The Virtual LIS VLIS: An Emerging LIS Architecture for the Clinical Laboratories

1
The Virtual LIS (V-LIS) An Emerging LIS
Architecture for the Clinical Laboratories

• Bruce A. Friedman, M.D.
• Department of Pathology
• University of Michigan Medical School
• Ann Arbor, MI
• bfriedma_at_umich.edu

2
Lecture Outline

• Describe how the centralized lab model supported
  by classic LIS but challenged by recent emergence
  of decentralized venues
• Discuss dis-integration of lab databases as
  centralized testing becomes less important
  challenge of physician office testing
• Describe emergence of virtual LIS (V-LIS) as
  substitute for central LIS (C-LIS) show how
  (V-LIS)(C-LIS) (SLAMs)
• Explain how the e-lab meshes with the virtual LIS
  and how these two models will define future of
  laboratory computing
• New lab product lines stimulated by the
  web-based lab computer environment direct access
  testing lab consulting
• Explain role of pathology informatics in the
  rationalization of the emerging complex
  lab/healthcare computing environment

3
Centralized Lab Model Supported By Classic LIS
Challenged by Multiple Decentralized Lab Venues
4
Centralized Lab Model Has Dominated Lab Operations

• Centralized lab model has dominated hospital labs
  since the 1950s specimens transported to lab
  factories
• Lab factories with assembly-line processes
  spawned need for increasingly sophisticated
  high-throughput analyzers
• Wholesale business with large volume of raw data
  reported to physician customers who then
  interpret the results
• Infrastructure (blood drawing centers, analyzers,
  LISs) is expensive, discouraging new entrants in
  market
• Hospital labs reference labs enjoyed relative
  monopoly driven by high test volume low
  cost-per-test

5
Classic LIS Has Served Lab Professionals for
Three Decades

• LISs specifically designed to manage information
  in hospitals based on hospital work
  flows/processes
• For 30years, total IT purchase by hospital lab
  directors was simple buy a classic LIS suitable
  for lab size
• Best-of-breed argument held sway labs optimized
  LIS and instrument functionality to lower
  cost-per-test
• Many LIS vendors persisted in the relatively
  small market new entrants developed C-LIS
  products
• C-LISs served labs well until new testing venues
  evolved (e.g., POCT) that didnt fit centralized
  lab model well

6
Reasons for the Weakening of the Centralized Lab
Model

• Healthcare becoming less centralized removed
  from hospitals to reduce costs increase patient
  convenience
• Clinicians nurses demanding faster TAT
  greater control over testing they have little
  concern about cost-per-test
• IVD manufacturers marketing POCT devices directly
  to clinicians emphasizing benefits for their
  workflow
• New POCT data management and communication
  standards facilitated order result integration
  into LIS/CDR databases
• Key lab drivers (e.g., budget, lab efficiency,
  data integration, quality issues) do not
  resonate with clinicians

7
Decentralized Venues That Will Comprise Major
Components of Lab Testing

• Home-testing associated with chronic and
  post-operative care to reduce delivery costs
• Direct access testing (e.g., web-mediated, paid
  for by customers out-of-pocket)
• Sophisticated genomic testing offered by
  biotechs/reference labs to retail testing market

• All forms of POCT with rapid TAT requirements by
  hospitals/clinicians
• Testing in skilled nursing chronic care
  facilities as emerging venues for lab testing
• Home kits instruments (e.g., glucometers,
  pregnancy, HIV)

8
Home Health/Home Testing Matures as Logical
Extension of IDN Lab Services

• Home health, supported by home lab testing, will
  be next lab frontier logical extension of POCT
  as care migrates to home
• Cascade effect to reduce healthcare costs less
  sick patients migrate from ICU?general care
  units?outpatient units?home
• Home care workers will soon draw blood from
  patients perform tests in-home with portable
  analyzers
• Such instruments will upload data to nurses/MDs
  for near real-time monitoring and to hospital
  databases/PHRs via the web
• Aggressive IDNs will pursue home health/lab as
  logical extension of other services to reduce
  costs/retain patients

9
New Definition of Clinical Lab Prompted by
Growth of Decentralized Testing

• A clinical lab consists of one instruments
  using patient specimens to create new information
  about the specimen
• A glucometer operated by a diabetic patient in
  his bedroom is a clinical lab so is the largest
  reference lab in the country
• Irrelevancies under new definition size of
  lab, volume of testing, training of the
  instrument operator, IT support
• Any new information about a patient has some
  intrinsic value so should be captured, stored,
  integrated in lab database
• From IT perspective, the key issue will be how to
  capture all relevant lab information not just
  hospital-generated lab data

