LIS Shake-out - HIPAA changes - Industry Trend or Event

Health Management Technology, June, 2001 by Richard R. Rogoski

From DOS-based to Web-based, laboratory information systems are preparing for changes driven by HIPAA, government-mandated coding requirements and the Internet.

If change is inevitable, it seems to come more slowly in the laboratory. While Windows NT and Internet-based applications are now commonplace in healthcare facilities, many laboratory information systems are still being run on clunky old minicomputers with the look of DOS-based systems.

But change is coming says Will Campbell, president of Woodbridge, VA-based Intellidata, Inc. According to Campbell, this change is being driven by a growing disparity between the technological have's and have-not's--in Campbell's words, "those who are still using the old green screen and those who have gone to Windows." He admits that while many of the old systems are expensive and often proprietary, they also have proven to be very reliable.

Scott Bagwell agrees. As vice president and general manager of Piano, TX-based eSuite Inc., a wholly-owned subsidiary of Tucson, AZ-based Sunquest Information Systems, Inc., Bagwell believes the reluctance to incorporate newer information systems is due, in part, to the very nature of lab work. "Labs are focused on getting tests in and getting results out. It's a heads-down environment," he explains.

As a result, many labs still rely on text-based screens rather than incorporating a point-and-click graphical user interface (GUI). But it's no longer just a choice between text-based or GUI, says David Medeiros, vice president of sales for Wellesley, MA-based Psyche Systems Corp. "Everybody is asking for Web features," he notes. "Clients want to offer their physicians order entry and reports-reading on the Web." Medeiros says the latest trends in laboratory information systems (LIS) are being driven by a desire to e-mail reports and to add a wireless capability so more can be done using handheld devices.

Online Challenge

The growing use of the Internet in healthcare has raised a number of questions concerning not only privacy, but also how to keep information moving through the system while controlling access to it. In the lab, this presents a major challenge, says Campbell.

Unlike other offices or departments where employees can logon in the morning and log off at night, proposed HIPAA rules may require lab technicians to "log in and out all day," he explains. As a result, safeguards must be built in that identify users and track them as well. "At the end of the day, you have to know who actually viewed the reports," says Campbell. Many older systems, however, cannot track user access. When HIPAA regulations covering lab systems are finalized, these systems won't be compliant, he notes.

Jeff Fisher, CEO of Santa Rosa, CA-based Comp Pro Med, Inc., also sees HIPAA looming large on the horizon. He says concerns over HIPAA regulations that are influencing the types of products and services now being delivered by LIS developers and providers.

Fisher, for example, admits his company is bucking the trend by advising laboratory clients to stay away from Internet-based systems. "Let the IS department deal with the Internet," he states. "No one outside the laboratory should have access to the data until it has been reviewed and released officially. Then and only then should the data be available to other systems."

Fisher says putting data on the hospital's network before the lab signs off on it shifts the responsibility for that data. "By law, the lab is responsible for the information it releases," he notes. If the data is put on a server, it's under the control of the IS department and can be accessed by anybody. "The IS people do not want responsibility for that data until it is publishable. But if it's on the server, they are responsible," he says.

Comp Pro Med's LIS, called Polytech, uses a network called "Medlink" which ensures that critical information stays in the lab until it is appropriate to release it to other systems or networks. "Polytech is a secure turnkey hardware and software services product. We view and treat it as if it were a medical device, no different than, say, a chemistry or hematology analyzer," says Fisher.

NT or Not NT

Using a "redundant database topology," Medlink allows lab results to be sent out to a series of nodes (PCs) within its own self-healing network. While it can run on Windows and Windows NT 2000, the system was specifically designed to run on non-Windows boxes or on Dell computers which Comp Pro Med supplies already loaded with the software.

On the other hand, Intellidata's product, called IntelliLab[R], was specifically architectured for the Internet and runs on a secured Web server instead of the traditional client-server architecture, says Campbell. Using a Visual Basic front end, the system is fully scalable and runs on Windows NT. However, Campbell says a Linux version also will be available this summer. Incorporating everything from order entry and bar code label production to lab report distribution, the LIS also can handle managed care contracts.