2c:null 2d:["$","title",null,{"children":"Global LIS Atlas | gershkovich | Observable"}] 32:T15c5,33:T51d, ## How respondents are protected Every lab picks one of three consent levels in the survey, and the public view applies two rules on top of them. - **Named** (${d3.format(",")(consentCounts.get("named") ?? 0)} labs): name shown with systems and announced plans. - **Unnamed** (${d3.format(",")(consentCounts.get("unnamed") ?? 0)} labs): systems and plans shown as, say, "a community hospital in Germany". Where a country has fewer than ${MIN_CELL} responding labs, only the region is given. - **Totals only** (${d3.format(",")(consentCounts.get("aggregate") ?? 0)} labs): counted in maps, charts, and totals, but never listed individually. - **Plans:** a listed lab's new vendor, go-live date, reason, and decision-maker appear only once the lab says they're announced or under contract. "Evaluating" is only ever counted in totals. - **Small-cell suppression:** any number based on fewer than ${MIN_CELL} labs is hidden. Map areas are hatched, and counts read "fewer than ${MIN_CELL}". ${publicView ? "On the vendor map, that currently hides " + hatchedCountries + " countries." : "The staff view switches this off."} Switch **Show as** to *Staff view* at the top of the page to see the raw data these rules protect. In the live atlas, that view would sit behind a staff login.34:Tee1,const VENDORS = ["Sirius Cybernetics", "Cassandra Health", "Magrathea Labs", "Babel Fish Health", "Labyrinth Clinical", "Heart of Gold Medical", "Deep Thought Computer", "Whirlwind Medical", "Vineyard Software", "Other commercial", "Bespoke (in-house)"]; const TRACKED = ["Sirius Cybernetics", "Cassandra Health", "Magrathea Labs"]; const OTHER = "All other vendors"; const GROUPS = [...TRACKED, OTHER]; const GROUP_COLORS = ["#2a78d6", "#eb6834", "#1baf7a", "#a9a79f"]; const BLANK = "#e9e8e3"; const UNDECIDED = "Undecided (evaluating)"; const UNDECIDED_COLOR = "#d6d4cc"; const DEGREE_COLORS = ["#0d366b", "#184f95", "#256abf", "#3987e5", "#86b6ef"]; const DEGREE_LABELS = ["Board", "1–2 hops", "3–4 hops", "5–6 hops", "7+ hops"]; const degreeBin = (k) => (k === 0 ? 0 : k <= 2 ? 1 : k <= 4 ? 2 : k <= 6 ? 3 : 4); const SHARE_RAMP = ["#cde2fb", "#86b6ef", "#3987e5", "#1c5cab", "#0d366b"]; const MULTIPLE_VENDORS = ["Sirius Cybernetics", "Cassandra Health", "Magrathea Labs", "Babel Fish Health", "Labyrinth Clinical", "Heart of Gold Medical"]; const COVERAGE_BINS = ["No responses yet", "1–4", "5–14", "15–49", "50+"]; const COVERAGE_COLORS = [BLANK, "#86b6ef", "#3987e5", "#184f95", "#0d366b"]; // Privacy rules: the smallest group the public view will show, and the survey's consent levels. const MIN_CELL = 5; const CONSENT_LEVELS = ["named", "unnamed", "aggregate"]; const CONSENT_LABELS = {named: "Named", unnamed: "Unnamed", aggregate: "Totals only"}; const CONSENT_CHOICES = {named: "Show our name with our systems and plans", unnamed: "Show our systems and plans, but not our name", aggregate: "Count