10
Reimbursement Implications Given This New
Definition of Clinical Lab

• Everyone will rapidly grasp that this broad
  definition of a clinical lab has broad
  reimbursement implications
• Current reimbursement model pays for direct
  service to the patient procedures usually
  reimbursed at higher rate
• Definition implies that background lab info.
  management services (capture, quality,
  integration) also reimbursable
• Payors strive continuously to decrease limit
  rather than increase definition of reimbursable
  services to physicians
• Penny-wise, pound-foolish NOT to reimburse data
  management services because makes delivery more
  efficient

11
Pathology Informatics Decentralized Testing A
Congenial Match

• Weakening of centralized lab model has weakened
  classic LIS model which provided an integrated
  database
• Pathology informaticians need to develop a global
  strategy for presenting coherent rational view
  of data downstream
• Need shift of raison detre of central lab from
  primarily data creation to data creation data
  integration management
• Hopefully, hospital lab will remain as a central
  hub through which multiple data streams will
  converge/integrate
• Biggest challenges will be recruiting sufficient
  talented personnel justifying reimbursement for
  data management

12
Dis-integration Of Lab Databases Special
Challenge Of Physician Office Testing
13
Dis-integration of Lab Data Repositories as
Testing Migrates to New Venues

• Consequences of POCT, home testing, expanded
  office testing hospital-based labs may lose
  control of lab data
• Problem has been exacerbated by the fact that the
  EMR is now the prime integrated clinical
  database C-LISs feed data to it
• Logical conclusion is to embrace decentralization
  when demanded by customers but emphasize lab data
  re-integration
• Good business strategy because test performance
  more commoditized data integration as a
  value-adding step
• Integration of lab data important for clinicians
  who desire one-stop data shopping also platform
  for lab medicine consulting

14
Balancing Two Clinical Data Domains Hospital
CDRs and Office PMSs

• Hospital labs with outreach programs lab
  portals for office-based OE/RR getting requests
  from MDs for PMS integration
• Lab professionals torn between challenges of
  enhancing and integrating lab data across
  hospital and MD office PMS/EMRs
• PMS vendors often view products as office EMRs
  which can also accommodate lab, radiology,
  retail pharmacy ordering
• Hospital-based lab in unique position of being
  able to span gap and serve patients MDs in both
  hospital/office setting
• Integrating hospital office-based lab testing
  admirable goal for continuity of care
  opportunity to capture business

15
Lab Portals Offer Special Challenge to LIS
Separate Database/EMR Integration

• Lab portals unique among SLAMs evolving quickly
  as mini-LISs with web-based architecture/cost
  advantage
• Some lab portals now accessible via the EMR via a
  button for lab outreach ordering across entire
  health system
• Lab portal vendors can be more nimble than LIS
  vendors because of more modern architecture/aggres
  sive sales
• Some hospital lab clients turn to lab portal
  vendors for new features when their C-LIS vendor
  is unresponsive
• If the lab portal has its own unique lab
  database, spawns both opportunities and
  challenges for hospital lab

16
Emergence of the Virtual LIS (V-LIS)(C-LIS)
(SLAMs)
17
The Virtual LIS (V-LIS) as a Substitute for the
Classic LIS (C-LIS)

• Classic LIS (C-LIS) will persist despite
  limitations but some key functionalities will
  migrate to supplemental modules
• We call them SLAMs (supplemental lab application
  modules) key examples are lab portals and
  middleware
• Lab portals are web-based systems initially
  deployed by reference labs to easily provide
  OE/RR to physician offices
• Middleware is software running between
  instruments and C-LISs to add value to test
  results (e.g., rules, tags)
• The C-LIS plus variety of new emerging SLAMs
  constitute the virtual LIS (V-LIS) which is an
  integrated lab network

18
Examples of SLAMS Used to Enhance Lab Efficiency
Productivity

• Anatomic pathology LISs
• Surgical pathology imaging
• Autopsy databases gross imaging
• Servers supporting TLA (form of middleware)
• Middleware developed and marketed by IVDs
• Home lab testing
• Specialized molecular diagnostics servers

• Lab portals
• Outreach laboratory logistics
• Point-of-care testing (POCT)
• Positive patient identification systems
• Outreach logistics systems, including courier
  support
• Quality control across multiple instruments

