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Talking with Rob Bush, president of Orchard Software Corporation. (In the Eyes of the Experts Medical Laboratory Industry -- 2007).

Rob Bush is president and founder of Orchard Software Corporation. A native of Indiana, he holds an MBA from Carnegie Mellon University. He was an international financial analyst for Eli Lilly before co-founding Orchard Software Corporation, a privately owned company, in 1993. Orchard, headquartered in Carmel, IN, has installed more than 350 laboratory information systems nationwide. Its clients include clinics, multi-site and multi-specialty physician office laboratories, regional reference laboratories, and hospital laboratories of various sizes.

Anne Pontius: What one factor do you believe will have the most impact on the laboratory computer industry's five-year future?

Rob Bush: Five years can seem like an eternity in the software business. Our technology changes so rapidly that it is difficult to predict five years out. However, I believe two factors emerging today will have a tremendous impact on the laboratory computer industry. Molecular (genetic) testing and consumer ordering of laboratory testing will cause changes in the entire laboratory industry.

Molecular testing creates several challenges for a laboratory information system (LIS) company. Currently, these tests are, to a large degree, still manual. The results are both numeric and alphanumeric, and they must be translated into usable information for the physician. Not only must the LIS deliver the results; it must assist the primary physician in understanding the results.

Along with genetic testing, consumer ordering of laboratory testing will become commonplace. It will be necessary for an LIS to be able to assist both the consumer and the laboratories in dealing with this change. Web browser technology will become a necessity as this market matures.

Pontius: The laboratory professional associations claim the laboratory industry is facing a personnel shortage, which has recently started and may not peak for several years. Does your business strategy focus on that, and if so, in what way?

Bush: Turnover and long training curves will cause laboratory managers to worry about the quality and consistency of results for which they are responsible. One helpful strategy for this problem is the extensive use of rules that help the less-experienced technologists follow the procedures established by the lab. Historically, rules have been tightly linked to auto-verification. Those uncomfortable with auto-verification may overlook the great value of rules that can be used to encourage consistency even when the auto-verification step is not activated.

For example: Rule No. 56: Dr. Jones wants a phone call if a patient's WBC is elevated, but only for his hospitalized patients. Rule No. 92: The chemotherapy department wants fast turnaround on CBCs because patients are waiting for treatment. Don't hold the abnormal results for a manual duff.

Remembering each rule is difficult, and recognizing when each condition has occurred is even harder. The computer can quickly review each result and apply any number of rules to see if a result has changed too much, a specific doctor has ordered the test, the patient is in a critical location, an instrument flag has occurred, testing is happening in a remote location, or a specific sex or age reference range has been exceeded. The computer doesn't have to decide if the result is reportable - just help the technologist recognize which results need a closer look. This rules-based highlighting is one way we are trying to help lab managers with their staffing difficulties.

Pontius: Over the next five years, do you foresee more or less consolidation of computer companies that focus on laboratory services?

Bush: Consolidation naturally occurs as markets mature. It is usually driven by economies of scale, which allow large companies to deliver a product at a lower cost, and barriers to entry, the various difficulties faced by new players entering the market. Substantial change, however, levels the playing field and opens the market to new players. Today, both of these conditions are occurring together. Let me explain with a few examples.

Misys, Cerner, and SCC have mature lab systems for the large hospital market segment. It would be very difficult, expensive, and time-consuming to write a new system that delivered the same maturity for these hospital clients. Unless you deliver something important that is not being delivered by the existing companies, your new product is not likely to be successful.

Ten years ago, however, a major market change occurred that allowed for new players to enter the lab software market. Physicians started investing in small labs. These labs needed software tailored to their size and budget. Completely new software was needed that would run on PCs instead of mainframes. More than 50 companies entered the new lab software market over the last 10 years. Interestingly, none of the large, successful LIS companies entered the POL market segment. Today, this market segment has also started consolidating, and fewer than 10 companies are thriving in it.

A market change is taking place today that is opening the door to new players once again. Web-based ordering and "resulting" (results reporting) can't be written with old tools. If we all need to write new software, then the door is open to new players.

Pontius: Orchard has collaborated with Beckman, Abbott, and others in the past. Are your future sales aimed more toward laboratories or instrument manufacturers?