us in totals only; don't list us"}; const AUDIENCES = ["Public view", "Staff view (raw data)"]; const HATCH_CSS = "repeating-linear-gradient(45deg, #ecebe6 0 3px, #b9b7ae 3px 4.5px)"; const INK = "#0b0b0b"; const INK2 = "#52514e"; const MUTED = "#898781"; const GRID = "#e1e0d9"; const AXIS = "#c3c2b7"; const SURFACE = "#fcfcfb"; const PLOT_STYLE = {fontSize: "12px", fontFamily: "system-ui, -apple-system, 'Segoe UI', sans-serif", color: INK2, background: "transparent"}; const DISCIPLINES = [ {key: "cp", label: "Clinical pathology"}, {key: "ap", label: "Anatomic pathology"}, {key: "micro", label: "Microbiology"}, {key: "bb", label: "Blood bank"} ]; const STATUSES = ["Stable", "Evaluating", "Selected", "Implementing"]; const TYPES = ["Academic medical center", "Community hospital", "Reference / commercial lab", "Public health lab", "Independent pathology practice"]; const REASONS = ["Enterprise EHR consolidation", "Vendor end-of-life / sunset", "Health-system merger or acquisition", "Digital pathology & AI readiness", "Total cost of ownership", "Usability & workflow", "Regulatory & interoperability"]; const CONSOLIDATION_REASONS = ["Enterprise EHR consolidation", "Health-system merger or acquisition"]; const DECIDERS = ["Lab or pathology leadership", "Joint lab and IT committee", "Health-system IT or executives", "Followed the EHR decision", "Parent organization after a merger"]; const LAB_AT_TABLE = ["Lab or pathology leadership", "Joint lab and IT committee"]; const REGIONS = ["North America", "Europe", "Middle East", "Asia-Pacific", "Latin America", "Africa"]; const REGION_EXTENT = { "North America": [[-168, 14], [-52, 72]], "Europe": [[-25, 35], [42, 71]], "Middle East": [[25, 12], [62, 43]], "Asia-Pacific": [[66, -47], [178, 50]], "Latin America": [[-118, -56], [-34, 33]], "Africa": [[-18, -36], [52, 38]] }; const utc = (y, m, d) => new Date(Date.UTC(y, m - 1, d)); const TODAY = utc(2026, 10, 7); const PHASES = [ {name: "Pilot", start: utc(2026, 8, 3), end: utc(2026, 8, 25)}, {name: "LinkedIn wave", start: utc(2026, 8, 25), end: utc(2026, 9, 15)}, {name: "Ambassadors", start: utc(2026, 9, 15), end: utc(2026, 10, 8)} ];35:Td5c,const vendorGroup = (v) => (TRACKED.includes(v) ? v : OTHER); const vendorColor = (v) => (v === UNDECIDED ? UNDECIDED_COLOR : GROUP_COLORS[GROUPS.indexOf(vendorGroup(v))]); const pct = (a, b) => (b ? d3.format(".0%")(a / b) : "—"); const quarterLabel = (date) => `Q${Math.floor(date.getUTCMonth() / 3) + 1} ${date.getUTCFullYear()}`; const articleFor = (s) => (/^[aeiou]/i.test(s) ? "An" : "A"); const hatchId = () => `hatch-${Math.random().toString(36).slice(2, 9)}`; // A diagonal hatch for map areas hidden by small-cell suppression. function hatchDefs(id) { return () => svg``; } function swatchLegend(items) { return html`

${items.map(([label, fill]) => html`${label}`)}

`; } function kpi(label, value, note) { return html`

${label}

${value}

${note}

`; } function emptyNote() { return html`

No responses match these filters yet.