19
Introducing the Lab Portal TheFirst ASP/Web
Success Story

• Lab portal software provides connectivity to lab
  customers, applications such as OE/RR,
  information about tests
• Utilizes web to provide office connectivity
  application is accessed using a browser -- thick
  client (PC) also possible
• Strategy driven by need for easy access in MD
  offices for outreach but equally good solution
  for hospital-based MDs
• Lab portals example of traditional LIS
  functionality (e.g., OE/RR) moving to web
  software can run also as ASP
• Software can be obtained from classic LIS vendors
  as part of their software but also from
  specialized lab portal vendors

20
The Special Case of Middleware Definition,
Function, and Integration

• Roche coined the term of Middleware Solutions
  defined as software located between analyzer
  LIS
• Roche outsourcing software development to Data
  Innovations Beckman Coulter uses Orchards
  Aqueduct
• Middleware market driven in part by goal of IVDs
  to add value to their products compete
  successfully
• Also driven by need of IVDs to add useful
  features (e.g., flags rules) that some older
  LISs are unable to provide
• Challenge from lab perspective is how to
  integrate middleware into lab network dominated
  by the C-LIS

21
Software Standards as Basis for the Evolution of
the Virtual LIS

• Have emphasized the V-LIS as integrated lab
  network consisting of the C-LIS plus SLAMs for
  specialized tasks
• Evolution of this integrated network is a tall
  order given the fact that hospital labs are
  capital-poor who pays?
• Answer needs to be integrated network based on
  communication standards and not customized
  interfaces
• Set of web-based standards called Web Services
  underpinning e-biz (e.g., SOAP, WSDL) may be
  answer
• Will need vendor or government-endorsed effort to
  put forward proposal for lab (and healthcare)
  environment

22
Virtual LIS Already a Reality for Many Labs Now
Name Available for Architecture

• Complex labs have been supplementing
  functionality of their C-LIS for years by
  addition of specialized modules
• Oldest example of such modules has been the
  anatomic pathology LIS (AP-LIS) best-of-breed
  now withering
• Historically, complex labs have had IT group
  sufficiently sophisticated to architect for them
  an integrated V-LIS
• Lab software market now differs qualitatively
  quantitatively due to the proliferation of SLAM
  offerings
• In addition, smaller labs now also facing more
  complex business plan but system integrators
  still not available

23
E-lab Meshes With Virtual LIS How These Two
Models Will Define Future of Lab Computing
24
Converting the Hospital Laboratory to a
Web-Based E-Laboratory

• Any e-business manages its transactions over
  internet capitalizes on traditional IT vast
  reach of the internet/web
• Key element of an e-business is offering
  transactions on the web most dynamic/interactive
  processes are placed online
• As soon as a hospital offers web-based OE/RR
  (e.g., using a lab portal for outreach), it then
  qualifies as an e-laboratory
• Moving to e-lab improves service, cuts costs, and
  increases test volume the web is a labs window
  on the whole world
• Lab portal provide web-enabled OE/RR, enabling
  lab to compete with large reference labs for
  outreach business

25
V-LIS Pus E-lab How Two Models Will Define
Future of Lab Computing

• V-LIS weans hospital lab from a pure C-LIS
  provides opportunity to selectively add SLAM
  functionality as needed
• Challenge will be integration of C-LIS with the
  newly purchased SLAMs without expense of
  customized interfaces
• SLAM market will allow small companies to move
  into lab IT space more competitive than pure
  C-LIS business model
• E-lab model moves hospital labs to more
  competitive service-oriented, even
  retail-oriented business model
• Prime example has been lab portal products which
  allowed lab outreach program to compete with
  large reference labs

26
How Web-Based Services Will Change Lab/Patient
Relationship to MD

• Lab portal OE/RR allows MD offices to operate
  more efficiently avoid patient calls for
  resulting save money
• Lab portal software as wraparound can also
  provide on-ramp to hospital-based lab, radiology,
  cardiac diagnostic
• Integration of OE/RR into office-based physician
  management systems (PMSs) will promote
  efficiencies/development of EMR
• Decentralization of lab testing (POCT biotechs
  offering retail genomic testing) will present
  new data integration challenges
• DAT for consumers will complicate their
  relationship with MDs patients bring complex
  results to MDs for interpretation

