One Size Fits Few

Bless me, Father, for I have sinned. It has been about three weeks since my last Lab IT confession. I have harboured sympathy in my heart for my competitors.

How can this be? Allow me to complain. I mean, explain.

I am often asked why a given LIS is so [insert bad quality here]. Much as I often agree with specific complaints about specific systems, I usually feel a hidden stab of pity for the team which produced the system because that team was asked to provide a single solution (the software) for a large problem area ("the lab.")

The fact of the mater is that the typical case of "the Lab" is not a monolith. It is not even a collection of more-or-less similar parts; rather it is a patchwork of very different subgroups who happen to share a need for a particular kind of work area.

Specifically, the requirements of the different workflows vary over such a large area that I am not surprised that a "one size fits all" approach usually fails: either the one size is the wrong size or the one size is also a collection of loosely-affiliate software modules which interoperate rather poorly.

Consider those requirements: on one end is clinical Chemistry:

• high volume, low relative cost (although vital to more valuable services)
• highly automated (very reliable auto-verification and analyzers)
• significant time pressure
• well-suited to an industrial approach such as Six Sigma
• high throughput required, turn-around-time is very important

At the other end is Microbiology or much Genetic and Molecular testing:

• lower volume, higher relative value
• difficult to automate
• poorly suited to industrial process control
• takes a long time--no way around it
• yields an often complex result requiring expertise to characterize

 Throw Haematology into the middle somewhere. Immunology is somewhere closer to Microbiology. Slot your favourite lab section into the appropriate place on the fast/simple vs slow/complex continuum.

So how does one provide a solution which is optimized for both of these extremes? Very carefully.

All to often vendors pick a section, optimize for that section and then claim that all others sections are "easier" in some way so most systems are not optimized for most of the users. Why is there so much complaining about lab systems? Because the situation makes it inevitable. Perhaps we should be surprised that there is not more even more complaining about lab systems.

EMR Disappointment And Acceptance

This past summer I was on a train in the Paris area and happened to share a train car with someone who was also from the East Coast of the US. We chatted and found out that he was a doctor, which always makes me slightly tense. Sure enough, once I mention that I am a medical information systems specialist we somehow end up on the topic of how bad so many of them are.

Why is that? I assume so many health care professionals have so little regard for their Electronic Medical Records system and other e-tools of the trade because these tools are not very good.

At least these medical informations are not very good at supporting many of their users. These medical information systems probably excel at supporting corporate goals or IT departmental goals.

The specific complaints by my companion on the train were painfully typical:

• the screen layout is cramped and crowded;
• the history available on-line is too short;
• the specialized information (labs, x-rays, etc) are not well presented;
• the data is biased toward general medicine and internal medicine.

But what struck me about our conversation with his resignation. While we rehashed the usual complaints and frustrations with large Commercial Off-the-Shelf (COTS) systems, he was more resigned than anything else. He just doesn't expect anything more from the software supporting his efforts to deliver clinical care.

We expect great things from our smart phones. We have high standards for our desktops and laptops and tablets. But somehow we have come to accept mediocrity in our systems supporting clinical care. And since we accept it, there is little chance of correcting it.

At least I will have lots to talk about with random clinicians I run into on trains.