`; } // A shared hover card for the D3 charts. Labels are set with textContent. function tooltip(container) { const tip = document.createElement("div"); tip.className = "viz-tip"; container.append(tip); return { show(event, title, rows = []) { const titleEl = document.createElement("div"); titleEl.className = "tip-title"; titleEl.textContent = title; tip.replaceChildren(titleEl, ...rows.map(([value, label, color]) => { const row = document.createElement("div"); row.className = "tip-row"; if (color) { const key = document.createElement("span"); key.className = "tip-key"; key.style.background = color; row.append(key); } const strong = document.createElement("b"); strong.textContent = value; row.append(strong, document.createTextNode(` ${label}`)); return row; })); const box = container.getBoundingClientRect(); const x = event.clientX - box.left; const y = event.clientY - box.top; const flip = x > box.width - 320; tip.style.left = `${flip ? x - 14 - tip.offsetWidth : x + 14}px`; tip.style.top = `${Math.max(0, y - 10)}px`; tip.style.opacity = 1; }, hide() { tip.style.opacity = 0; } }; } function projectionFor(region) { const extent = REGION_EXTENT[region]; if (!extent) return {type: "equal-earth", domain: land}; const [[x0, y0], [x1, y1]] = extent; return {type: "equal-earth", domain: {type: "MultiPoint", coordinates: [[x0, y0], [x1, y0], [x0, y1], [x1, y1], [(x0 + x1) / 2, y0], [(x0 + x1) / 2, y1]]}, inset: 4}; } function regionOf(feature) { const known = COUNTRY_BY_ID.get(feature.id); if (known) return known.region; const [lon, lat] = d3.geoCentroid(feature); for (const region of ["Middle East", "Europe", "Africa", "North America", "Latin America", "Asia-Pacific"]) { const [[x0, y0], [x1, y1]] = REGION_EXTENT[region]; if (lon >= x0 && lon <= x1 && lat >= y0 && lat <= y1) return region; } return lat > 45 ? "Europe" : "Asia-Pacific"; }36:T2897,// [ISO numeric id, name, region, synthetic responses, vendor profile] const COUNTRIES = [ ["840", "United States", "North America", 190, "us"], ["124", "Canada", "North America", 34, "ca"], ["484", "Mexico", "Latin America", 7, "latam"], ["826", "United Kingdom", "Europe", 40, "uk"], ["372", "Ireland", "Europe", 6, "uk"], ["276", "Germany", "Europe", 28, "dach"], ["040", "Austria", "Europe", 6, "dach"], ["756", "Switzerland", "Europe", 8, "dach"], ["250", "France", "Europe", 18, "south"], ["056", "Belgium", "Europe", 7, "south"], ["380", "Italy", "Europe", 14, "south"], ["724", "Spain", "Europe", 14, "south"], ["620", "Portugal", "Europe", 5, "south"], ["528", "Netherlands", "Europe", 14, "nordic"], ["208", "Denmark", "Europe", 6, "nordic"], ["752", "Sweden", "Europe", 8, "nordic"], ["578", "Norway", "Europe", 5, "nordic"], ["246", "Finland", "Europe", 5, "nordic"], ["616", "Poland", "Europe", 6, "east"], ["203", "Czechia", "Europe", 4, "east"], ["300", "Greece", "Europe", 3, "east"], ["682", "Saudi Arabia", "Middle East", 10, "gulf"], ["784", "United Arab Emirates", "Middle East", 8, "gulf"], ["634", "Qatar", "Middle East", 3, "gulf"], ["376", "Israel", "Middle East", 6, "east"], ["792", "Turkey", "Middle East", 5, "east"], ["036", "Australia", "Asia-Pacific", 20, "anz"], ["554", "New Zealand", "Asia-Pacific", 6, "anz"], ["392", "Japan", "Asia-Pacific", 10, "eastasia"], ["410", "South Korea", "Asia-Pacific", 8, "eastasia"], ["158", "Taiwan", "Asia-Pacific", 4, "eastasia"], ["156", "China", "Asia-Pacific", 6, "eastasia"], ["356", "India", "Asia-Pacific", 12, "southasia"], ["608", "Philippines", "Asia-Pacific", 3, "southasia"], ["458", "Malaysia", "Asia-Pacific", 