27
The Wired Pathologist A Vision of Future Role,
Capabilities, Mission

• We use term wired pathologist to represent
  shift for informatics-enabled pathologist in
  multiplicity of roles
• In order to provide just-in-time consultations,
  equipped with headset for digital voice-over-IP
  (VOIP) conversations
• Provides office-based physicians with web-access
  to smart reports using hand-held web-enabled
  portable devices
• Expert in integrating multiple clinical data
  streams converging in pathology and properly
  formatted
• Expert in developing complex clinical/financial
  databases to answer questions support
  strategic initiatives

28
Challenges to Clinicians in New Healthcare Lab
Environment

• Seeing more patients per hour without allowing
  quality to suffer while maintaining respect
  confidence of patients
• MDs working under increasing regulatory payor
  documentation burden distracts them from
  patients
• Malpractice insurance crisis, driving MD
  increasingly out of private practice increasing
  their estrangement
• Increasing capital and training costs to enhance
  the IT capabilities of office practice
  clinicians often cyberphobic
• Patients surfing the web and increasingly IT
  savvy higher expectations about office
  information-access capabilities

29
New Lab Product Lines Stimulated by the Web-Based
Lab Computer Environment
30
What Is Direct Access Testing? Why Sudden Surge
of Interest?

• DAT enables consumer to order a menu of
  high-quality lab tests via the web without
  obvious MD intermediary
• Although concept not new, web-mediated OE/RR has
  taken this this lab product into homes of all
  consumers
• DAT not a new form of alternate healthcare but
  rather a new approach to case-finding/wellness-mo
  nitoring
• DAT only one facet of larger phenomenon of
  consumer-controlled selection/utilization of
  healthcare services
• Surge of media interest prompted by keen interest
  web initiatives, e-business, and connection to
  healthcare

31
Various Rationales for Consumers Use of DAT
Services
32
Success of Various DAT Programs Need to Examine
Business Models

• OSU Medical Center has program in conjunction
  with Kroger increases store traffic and
  showcases OSU logo
• Customers selects DAT tests in pharmacy tests
  ordered customer reports to patient service
  center
• Profit margin for DAT testing not the only
  rationale for the program program also prompted
  by competition
• Results Direct is DAT program initiated by PAML
  regional reference lab spun off from Sacred Heart
  Health System
• Results reported only to DAT customers health
  system physicians did not want to be sent results
• Results Direct has now spun off new company that
  will provide turn-key DAT software solutions to
  hospital labs

33
Pathology Informatics Molecular Dx as Major
Challenges Facing Pathologists

• Pathologists define greatest challenges facing
  them today (1) molecular diagnostics (2)
  informatics
• Molecular diagnostics encompasses all
  discoveries of new biology and emerging science
  (e.g., genomics, proteomics)
• Pathology informatics encompasses capture,
  integration, storage, integration of all data
  generated in CP and AP
• These two new areas linked in that molecular dx
  poses challenges about how data of this
  complexity can be managed
• Two disciplines spawning new biz models Roche
  Ameripath1, Lab Corp2 creating centers of
  excellence in new biology

1. http//us.diagnostics.roche.com/press_room/200
3/021103.htm 2. http//www.labcorp.com/centers_of
_excellence/index.html
34
Genomics and Proteomics Will Spawn New Testing
Opportunities Challenges

• Genomic proteomic testing will overwhelm
  clinicians they will need IT tools lab
  consultation to manage patients
• Current LISs cannot acquire manage deluge of
  data that will be presented to from both volume
  complexity perspectives
• Biotech companies, holding patents to new tests,
  may not kit-ize testing for hospital labs or
  will license only to selected labs
• Consumer sensitivity to genetic testing may balk
  at results integration into hospital databases
  favor web-based labs
• Current testing model may not lend itself to
  genomics testing need for recurring
  alerts/subscription relationship with patients

35
The Key to Reporting New Biology Test Results
Hot Links to Other Servers

• In same way that smart lab reports will have
  hot-links to references, new biology test
  results will also be hot-linked
• Inconspicuous linking to another web server may
  solve formatting, storage, upgrading challenges
  for hospital LISs
• Because genomic reporting web servers will be
  layered, will also offer specialized raw data
  interpretation tools
• Personnel supporting specialized
  genomic-reporting web servers can update
  interpretations as the science advances
• Unknown at this time how specialized genomics
  servers will be funded expensive to offer
  patient alerts during lifetime

36
Lab Medicine Consulting as New Product Line for
Clinical Laboratory

• Tradition in clinical pathology not surgical
  pathology of reporting raw data, providing
  little interpretation for them
• In surgical pathology, like radiology, the report
  is the consultation CP reimbursed consultations
  use 26 modifiers
• History of useless automated lab consults that
  report redundant or obvious information to MDs
• Value-adding consulting provides opportunity for
  additional lab revenue that can be billed under
  existing CPT codes
• Sophisticated lab medicine consulting should be
  initiated now prepare for complex molecular dx
  testing

