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  • September 27 2011

    The continuing evolution of lab informatics

    Google turned 13 years old (9/27/1998) yesterday, and I feel old. I remember toiling away as an undergrad in the engineering computer lab, using NCSA's Mosaic as my browser and AltaVista as my main search engine. I also remember my first encounter with a laboratory information system (LIS) as a medical student, using a light pen to call up a floor census and printing out pages of labs to stuff into my pockets for rounds. EMRs were barely there, paper was everywhere. The big movement in all parts of health care IT at the time was “get the data into the computer,” and all of those printouts, paper charts, and the like slowly migrated into an electronic format. Now spin the clock forward…

    Today, most things are in an electronic format, and LIS and EMR footprints are acting as cornerstones of health care enterprises. We're moving beyond transitioning paper charts and reports to electronic formats. We're now connecting medical and laboratory devices to electronically capture data, enabling the rapid and secure movement of health data across various platforms and systems. That movement is how the paradigm has shifted in health care IT, especially in a LIS. It is not enough to capture a pathology report in an electronic format, place an electronic signature and call it a day. That report now must move beyond the electronic “four walls” of the LIS, potentially reaching multiple EMRs for clinicians, public health departments, and a personal health record (PHR). Data has to move…it's a fluid construct that cannot be kept in a silo. Those electronic spreadsheets of data inside an EMR or LIS have to transform into dynamic, living constructs that support an individual's healthy intent. This is echoed in Cerner's new mission statement that was launched last year:

    “To contribute to the systemic improvement of health care delivery and the health of communities.”

    You can read between the lines in that mission statement and look past some of the turbulence around health care reform to see that the patient is moving to the center of the dialog (finally!). Look past the issues around coverage mandates, payment structures, and incentives, and you should see a patient in control of his or her own health care. A patient empowered by a truly portable PHR (that can effectively move data across multiple venues of health care delivery) to make informed choices about lifestyle, health care and wellness.

    So what do we (and you) in the lab community do in this new era of health care IT? Well, the first thing is connect. Connect to anything and everything that interacts with laboratory data. This is where you bring in alphabet soups like HL7, DICOM, HIE, etc. and concepts like Cerner's Device Certification Program to make that happen efficiently. This is why Cerner actively participates with these organizations. Next, you optimize your workflow, both inside and outside the lab, because the right test needs to be performed at the right time at the right cost for the laboratory to meaningfully impact a patient's health. Solutions like the Advanced Barcoding and Tracking (inside the lab) and Reference Lab Network, Gajema, and WebConnect (outside the lab) help this effort. Finally, you always keep looking down the road for the next technology shift in the laboratory. Sometimes gradual, sometimes sudden, the event horizon of innovative laboratory testing that bridges the research bench with the clinical setting is the genesis of change. Through collaborating directly with companies, academic institutions, and our client base, we can enable this change in a positive manner.

    With the avalanche of new innovations and market forces in health care, it is truly an amazing time to be in health care IT. While we have traded in the reams of paper and the light pen, there is still much work to be done to meet Cerner's mission statement. Enjoy the ride, and I hope to see you at the Cerner Health Conference this year.

    John David Larkin Nolen, MD/PhD/MSPH calls himself “the engineer who went medical school” and he leads the design and implementation of Cerner's laboratory solutions and enables the vision of the future of laboratory medicine. He joined Cerner in January 2010 and has been instrumental in guiding the incorporation of new technologies, such as RFID, advanced diagnostics, and integrated reports into current and new Cerner solutions. Prior to joining Cerner, he worked as a medical director in a reference lab and as the medical director of a blood center. He received bachelor's degrees in electrical engineering and mechanical engineering and cell and molecular biology, a master's degree in public health, and a medical degree and a doctorate in biomedical engineering, all from Tulane University in New Orleans. He completed his pathology residency at Emory University in Atlanta, and subspecialty fellowships at the University of Iowa in Iowa City. Nolen is board certified in pathology with sub-specialty boards in transfusion medicine and hematopathology. He has extensive experience in HLA, coagulation, molecular diagnostics, and informatics and is fluent in multiple computer languages.

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