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- Acquisitions, Alliances, and Mergers 1995 saw widespread acquisitions, alliances, and mergers among healthcare providers, laboratories, and system vendors alike. Examples of LIS vendors include HBOC's acquisition of Advanced Laboratory Systems (ALS) and Compucare's acquisition of Antrim. Reference laboratory examples include MetPath's acquisition of Nichols and Damon and MetPath's subsequent acquisition by Corning. In healthcare organizations, Epic and, subsequently, Healthtrust were acquired by Columbia/HCA. More of the same is predicted for 1996.
Acquisitions, alliances, and mergers have created complex provider and vendor organizations with multiple entities and computer systems. This trend has fueled LIS vendor transition from lab systems only to clinical system providers (Figure 1) and to the support of multiple hardware and software platforms (Figures 2 and 3). Since 1991 LIS vendors have increasingly moved toward becoming broader clinical systems vendors offering LIS plus one or more other clinical systems. Those LIS vendors with only an LIS product will, in 1996, need to clearly demonstrate their ability to provide the levels of accessibility and integration offered by vendors with broader systems product lines. Managed Care Managed care grew significantly in 1995 as more employers offered HMO's as a choice for employee benefit packages. Managed care is defined as pre-paid comprehensive healthcare services to enrolled members, representing a major shift from the traditional fee for service or indemnity plans. The setting is much more information intensive, as needed for managing complex contracts and reimbursements (i.e., capitation). There is also the need to focus on the most efficient use of laboratory and other resources. This implies the need for more closely monitored utilization. Healthcare is moving toward a more integrated "continuum-of-care"; i.e., a shift towards case management or patient management encompassing acute care, outpatient services, long-term care, and home care across geographically diverse entities. In addition, healthcare providers need to provide consumers, purchasers, and regulators with information to assess health plan performance clinical indicators for evaluation of the processes and outcomes of healthcare services; e.g., cholesterol screening rate and cervical cancer screening rate, etc. Employers also are demanding more utilization statistics on the services provided to their employees. The implications for LIS are readily available utilization and cost data analysis (e.g., via relational databases, ad hoc reporting, and expert system technology). Further, the need for multi-entity support and higher levels of integration with other clinical, administrative, and financial systems becomes paramount. Integration implies the co-existence of LIS with other clinical and administrative or financial systems in order to offer users comprehensive views of enterprise-wide clinical and/or administrative/financial data necessary for effective management. Such capabilities will permit management to make better decisions based on patient demographic, care profile, diagnosis, and cost information. VENDOR RESPONSES In 1996 we can expect LIS vendors to respond to these existing forces by increasing their capabilities for connectivity and data integration. Connectivity
Connectivity is important to permit LIS to exchange information with other systems. LIS must exchange information with other systems including other LIS which are part of joint ventures, mergers, and broader healthcare entities; e.g., integrated delivery systems (IDS) and community healthcare information networks (CHINs). At least for the foreseeable future, these entities will be composed of heterogeneous systems from various vendors all of which will need to be more tightly coupled, connected, integrated in order to meet the informational needs of the customer. LIS vendors will continue to use interface engine technology to interconnect with other information systems in these complex organizations and networks. Compliance with information system standards, communications / network protocols, and good manufacturing practices will be required. Transition to open systems, non-proprietary operating systems, and multiple hardware and software platforms will continue (Figures 2 and 3). Data Integration
To achieve business and healthcare delivery success, competitive healthcare organizations must be able to provide the most efficient clinical practices for their patient populations. Healthcare information systems today are largely fragmented, often with departmental-specific data bases and with limited interchange of information. In order to provide the most effective and efficient patient care, organizations need to have accurate and timely information regarding patient population demographics, the pattern of care provided, utilization of resources, the cost of those resources, and the resultant outcomes. Lab information is necessary but not sufficient to provide this. Clearly the inter-relationship, collation, and analysis of data from various sources become a paramount consideration. In 1996 LIS vendors will take advantage of existing technologies to become "feeder" systems to clinical data repositories and enterprise-wide data repositories incorporating administrative and financial data as well as clinical data. Vendors will move to greater use of commercial relational data base systems (RDBs) e.g., Oracle, Sybase, Unify, etc. as part of their systems. SUMMARY The impact of managed care, acquisitions, and mergers is driving the need for LIS vendors to provide for high levels of integration with other healthcare systems. Clearly LIS cannot effectively function in today's healthcare environment unless they can interconnect with many different types of users and information systems. LIS cannot succeed as "islands" unto themselves. |
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