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Hospital laboratories
An LIS integrated with the hospital EHR over HL7 v2 and FHIR.
Healthcare / Laboratory Information System
Laboratory information system development
Clinical labs run on the handoffs: an order from the EHR, a specimen at the bench, a result back to the clinician, a charge to billing. Agnotic Technologies builds laboratory information systems that carry those handoffs over HL7 v2 and FHIR R4, with LOINC coding and CLIA report requirements designed in.
HL7 v2
ORM orders in, ORU results out
FHIR R4
DiagnosticReport and Observation
LOINC
Standard codes on every result
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Industry Overview
What is a laboratory information system?
A laboratory information system (LIS) is the clinical lab's system of record: it receives orders from the EHR, routes specimens and analyzer results, applies LOINC codes, releases reports to clinicians and hands off charges to billing. Agnotic Technologies builds laboratory information systems for hospital, reference and physician office labs, with HL7 v2, FHIR R4 and CLIA reporting designed in.
Industry Challenges
What goes wrong between the EHR and the lab?
Failure points we check first when a lab asks us to replace or extend its LIS.
Orders that do not match: an ORM message arrives with a test code the LIS does not map, and the specimen waits.
Results without codes: a result goes back as free text with no LOINC code, so the EHR cannot trend it.
Critical values by phone only: the alert is made but not recorded, so the lab cannot prove it happened.
Corrected results that overwrite: the first value disappears instead of being marked superseded.
Charges typed twice: the LIS and the billing system disagree on what was performed.
Our Approach
How do we keep orders and results in step?
Interface rules we build into every LIS so the EHR, the bench and billing agree.
Every test has a map
Order codes, LOINC codes and billing codes maintained in one place, with unmapped orders routed to a queue instead of silently failing.
Results are versioned
Preliminary, final and corrected results keep their history, and the EHR receives the status with each ORU message.
Alerts are recorded
Critical value notifications capture who was told, when and by whom, as CLIA expects.
Capabilities
What we build into a LIS
Modules delivered for clinical laboratory information systems, in the order the lab needs them.
Order management
Orders from the EHR, portal or paper, with specimen requirements and labels.
Specimen tracking
Collection, receipt, routing and storage with barcodes.
Analyzer interfaces
Bidirectional connections to chemistry, hematology and molecular analyzers.
Result review and release
Auto-verification rules, delta checks, critical value handling and sign-out.
Reporting to clinicians
ORU messages, FHIR DiagnosticReport, PDF reports and portal release.
Billing handoff
Performed tests mapped to charges and sent to the billing system or clearinghouse.
How It Works
How does an order become a result?
The reference path we build for a laboratory information system. Each step has a message, a record and a status the EHR can see.
Order received
The EHR sends an HL7 v2 ORM (or a FHIR ServiceRequest). The LIS maps the order code, creates the accession and prints labels.
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1
Specimen collected and received
Collection time, container and receipt are recorded against the accession, as CLIA test records require.
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2
Analyzer run
The instrument receives the worklist and returns raw results with flags, linked to the accession and the operator.
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3
Review and release
Auto-verification or a technologist releases the result; critical values trigger a recorded notification.
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4
Result delivered
An HL7 v2 ORU message or a FHIR DiagnosticReport with Observation resources, each LOINC-coded, reaches the EHR and the portal.
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5
Charge posted
Performed tests are mapped to charges and handed to billing, with the accession as the reference.
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6
Engineering Stack
Technologies we use for LIS builds
Standards at the edges so the EHR, analyzers and billing can change behind them.
Standards
HL7 v2 (ORM, ORU, ADT)FHIR R4LOINCSNOMED CT
Interfaces
Mirth ConnectMLLP listenersAnalyzer middleware
Platform
PostgreSQLNode.jsNext.js
Infra
AWSAzureOn-premise where the lab requires it
Message map
Which messages carry each lab handoff?
The messages and resources a LIS exchanges, and what each one must carry. This is the map we agree with the EHR team before the first interface is built.
| Handoff | HL7 v2 | FHIR R4 | Must carry |
|---|---|---|---|
| Patient registration | ADT (A01, A04, A08) | Patient | Identifiers, demographics, visit |
| Order placed | ORM^O01 (OML in newer versions) | ServiceRequest | Order code, priority, specimen requirements, ordering clinician |
| Order status | ORR, ORM with status | ServiceRequest.status | Received, in progress, cancelled |
| Result released | ORU^R01 | DiagnosticReport with Observation | LOINC code, value, units, reference range, status, performing lab |
| Corrected result | ORU^R01 with corrected status | DiagnosticReport.status amended | Superseded value kept, correction reason |
| Charge | DFT^P03 | ChargeItem | Performed test, accession, date of service |
Measured Impact
What decides the scope of a LIS build?
There is no fixed price. These factors move effort most, and we size each on the scoping call.
Interfaces
EHRs and analyzers to connect
Each EHR feed and each analyzer has its own message profile and testing cycle.
Test menu
Tests to map and code
Every test needs order, LOINC and billing codes, reference ranges and release rules.
Sites
Locations and lab sections
Multiple sites add routing, send-out and reporting rules.
Migration
Historical results
Result history migrated so trends in the EHR stay intact.
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Use Cases
Who builds a laboratory information system with us?
Lab types and first releases we scope most often.
02
Reference laboratories
Orders and results from many client EHRs, with routing and send-out.