3, "southasia"], ["764", "Thailand", "Asia-Pacific", 3, "southasia"], ["076", "Brazil", "Latin America", 12, "latam"], ["032", "Argentina", "Latin America", 5, "latam"], ["152", "Chile", "Latin America", 4, "latam"], ["170", "Colombia", "Latin America", 4, "latam"], ["604", "Peru", "Latin America", 2, "latam"], ["710", "South Africa", "Africa", 7, "za"], ["404", "Kenya", "Africa", 2, "africa"], ["288", "Ghana", "Africa", 1, "africa"], ["646", "Rwanda", "Africa", 1, "africa"] ]; const COUNTRY_BY_ID = new Map(COUNTRIES.map(([id, name, region]) => [id, {id, name, region}])); // Relative weights for the LIS a lab runs today, by market. const PROFILES = { us: {"Sirius Cybernetics": 34, "Cassandra Health": 17, "Magrathea Labs": 18, "Deep Thought Computer": 9, "Whirlwind Medical": 9, "Vineyard Software": 7, "Other commercial": 3, "Bespoke (in-house)": 3}, ca: {"Sirius Cybernetics": 28, "Cassandra Health": 26, "Deep Thought Computer": 18, "Magrathea Labs": 10, "Whirlwind Medical": 12, "Other commercial": 6}, uk: {"Magrathea Labs": 44, "Babel Fish Health": 20, "Sirius Cybernetics": 10, "Cassandra Health": 10, "Other commercial": 12, "Bespoke (in-house)": 4}, dach: {"Heart of Gold Medical": 32, "Labyrinth Clinical": 24, "Magrathea Labs": 10, "Other commercial": 24, "Bespoke (in-house)": 10}, south: {"Labyrinth Clinical": 34, "Magrathea Labs": 16, "Other commercial": 34, "Bespoke (in-house)": 16}, nordic: {"Sirius Cybernetics": 40, "Magrathea Labs": 14, "Cassandra Health": 4, "Other commercial": 30, "Bespoke (in-house)": 12}, east: {"Other commercial": 46, "Labyrinth Clinical": 14, "Heart of Gold Medical": 14, "Bespoke (in-house)": 26}, gulf: {"Cassandra Health": 42, "Sirius Cybernetics": 20, "Babel Fish Health": 14, "Other commercial": 24}, anz: {"Babel Fish Health": 30, "Other commercial": 30, "Cassandra Health": 14, "Sirius Cybernetics": 10, "Magrathea Labs": 16}, eastasia: {"Other commercial": 60, "Bespoke (in-house)": 40}, southasia: {"Other commercial": 50, "Bespoke (in-house)": 30, "Cassandra Health": 10, "Babel Fish Health": 10}, latam: {"Other commercial": 46, "Deep Thought Computer": 14, "Labyrinth Clinical": 10, "Bespoke (in-house)": 30}, za: {"Babel Fish Health": 45, "Other commercial": 30, "Magrathea Labs": 10, "Bespoke (in-house)": 15}, africa: {"Other commercial": 40, "Bespoke (in-house)": 45, "Babel Fish Health": 15} }; const AP_PROFILES = { us: {"Cassandra Health": 30, "Sirius Cybernetics": 25, "Other commercial": 30, "Magrathea Labs": 10, "Bespoke (in-house)": 5}, ca: {"Cassandra Health": 30, "Sirius Cybernetics": 25, "Other commercial": 30, "Deep Thought Computer": 15} }; // Where labs that have picked a new vendor are going, by market. const TARGETS = { us: {"Sirius Cybernetics": 72, "Cassandra Health": 7, "Magrathea Labs": 9, "Other commercial": 12}, ca: {"Sirius Cybernetics": 62, "Cassandra Health": 18, "Magrathea Labs": 8, "Other commercial": 12}, uk: {"Sirius Cybernetics": 30, "Magrathea Labs": 34, "Babel Fish Health": 22, "Other commercial": 14}, dach: {"Labyrinth Clinical": 32, "Heart of Gold Medical": 28, "Sirius Cybernetics": 12, "Magrathea Labs": 10, "Other commercial": 18}, south: {"Labyrinth Clinical": 40, "Magrathea Labs": 28, "Sirius Cybernetics": 6, "Other commercial": 26}, nordic: {"Sirius Cybernetics": 64, "Magrathea Labs": 16, "Other commercial": 20}, east: {"Labyrinth Clinical": 30, "Heart of Gold Medical": 20, "Magrathea Labs": 15, "Other commercial": 35}, gulf: {"Sirius Cybernetics": 56, "Cassandra Health": 20, "Babel Fish Health": 12, "Other commercial": 12}, anz: {"Sirius Cybernetics": 38, "Babel Fish Health": 