37
Lab Medicine Consulting An Integral Component of
New Reporting Style

• Tradition in clinical pathology is to offer
  consultative support to clinicians, in person or
  via the telephone
• CPT codes 80500 and 80502 permit reimbursable lab
  medicine consultations under the following
  conditions
• Requirements not onerous to bill under these
  codes but this opportunity has not been seized in
  the past
• Can create rules that scrutinize lab data as
  generated cull out abnormals as candidates for
  further consultations
• Key issues are the review of the lab data
  integrated with other clinical elements the
  provision of actionable advice

38
Role of Pathology Informatics in Rationalization
of Complex Lab/Healthcare Computing Environment
39
Information Technology Informatics as Prime
Value-Driving Features

• Because of lab inspections quality control,
  assumption made by customers that most lab
  testing is roughly equivalent
• Assessment of lab services then calibrated by
  test results TAT, communication, integration, and
  storage/archival services
• Particularly true in service-oriented lab
  outreach sector where hospital labs must compete
  with national reference labs
• No accident that reference labs pioneered use of
  lab portal software to push electronic OE/RR into
  MD private offices
• Lab portal software, e-commerce, DAT are also
  shaping style substance of early forms of
  genomic testing

40
General Description of Tool Kit Provided by
Pathology Informatics
41
Defining the Sweet Spot Ideas About How to
Navigate to This New Place

• The sweet spot is the time/place continuum in
  healthcare delivery when/where the clinician
  peruses dx/tx options
• Critical prestigious nexus appropriate goal
  for pathology should be to increase participation
  at the sweet spot
• No announcement by clinicians when arrive at this
  juncture but most willing to seek lab
  consultations if readily available
• Because MDs are mobile (e.g., office, hospital,
  travel) data sources varied, this requirement
  can be challenging
• Good news is that IT annihilates time distance
  feasible for pathologist to be readily available
  for paid lab consultations

42
Describe How These Informatics Tools Will Guide
the Pathologist to Sweet Spot

• Basic idea is that information technology
  destroys time and distance breaks down glass
  curtain between lab/clinicians
• IT can provide clinicians the information/consulta
  tions in various clinical settings precisely when
  they need it
• Need to move to the smart report which is web
  report with information, images, hot-links to
  other resources on web
• We should view our reports as mini-textbooks
  about various diseases so valuable that
  clinicians will file for later reference
• Need to create icons on reports so that
  clinicians can click to get rapid access to the
  pathologist who created them

43
Strengths of Pathology Informatics That Must Be
Preserved in Future

• Opportunity to develop new consulting
  relationships with clinicians via real-time
  web-based communication channels
• Existing expertise in IT and emerging web
  platforms which will be basis for evolving
  in-silico medicine
• Control over the laboratory database which will
  be the repository for new genomic/proteomic test
  results images
• Control over supply of normal diseased tissues,
  forming basis for tissue repositories supporting
  genomic research
• Relationship with pathology-based bench
  researchers create translational bridge between
  researchers and care

44
Pathology Informatics, Molecular Dx, Oncology
as Basis for Pathology of Future

• When pathologists asked about greatest challenges
  in field, they often refer to molecular dx,
  oncology, pathology informatics
• Molecular dx serves as bridge to incorporate
  discoveries of new biology (e.g.,
  genomics/proteomics) to healthcare delivery
  system
• This new discipline will lead to most new lab
  testing informatics, in turn, will support the
  management of all this new information
• The two also connected in that molecular dx poses
  challenges about how data of this
  volume/complexity can be managed
• Molecular dx is the conduit for new biology to
  patient, oncology is clinical focus,
  informatics provides means to manage new data

45
Big Three Clinical Informatics Disciplines with
Staying Power

• Three emerging informatics disciplines with
  staying power, funding, opportunity to
  create/manage large clinical databases
• Oncology informatics, theranostics/internal
  medicine, and cardiovascular informatics
• Common features among them are also strong links
  to the drug development pipeline, research funds,
  public health reporting
• Plentiful resources available for integration of
  clinical data with research data for grant
  support and to respond to IRB demands
• The associated specialties are favored by
  hospital administrators because of number of
  admissions lucrative reimbursement
• CP and AP data are also critical to the
  infostructure of all three of these
  disciplines specialties cant operate without
  lab data

