The Need for the API Strategic Summit - Part 1 of 2

Laboratory Information Systems are at a cross-roads.  With the passed and impending legislation surrounding health information technology, the primary focus has been on Electronic Health Records (EHRs).  Laboratories generate vast amounts of data.  The reason why we generate vast amounts of data is because providers order laboratory tests on patients at almost every encounter.


If laboratories don't have high quality and highly specialized systems to support the work that they do, providers will find it very difficult to take care of of patients.  Here's why:

• Laboratories generate a huge amount of data, and much of that data, while not seen by providers, is critical to store, manage and review as part of our quality and compliance processes.  These are data generated by intermediate steps during the testing process.  These data are often more important than the final result when trying to troubleshoot a problem that occurs at the time of testing or at a later date.  I estimate that the final result (the piece that providers see) comprises only about 20% of the actual data that is produced and stored by the laboratory during the performance of a simple test.  For highly complex tests, this estimate goes down to 5% or less.  Laboratories that cannot utilize their information system to store critical pieces of testing data such as this must resort to paper worksheets which are subject to retrieval and permanent loss.  Use of paper worksheets can facilitate:
• Manual data entry errors
• Delays in turnaround times (when compared to automatic batch run generation in an appropriately configured information system)
• Errors in manual calculations
• The workflow within an individual laboratory is largely managed by the routing of the specimen in the information system.  When the workflow in the laboratory does not match that of the information system, the results typically cause confusion, delays in turnaround time, and rarely patient-to-specimen mismatches.
• Just as patients do not always present with the typical by-the-book signs and symptoms of a particular disease, neither do their laboratory results.  Laboratories need systems that can flex to the strange and unexpected, and those systems should be able to communicate those results to EHRs in clear and unambiguous ways. 
• Providers make a LOT of decisions based on the data that laboratories provide them.  If we can't provide the right test and right result at the right time, then patients suffer.  Laboratories are full of smart people who want to help others.  Imagine what it is like to try and do that when the computer is fighting you at certain steps in the process.

The Association for Pathology Informatics (API) is working to help laboratories get the very best information systems for their laboratories.  Over and over again, we hear stories of laboratories being "burned" by unanticipated problems in functionality, resulting and mis-interpretation of those results by a provider due to poor display of those results in the EHR.  These are all being compounded by new technologies that providers need and want for their patients that current information systems are struggling to house.  Standard molecular tests, next generation sequencing, whole slide imaging, proteomics, and high-throughput image analysis with the future promise of combined imaging/molecular analyses are either currently in use in some laboratories or will be in the next five years...and laboratories currently using those modalities are having to work-around the deficiencies in their information systems to bring this needed technology to patients.  See my next blog entry for more on some of the exciting activities that API is working on to help laboratories work with vendors to bring in the next generation of systems.