Bush: Almost all Orchard sales are directly to laboratories, but our collaboration with instrument manufacturers is important to us. In addition to a nine-year co-selling relationship with Abbott, we work with development groups as they validate new instrument interfaces. They are gracious enough to ask for our input and use our software in many of their manufacturing research facilities in the U.S. Our software benefits from such exposure, which means our customers benefit.

Beckman Coulter asked us to participate in a special project for hematology departments. It identified a need for special departmental software that supplemented its instrumentation. For example, long-term storage of histograms and scatter plots are required in some states, but is not likely to be accommodated electronically by most LIS systems. Additionally, work patterns in a department could be fine tuned specifically for the Coulter analyzers, supporting valuable instrument features that might not otherwise be easy to use. Naturally, all of our lab software clients benefit from this experience of working with Beckman Coulter.

Pontius: Over the next five years, what types of software advances do you foresee the average physician's office lab or small hospital laboratory using?

Bush: Web-based access to lab information will be important in providing service to the clients of any lab. Additionally, physicians are investing in electronic medical records (EMRs) and will require interfaces to their labs. Orchard has developed tight working relationships with several of the most prominent EMRs and has written substantial enhancements to handle both the electronic interfaces and the human interfaces with people who use the software.

Small hospital labs have had difficulty competing with large national reference labs for local physicians' business. The reference labs have computer connectivity, a larger profile of available tests, and salespeople. The physician/hospital relationship gives the local hospital lab a natural advantage, but not if the hospital service level is perceived as lower. With sophisticated and affordable software, the hospital lab can overcome some of those disadvantages. If it enhances its outreach programs with the ability to also order esoteric tests from reference labs, the service becomes even better.

Pontius: Are new advances going to require overhauls to current computer systems, or will upgrading be more likely?

Bush: Modular software is here. Vendors will continue to add capabilities to existing software using existing tools, but when new features require new tools, we can now do a little mixing and matching without the need to start over. Web-based outreach systems can be added to the front of your LIS without requiring the complete replacement of that system, and now you have the option of purchasing that Web solution from either your LIS vendor or from someone else. As I mentioned before, departmental systems are being offered by instrument manufacturers to extend functionality within the lab. Evaluating all these options and coordinating the integration will require a more knowledgeable consumer, but the available flexibility is a good thing.

Pontius: Is an application service provider (ASP) product in Orchard's future?

Bush: The term "ASP" brings up the image of rented software housed outside a client's sphere of control. Both of those concepts have been met with resistance, regardless of the price tags. These same concepts are being renamed, and Orchard does offer some of these services. Web-based ordering/resulting systems can be hosted on a Class One hosting facility on the Web or placed inside the client's firewall. A large majority of ordering/resulting will be done soon using these types of Web solutions.

Pontius: What do the future costs look like for computerizing a clinic or small hospital laboratory?

Bush: Costs for computerizing your laboratory are not going down, but for the same dollars, the capabilities are substantially growing. For example, an outreach program was cost prohibitive for a small lab just a few years ago. Today, with Internet access, it is an essential part of any new system. Rules-based decision support was once only available in the most expensive of systems, but now it is affordable to all labs.

Let me put a different twist to your question. What does it cost to postpone computerizing? If you lack sufficient personnel to run all your lab tests, it can be very expensive. People are your most valuable asset, and spending to make them more efficient is usually a good investment.

Pontius: Will the events of Sept. 11, 2001, affect Orchard's future?

Bush: The events of last Sept. 11 were tragic. However, the anthrax scare that followed Sept. 11 is having a larger impact on our business. Orchard has customers at the county, state, and federal government levels who are now dealing with even more microbiology testing and bioterrorism testing. Orchard is working closely with these accounts to be sure our software is well-integrated into their designs and systems for combating bioterrorism.

C. Anne Pontius, MBA, CMPE, MT (ASCP), a member of MLO's editorial advisory board, is president of Laboratory Compliance Consultants in Raleigh, NC.
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Author:Pontius, C. Anne
Publication:Medical Laboratory Observer
Article Type:Interview
Geographic Code:1USA
Date:Aug 1, 2002
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