Point of Inflection

The LIMS-LIS equation

Randy C. Hice

I was searching the dark corners of my mind for a little parable differentiating versatility from mediocrity. I was complaining to a friend that I fell short of my goals in athletics. But he said, "you weren't mediocre, you were versatile!" Hey, yes! He's on to something. I can easily rationalize away my monotonous string of near misses by proclaiming myself 'versatile.'

I grew up as a competitive swimmer, first throwing down as an eight-year-old, rising through the ranks as an age group swimmer, through high school, college, then Masters swimming. Let me tell you; unless you've done it, there is no sane way to describe college swimming - with two-a-day workouts approaching 15,000 meters a day - as anything less than hell on Earth. At that level, your stroke is well-established, and little can be done to change it. The college swim coach thus is relegated to the role of Marquis de Sade, trying to convince, cajole, connive, coerce and otherwise threaten the athlete into pushing his body to a level of pain and exhaustion approaching abject masochism.

Ah, but swimming is cruel in many ways. Probably 99 percent of the world would tell you Mark Spitz, the greatest ever, is the only name that comes to mind when pressed to name a swimmer. And why not?

• 32 world records
• 25 individual and seven relay from 1967-72
• nine gold, one silver and one bronze in two Olympics
• five gold at 1967 Pan American Games
• 10 first place high school All American rankings 1966-68
• NCAA — eight first, one second and two thirds during 1969-72
• AAU — 24 first, six second and one third from 1966-72 • Sullivan Award Winner, 1971
• AAU Swimming Award Winner, 1972
• World Swimmer of 1967, 1971 and 1972

Of course, no one can name USC's Frank Heckl, a swimming god during the same era, who happened to peak at the 1971 Pan Am Games in Cali, Columbia, and not the 1972 Olympics in Munich, as Spitz did. Unfortunately, success in swimming is measured by Olympic gold…never mind that making the U.S. Olympic team is reserved for athletes possessing a one-in-a-million balance of stroke, strength and ferocity.

Okay, I had to beat Spitz, Heckl, Gary Hall and a cast of thousands to get to the Olympics. That didn't happen. However, somewhere in my early teens I learned that I had some ability in racquet sports, and thus parlayed some decent hand-eye coordination into another well-rounded, yet undistinguished career.

In four wall paddleball, a sport developed in the 30s at the University of Michigan, and the precursor to racquetball, I clawed my way from city championships to a showdown for the National Doubles Championship in 1981, only to lose to a team that, to this day, still wins the National Championship on a fairly routine basis. Rats.

Okay, that didn't work either, so I turned to squash in the late 80s. But my habit of diving for the ball, as I did in paddleball and racquetball, didn't translate to squash. First, it was considered gauche, if not profane. Second, it only takes one dive onto a squash floor to learn the difference between the varnished basketball-like surface of a racquetball court, and the sandpaper finish of a squash court. The first time I torpedoed to retrieve a too-good shot by my opponent, I left enough leather on the court to produce a parka for Shaquille O'Neal. By 1989, I had a racquet contract, and a crack at the U.S. Open Men's C title in Houston, only to lose to a player from the Mexican National Team. To make matters worse, the housekeeper at the hotel put my trophy through a dishwasher…not a recommended way of cleaning silver

So, I wasn't a hack at all of those miserable efforts. I was 'versatile,' at least that's an easier concept to swallow. But where is the point of inflection whereby mediocrity gives way to versatility?

That is the point in the informatics field now as laboratory information management systems (LIMS) collide with clinical laboratory information management systems (LIS). Clinical lab systems heretofore differentiated themselves from mainstream LIMS by allowing all of the complexities of clinical protocols, patient management and esoteric instrument interfacing. The power ally of conventional LIMS has been lot management, stability protocols, ESIG and unadulterated sample tracking at every phase.

There is an interesting line in the movie, The Color of Money, the pool shark's sequel to The Hustler, in which Paul Newman's character says to Tom Cruise's character, "I taught you everything you know, but I didn't teach you everything I know."Some LIMS vendors have reasoned that the nuances of clinical study management are little more than complicated front ends for traditional sample management. Thus, cagey and prognosticative vendors are encroaching on the traditional turf of those vendors bridging hospital protocol management, R&D pathfinders and the niche of the contract research organization (CRO).

But is the converse true? It would not appear so. There seems to be very little interest by the big clinical LIS companies in waging a border war on the LIMS vendors. You don't see the expected crossover from specimens to samples, even when considering that it is not so long of a commute to get from the management of many thousands of clinical samples in, say, the R&D side of a large pharmaceutical company, across the hall to the QC side of the company where none of the mystique of protocol management occurs.

Of course, clinical work is certainly not limited to the R&D arm of pharmaceutical companies. There are - ah - clinics, hospitals and the aforementioned CROs. And there are a great number of these, so it may well be that business is quite brisk in the clinical world, and walking off the path of clinical testing into the nether world of, arguably, less elegant routine sample testing, isn't compelling business-wise or architecturally.

Or it could be that there is simply a bias in terms cross pollinating clinical LIS and LIMS, at least from the vendor's perspective? Who can be sure? It's like going from a sub-chapter S corporation to a C corporation…wait, that's a terrible analogy, too much time buried in the Wall Street Journal. I know, how about a quote from the original Star Trek. I don't have it exactly right, but in the episode entitled "Mirror Mirror" a tale of parallel universes whereby evil doubles are swapped into our universe while Captain Kirk et al are spirited into a dimension of bellicose mayhem, the show is summed up by Spock at the end. When asked if they had problems spotting the evil twins in our world, the sage Vulcan replied, "No. It is easier for civilized people to act as barbarians than it is for them, as barbarians, to act as civilized people."

kay, don't write me letters saying that I misquoted Spock, and condemn me to some Klingon fatwa, or infer I am comparing products to ruthless, murderous barbarians, I mean only to say that, once all of the front end protocol management, definition of complex reflex calculations, and patient information security measures have been implemented, it's tougher to go back and gut that code out to become a pure sample management system. It may be easier to go from sample management to clinical management by addition of functional layers.

Will this change? I don't know. If it does, it will be because LIMS vendors are pushing into the clinical areas, and not the converse. Is a LIMS that can handle the nuances of the clinical world versatile, or mediocre? It depends on the implementation. I liken it to the cell phone/PDA hybrid devices that are coming out, such as the Treo 650. A few years ago, these devices were a joke, they were hastily contrived attempts to arrange a marriage of devices that most of us find invaluable. Who really wants to carry a phone and a PDA if they could be cleanly integrated? But the point of inflection has been bridged, the curve has changed from a half (baked) attempt to cram two devices into one shell to an interesting, okay, versatile device that lets us shed one more chunk of plastic and circuits from our loads. Will LIMS vendors be able to apply the sophisticated sample management lessons they have learned to the broader and exceedingly complex world of clinical LIS? Let's wait and see.

Randy Hice is the president of the Laboratory Expertise Center. He can be reached at