24, "Magrathea Labs": 20, "Other commercial": 18}, eastasia: {"Other commercial": 70, "Cassandra Health": 10, "Sirius Cybernetics": 10, "Babel Fish Health": 10}, southasia: {"Other commercial": 45, "Cassandra Health": 20, "Babel Fish Health": 25, "Sirius Cybernetics": 10}, latam: {"Other commercial": 40, "Deep Thought Computer": 20, "Labyrinth Clinical": 20, "Sirius Cybernetics": 10, "Cassandra Health": 10}, za: {"Babel Fish Health": 45, "Magrathea Labs": 25, "Other commercial": 30}, africa: {"Babel Fish Health": 40, "Other commercial": 45, "Magrathea Labs": 15} }; const PROPENSITY = {"Sirius Cybernetics": 0.25, "Whirlwind Medical": 1.6, "Deep Thought Computer": 1.35, "Bespoke (in-house)": 1.5, "Magrathea Labs": 1.15, "Cassandra Health": 1.2, "Vineyard Software": 0.9}; const TYPE_MIX = {"Academic medical center": 30, "Community hospital": 34, "Reference / commercial lab": 14, "Public health lab": 8, "Independent pathology practice": 14}; const REASONS_TO_SIRIUS = {"Enterprise EHR consolidation": 52, "Health-system merger or acquisition": 16, "Vendor end-of-life / sunset": 10, "Digital pathology & AI readiness": 8, "Usability & workflow": 8, "Total cost of ownership": 3, "Regulatory & interoperability": 3}; const DECIDER_MIX = { "Enterprise EHR consolidation": {"Followed the EHR decision": 55, "Health-system IT or executives": 33, "Joint lab and IT committee": 10, "Lab or pathology leadership": 2}, "Health-system merger or acquisition": {"Parent organization after a merger": 58, "Health-system IT or executives": 30, "Joint lab and IT committee": 12}, other: {"Lab or pathology leadership": 42, "Joint lab and IT committee": 36, "Health-system IT or executives": 22} }; const REASONS_OTHER = {"Vendor end-of-life / sunset": 25, "Digital pathology & AI readiness": 19, "Total cost of ownership": 17, "Usability & workflow": 15, "Regulatory & interoperability": 12, "Health-system merger or acquisition": 8, "Enterprise EHR consolidation": 4}; const BOARD_QUOTA = {"840": 8, "124": 2, "826": 2, "276": 1, "528": 1, "036": 1, "724": 1, "682": 1, "250": 1}; const REACH = {us: "core", ca: "core", uk: "core", dach: "core", south: "core", nordic: "core", anz: "core", gulf: "mid", east: "mid", za: "mid", eastasia: "far", southasia: "far", latam: "far", africa: "far"}; const WAVE_MIX = { core: {"Pilot": 12, "LinkedIn wave": 58, "Ambassadors": 30}, mid: {"Pilot": 4, "LinkedIn wave": 36, "Ambassadors": 60}, far: {"LinkedIn wave": 22, "Ambassadors": 78} }; // Invented place names, so no real institution is attached to made-up data. const STEMS_A = ["Lark", "Vell", "Quill", "Orren", "Staven", "Merrow", "Tolle", "Bracken", "Halven", "Corva", "Pell", "Wyn", "Thorn", "Elm", "Draven", "Kestrel", "Salt", "Ravel", "Amber", "Bel", "Cairn", "Delm", "Fen", "Gale", "Hollin", "Jessa", "Kell", "Loma", "Mir", "Nor", "Oak", "Penn", "Rook", "Sel", "Tarn", "Umber", "Val", "Wren"]; const STEMS_B = ["moor", "port", "field", "vale", "brook", "wind", "shaw", "rill", "ridge", "stead", "quay", "grave", "hall", "ton", "mere", "ford", "haven", "crest", "wick", "ley", "by", "dale", "holm", "gate"]; const NAME_PATTERNS = { "Academic medical center": [(p) => `${p} University Hospital`, (p) => `${p} Academic Medical Center`], "Community hospital": [(p) => `${p} General Hospital`, (p) => `${p} Regional Medical Center`, (p) => `${p} Memorial Hospital`], "Reference / commercial lab": [(p) => `${p} Reference Laboratories`, (p) => `${p} Diagnostics`], "Public health lab": [(p) => `${p} Public Health Laboratory`], "Independent pathology practice": [(p) => `${p} Pathology