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Physician office labs
A small LIS with analyzer connections and portal reporting.
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Molecular and genomics labs
Complex reports delivered as structured results plus PDF.
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Point-of-care programs
Device results captured and sent to the record with the right codes.
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Lab startups
A fixed-scope first release before the first client EHR is connected.
Integrations
Which systems does a LIS exchange data with?
The systems around a clinical lab, and the standards used to reach them.
EHR
Epic, Oracle Health (Cerner), athenahealth
Instruments
Chemistry, hematology and molecular analyzers
Integration
Interface engines (Mirth Connect)
Revenue
Billing systems and clearinghouses (X12)
Patient access
Patient portals
Reporting
Public health reporting
Self-assessment
Go-live checklist for a LIS interface
What we confirm with the lab and the EHR team before an interface carries real orders and results.
Compliance-First Development Services Backed by Global Standards
We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, and strict access controls.
Fast Healthcare Interoperability Resources
Enabling standardized health data exchange through standards-based API mappings.
Health Level Seven International
Supporting enterprise-grade interoperability for clinical messaging and record workflows.
Our Edge
Why Global Leaders Choose Us
We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.
Enterprise-Grade Security
We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.
High-Performance Scaling
Our architectures are built to handle massive data loads and user bases, keeping performance steady whether you're serving ten or ten million.
Accelerated Time-to-Market
Using our suite of internal tools and proven frameworks, we reduce development cycles and get your product to market 40% faster.
Embedded AI Integration
Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.
Engagement Model
How does an LIS engagement work?
Timing depends on interfaces and test menu size. We agree a fixed first release on the scoping call.
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Scoping call
We agree the lab type, the EHRs and analyzers involved and the first test menu.
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Interface mapping
Order, result and charge messages mapped with the EHR team using real examples.
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Fixed-scope first release
One EHR feed, one analyzer and one lab section in production, with weekly demos.
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Interfaces and sections
More analyzers, client EHRs and lab sections added in order of volume.
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Support and monitoring
Interface monitoring, message replay and change control for every later release.
Facts and sources
Rules and standards behind a LIS
Facts we design around, each linked to its primary source.
CLIA regulations at 42 CFR 493.1291 require each test report to show patient identification, the name and address of the laboratory that performed the test, the report date, the test performed, the specimen source where appropriate, and the result with its units or interpretation.
Source: 42 CFR 493.1291 (eCFR)42 CFR 493.1291(g) requires the laboratory to immediately alert the individual or entity that requested the test when a result indicates an imminently life-threatening condition or a panic (critical) value.
Source: 42 CFR 493.1291(g) (eCFR)42 CFR 493.1283 requires a laboratory record system that includes positive identification of each specimen, the date and time of specimen receipt, and the records and dates of all specimen testing, including the identity of the personnel who performed each test.
Source: 42 CFR 493.1283 (eCFR)The HL7 FHIR R4 DiagnosticReport resource carries the findings and interpretation of diagnostic tests, references Observation resources for the individual results, and links back to the originating order through basedOn.
Source: HL7 FHIR R4, DiagnosticReportThe HL7 FHIR R4 Observation resource represents measurements and simple assertions made about a patient, device or other subject, and is the resource individual laboratory results are exchanged as.
Source: HL7 FHIR R4, Observation
Voice of success
We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
“I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly.”
Aaron Phelan
Founder, Benchmark
“Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective.”
John Pasmore
Founder, Latimer
“Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together.”
Kim Smith
Founder, My Lauren
Related pages
Where should you start?
Detailed pages for the standards and services around a laboratory information system.
Lab integration services
Connecting lab systems and EHRs: orders in, results out.
HL7 v2 integration
ORM, ORU and ADT message handling and interface engines.
FHIR integration
DiagnosticReport, Observation and ServiceRequest over FHIR R4.
Laboratory management software development
The sample-centric LIMS for research, QC and specialty labs.
EHR software development
Custom EHR modules and platforms built around clinical workflows.
HIPAA requirements for software teams
The safeguards we build into every system that handles PHI.
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Cross-Industry Reach
The Same Engineering Patterns, Across Other Industries
The technical patterns behind this platform translate naturally into adjacent verticals.
Frequently Asked Questions
It depends on the number of EHR and analyzer interfaces and the size of the test menu. We agree a fixed-scope first release on the scoping call and give you its timeline before work starts.
A laboratory information system (LIS) manages patient orders and results for a clinical lab and exchanges them with an EHR. A laboratory information management system (LIMS) manages samples, tests, instruments and inventory for research, QC and specialty labs. We build both, on separate pages, because the data models and the rules differ.
Yes. Results go to Epic, Oracle Health (Cerner), athenahealth and other EHRs as HL7 v2 ORU messages through an interface engine, or as FHIR DiagnosticReport and Observation resources where the EHR supports them.
At minimum ADT for patient registration, ORM (or OML) for orders and ORU for results. Many labs also use DFT for charges and ORR for order acknowledgements. We map each message profile with the EHR team before building.
We build it as HIPAA-ready engineering: access controls, audit logging, encryption in transit and at rest, and a business associate agreement signed before any PHI is shared. HIPAA has no certification, so no vendor can call software HIPAA certified.
Yes. Most LIS engagements start with one EHR feed, one analyzer and one lab section in production before more interfaces and sections are added.
AI tools help our engineers draft code and tests, but a person reviews every change, and it passes the same automated tests and security checks as any other code.
Industries