46
Theranostics Driving Toward a New Blend of
Diagnostics Therapeutics

• Normal clinical lab testing used to diagnose or
  monitor a disease state but usually provide
  little advice/insight to rx
• Theranostics describes an approach to healthcare
  delivery that merges dx with application
  development of rx
• Purpose of theranostics is to provide objective
  tests based on molecular/biological rationale to
  guide drug therapy
• A theranostic test provides information on
  appropriateness/ efficacy of drug for particular
  disease particular patient
• Should not be confused with drug assays that
  simply monitor the therapeutic level of a drug
  in a patient to guide dosages

47
Reinventing Pathology Informatics Piggybacking
on Informatics Big Three

• Clinical pathology informatics is in a rut need
  to reinvent discipline and serve as a platform
  for reenergizing lab medicine
• Major problem is that discipline has become too
  focused on installing and maintaining LISs
  little opportunity for creativity
• Pathology informaticians are stewards of critical
  lab databases but this resource used generally
  only to retrieve patient results
• Research pathology informatics is thriving with
  great intellectual vigor and ever increasing
  funding, particularly in oncology
• Migration of major applications like OE/RR to EMR
  may be blessing in disguise force informaticians
  to return to roots

48
Cardiovascular Informatics Has Not Been Invented
Yet Only a Matter of Time

• Logical that oncology informatics evolved first
  rapid emergence of tumor tissue banks huge
  volume of cancer genomic data
• Multiple cardiovascular centers being built,
  certainty that clinical, lab, physiological,
  imaging data for pts. will be integrated
• Clinical pathology data will be of great
  importance to this field but, unlike oncology,
  few important surgical pathology specimens
• Algorithms for wellness testing monitoring will
  be critical for these patients also important
  links to home health care testing
• Hope that this reference to CV informatics will
  act as a stimulus for someone in the audience to
  act as a catalyst for change

49
Why Pathology/Radiology Informatics Are Not
Included among Big Three Disciplines

• Ancillary services not sufficiently clinical and
  integrative contribute to, but do not define,
  final dx work-ups rx regimens
• Constraints on profit margins most lab testing
  commoditized because of competition between
  hospital and commercial labs
• Little direct contact with patients, leading to
  diminution of recognition as major contributors
  to healthcare delivery
• Lab testing can be performed off-site and
  therefore outsourceable viewed more like
  utility than critical service
• Lab has few ties to big business/pharma not
  applicable to radiology with GE/Siemens/Phillips
  investing in basic research

50
Future Support for Standards for Data Sharing
Integration

• Work product of pathology/labs radiology is
  information supplied to clinicians who are
  responsible for care delivery
• It is for for a reason that pathology and
  radiology are called ancillary services root
  word for ancillary is servant
• Previous care paradigm was to report data to
  clinician(s) with paper record office/hospital
  documentation
• Evolving documentation paradigm is to report
  electronically in standard format so disparate
  data can be integrated
• Influence new product lines for
  pathology/radiology predicated on added value of
  integrated longitudinal data

51
Role of Pathology Informatics as OE/RR Clinical
Databases Migrate to EMR?

• Consider it a given that LIS database will be
  transient and integrated into EMR that OE/RR
  will also migrate to the EMR
• Only reason why LISs have supported
  enterprise-wide OE/RR is that the mainframe
  computers were not adequate for task
• The EMR integrated clinical database will be the
  permanent clinical record the virtual LIS will
  update it when/if necessary
• Also a given that lab managers will be pressed to
  justify all capital expenditures for lab software
  on basis of business plan
• Emphasis of lab IT will shift to enhancing the
  value of the lab information product
  integrating data from multiple sources

52
Take Home Summary Points about E-Lab and the
Virtual LIS

• Centralized lab model and the classic LIS (C-LIS)
  which was developed to support this work-flow
  model becoming obsolete
• As lab testing increasingly decentralized, need
  more flexible IT support for labs to accommodate
  to new modes of testing
• We advocate notion of the virtual LIS (V-LIS)
  which is integrated web-based flexible system
  with specialized SLAMs
• Market offerings of SLAMs now proliferating will
  increase lab functionality but also increase IT
  integration challenges
• Conversion to e-lab with ready access to both MD
  customers and consumers provides new lab product
  opportunities
• Path to the V-LIS will be rocky for
  capital-starved labs solution will be standards
  approach for C-LIS/SLAM integration