Associates`, (p) => `${p} Pathology Group`] }; const hospitalUniversitario = (p) => `Hospital Universitario de ${p}`; const hospitalUniversitario2 = (p) => `Hospital Universitário de ${p}`; const LOCAL_AMC = { "276": (p) => `Universitätsklinikum ${p}`, "040": (p) => `Universitätsklinikum ${p}`, "756": (p) => `Universitätsspital ${p}`, "250": (p) => `CHU de ${p}`, "056": (p) => `UZ ${p}`, "380": (p) => `Azienda Ospedaliera Universitaria di ${p}`, "528": (p) => `${p} UMC`, "724": hospitalUniversitario, "484": hospitalUniversitario, "032": hospitalUniversitario, "152": hospitalUniversitario, "170": hospitalUniversitario, "604": hospitalUniversitario, "076": hospitalUniversitario2, "620": hospitalUniversitario2 }; // Approximate population (millions), used to rank blank countries. const POP_M = {"360": 280, "586": 241, "566": 229, "050": 173, "643": 144, "231": 127, "818": 113, "180": 109, "704": 100, "364": 90, "834": 68, "104": 54, "800": 49, "729": 49, "012": 46, "368": 46, "004": 42, "504": 38, "804": 37, "024": 37, "860": 36, "508": 34, "887": 34, "524": 31, "450": 30, "120": 29, "384": 29, "862": 28, "408": 26, "562": 26, "466": 23, "854": 23, "760": 23, "144": 22, "894": 21, "398": 20, "642": 19, "218": 18, "686": 18, "148": 18, "706": 18, "116": 17, "716": 17, "348": 10, "112": 9, "688": 7};37:T14b7,const seedResponses = (() => { const random = d3.randomLcg(20261007); const consentRandom = d3.randomLcg(1729); const announceRandom = d3.randomLcg(4242); const decideRandom = d3.randomLcg(8128); const pick = (weights, rng = random) => { const entries = Object.entries(weights); let r = rng() * d3.sum(entries, ([, w]) => w); for (const [key, w] of entries) if ((r -= w) < 0) return key; return entries[entries.length - 1][0]; }; const pickExcept = (weights, except) => { for (let i = 0; i < 12; ++i) { const v = pick(weights); if (v !== except) return v; } return except === "Other commercial" ? "Bespoke (in-house)" : "Other commercial"; }; const pickWeighted = (array, weight) => { let r = random() * d3.sum(array, weight); for (const x of array) if ((r -= weight(x)) < 0) return x; return array[array.length - 1]; }; const choice = (array) => array[Math.floor(random() * array.length)]; const between = (a, b, skew = 1) => new Date(+a + (b - a) * random() ** skew); const used = new Set(); const placeName = () => { for (;;) { const p = choice(STEMS_A) + choice(STEMS_B); if (!used.has(p)) return used.add(p), p; } }; const rows = []; let serial = 0; for (const [countryId, country, region, n, profile] of COUNTRIES) { for (let i = 0; i < n; ++i) { const board = i < (BOARD_QUOTA[countryId] ?? 0); const type = board ? "Academic medical center" : pick(TYPE_MIX); const cp = pick(PROFILES[profile]); const lis = { cp, ap: random() < 0.55 ? cp : pick(AP_PROFILES[profile] ?? PROFILES[profile]), micro: random() < 0.85 ? cp : pick(PROFILES[profile]), bb: random() < 0.6 ? cp : pick(PROFILES[profile]) }; const switching = random() < Math.min(0.85, 0.36 * (PROPENSITY[cp] ?? 1)); const status = switching ? pick({Evaluating: 35, Selected: 22, Implementing: 43}) : "Stable"; const committed = status === "Selected" || status === "Implementing"; const newVendor = committed ? pickExcept(TARGETS[profile], cp) : null; let goLive = null; if (committed) { const year = +pick(status === "Implementing" ? {2026: 14, 2027: 56, 2028: 30} : {2027: 18, 2028: 47, 2029: 27, 2030: 8}); const quarter = year === 2026 ? 