integration should serve as the driving force.
Winsten suggests that as the integrated systems have evolved, many of the former "best of breed" companies have disappeared or expanded to become more comprehensive clinical systems, by offering laboratory, radiology and pharmacy in one suite.
"The argument I would make for the [up-front] integrated approach is that if you're the CIO in a hospital, irrespective of the fact that all of these systems can be interconnected, and the technology is proven, now you're dealing with multiple vendors," says Winsten. On the other hand, from an institutional standpoint, using this model, certain departments may believe they have a sub-optimal system for their work, he observes.
HURDLES TO JUMP
Once the initial decisions about approach are resolved, there are specific issues that must be addressed, such as security, patient privacy, patient access to lab results and distributing results to multiple departments.
Kevin D. Lyles, partner in the healthcare practice of Jones Day in Columbus, Ohio, raises the issue of security as it relates to HIPAA regulations and patient privacy.
Often the personnel charged with integrating networks are not security professionals. There are the usual in house challenges of maintaining a secure network within firewalls, and limiting access while insuring that clinicians can accomplish their