Many hospitals have had the same laboratory information system for a decade or more. So a growing number are now weighing whether to acquire a new system from a niche vendor or from the company that provides their core clinical system. Either way, they're searching for a system that offers new functions that meet their evolving needs.

"Lab systems have been around a long time, and you may think you know about all the functionality available. But in reality, there's a lot of innovation going on out there," says Chad A. Eckes, CIO at Cancer Treatment Centers of America, Schaumburg, Ill. For example, one reason the organization is using a lab system from niche vendor Sunquest Information Systems, Tucson, Ariz., is because it's well-designed to support point-of-care testing, complete with bar coding of lab test specimens.

Other new lab system features that appealed to recent hospital buyers include:

  • The ability to easily produce ad hoc reports, such as for state infection control efforts;
  • Customizable screens that display information in the way lab staff members prefer;
  • Alerts that offer reminders of action to take when critical test results are reported;
  • Open architecture that makes the system easy to interface with other clinical systems; and
  • Easy accommodation of speech recognition technology for report writing.

"We started by making a wish list and thinking of everything we wanted our lab system to do for us and not limiting our sights," says Gail Gross, assistant vice president, integrated laboratories, for MedStar Health in Baltimore. "I would advise others to look for a system that's easy to use in the lab and easily provides results back to the clinician who ordered the tests."
MedStar chose to buy a lab system from its core clinical system vendor, Kansas City, Mo.-based Cerner Corp. In contrast, Cancer Treatment Centers of America went with a niche vendor-despite standardizing its hospitals on core clinical systems from Eclipsys Corp., Atlanta.

Niche Loyalty

Back in 2005, the cancer hospital chain decided to move away from a best-of-breed strategy to standardize as many systems as possible, running them at two national data centers, Eckes says. The old strategy had resulted in a proliferation of systems.

"We looked at 97 legacy systems and Sunquest was the only one that came up as a keeper," the CIO says. He points out that the chain even uses the lab system at the hospital it recently opened in suburban Phoenix. "The main reasons for retaining the Sunquest system are that it works very well, meets all our end-users' needs and interfaces well with other systems."

Once the chain completes its migration to 25 clinical modules from Eclipsys, however, it may reconsider its decision to retain Sunquest, Eckes acknowledges. "We'll at least pose the question about whether there is strategic value in migrating from this niche solution to having it be the final piece moving over to our standard electronic health record platform."

Although installing Eclipsys' lab system would have eliminated some integration work, "patient care advantages of the current lab system trumped our I.T. challenges, at least for now," Eckes says.

Now that the Sunquest and Eclipsys systems are integrated, most clinicians grab lab test results from the core EHR system. And all lab tests are ordered using Eclipsys' computerized physician order entry system.

Because the cancer hospitals prefer to conduct point-of-care testing whenever possible, Sunquest's collection manager system was particularly appealing, Eckes says. Rather than sending a patient to the lab for a blood draw or other procedure, clinicians usually perform the procedures in patient rooms. They scan a bar code on the patient's wristband and a bar code on their own ID badge. Then they print a bar code label for the specimen with all the relevant information. The point-of-care approach helps guard against mislabeling of the sample and linking it to the wrong patient, Eckes contends.

Next, the hospital plans to use the Sunquest system to conduct similar bar coding steps for patients with blood transfusions.

Single Source

While Cancer Treatment Centers of America stuck with a niche vendor that offered all the features it wanted, MedStar Health concluded there were strong clinical benefits to using one vendor for virtually all of its clinical systems, including its lab system.

Faced with a "mishmash" of six lab systems at six of its acute care hospitals, MedStar yanked them and installed a standard system from Cerner, says Gross, the assistant vice president of the Columbia, Md.-based provider. "We wanted to standardize on one lab system so we could easily share test results," she says.

When it scrapped its old best-of-breed approach in favor of a single-source method, it chose Cerner because it liked the many clinical modules it offered, among them pharmacy, respiratory therapy and nursing systems, in addition to the lab system, Gross says.

Cerner's lab system scored high marks for its ability to generate ad hoc reports, such as for providing data to state infection control programs, she says. Plus the system easily accommodated speech recognition for creation of pathology and other reports. And the lab system can generate bills for area nursing homes and other facilities that rely on the hospitals for lab tests.

In addition, the Cerner system accommodates bar coding of specimens at the point of care, Gross adds.

Personalized Service

Despite the appeal of selecting a single source for most clinical systems to ease integration headaches, 265-bed Washington (Pa.) Hospital wound up selecting a lab system from niche vendor Orchard Software Corp., Carmel, Ind.

As it prepared to update its core clinical system from Eclipsys, it also faced the challenge of replacing its old lab system, which was being sunsetted by another vendor. It weighed the pros and cons of six lab systems, including one from Eclipsys, before settling on the Orchard system, says Chuck Kulla, laboratory information system coordinator.

"Orchard seemed small enough to care about us as a client but large enough to be competitive with the other vendors," he says. "It fit our needs." The niche vendor offered the most functionality at the best price, he adds.

One appealing feature of the Orchard system that many others lacked, Kulla says, was the ability to set up alerts for users. For example, when a critical result is delivered, the system can display a reminder for the lab to contact the ordering physician immediately, even providing the phone number to call.

The system also offered customizable screens to accommodate lab staff members' workflows, Kulla adds. Orchard provided an interface specialist who linked the lab system to the core clinical system using Health Level Seven standards.

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