4 : 1 + Math.floor(random() * 4); goLive = utc(year, quarter * 3 - 2, 1); } const reason = switching ? pick(newVendor === "Sirius Cybernetics" ? REASONS_TO_SIRIUS : REASONS_OTHER) : null; const decider = reason ? pick(DECIDER_MIX[reason] ?? DECIDER_MIX.other, decideRandom) : null; const previous = !switching && random() < (cp === "Sirius Cybernetics" ? 0.34 : 0.07) ? {vendor: pickExcept(PROFILES[profile], cp), date: between(utc(2021, 6, 1), utc(2026, 9, 1))} : null; const showName = board || random() < 0.68; const place = placeName(); const name = type === "Academic medical center" && LOCAL_AMC[countryId] ? LOCAL_AMC[countryId](place) : choice(NAME_PATTERNS[type])(place); rows.push({ id: `L${String(++serial).padStart(3, "0")}`, name, consent: showName ? "named" : consentRandom() < 0.6 ? "unnamed" : "aggregate", plansPublic: committed && announceRandom() < (status === "Implementing" ? 0.85 : 0.5), country, countryId, region, profile, type, lis, status, newVendor, goLive, reason, decider, previous, board }); } } // When each lab answered, by rollout phase. for (const d of rows) { if (d.board) { d.wave = "Board"; d.submitted = between(utc(2026, 8, 3), utc(2026, 8, 6)); continue; } d.wave = pick(WAVE_MIX[REACH[d.profile]]); const phase = PHASES.find((p) => p.name === d.wave); d.submitted = between(d.wave === "Pilot" ? utc(2026, 8, 6) : phase.start, phase.end, d.wave === "LinkedIn wave" ? 1.6 : 1.1); } rows.sort((a, b) => a.submitted - b.submitted); // Who referred whom: mostly a colleague in the same country who answered recently (their referral link is fresh), // with a pull toward labs that already referred others. const RICH = 1.2, BOARD_PULL = 0.6, FRESH_DAYS = 10; const boardRows = rows.filter((d) => d.board); for (const d of boardRows) Object.assign(d, {referrer: null, degree: 0, children: 0}); const done = [...boardRows]; for (const d of rows) { if (d.board) continue; let pool; if (d.wave === "Pilot") { pool = boardRows.filter((b) => b.countryId === d.countryId); if (!pool.length) pool = boardRows; } else { const r = random(); pool = r < 0.55 ? done.filter((x) => x.countryId === d.countryId) : r < 0.8 ? done.filter((x) => x.region === d.region) : done; if (!pool.length) pool = done.filter((x) => x.region === d.region); if (!pool.length) pool = done; } const ref = d.wave === "Pilot" ? pickWeighted(pool, (x) => 1 + x.children) : pickWeighted(pool, (x) => (1 + RICH * x.children) * (x.board ? BOARD_PULL : 1) * Math.exp(-(d.submitted - x.submitted) / (FRESH_DAYS * 864e5))); Object.assign(d, {referrer: ref.id, degree: ref.degree + 1, children: 0}); ref.children += 1; done.push(d); } return rows; })(); const board = seedResponses.filter((d) => d.board);38:T519,const publicView = audience === AUDIENCES[0]; const suppressed = (n) => publicView && n > 0 && n < MIN_CELL; const fmtCount = (n) => (suppressed(n) ? `fewer than ${MIN_CELL}` : d3.format(",")(n)); const pctOf = (a, b) => (suppressed(b) ? "—" : pct(a, b)); const countryTotals = d3.rollup(responses, (v) => v.length, (d) => d.countryId); // Unnamed labs in small countries are placed by region, so the country can't single them out. const placeOf = (d) => (!publicView || d.consent === "named" || (countryTotals.get(d.countryId) ?? 0) >= MIN_CELL ? d.country : d.region); const listable = (d) => !publicView || d.consent !== "aggregate"; // A lab's own plans are listed only once it says they're announced or under contract; "Evaluating" never is. const planShown = (d) => !publicView || d.plansPublic; function labelOf(d) { if (!publicView || d.consent === "named") return d.name; if (d.consent === "unnamed") return `${articleFor(d.type)} ${d.type.toLowerCase()} in ${placeOf(d)}`; return "A lab counted in totals only"; } const consentCounts = d3.rollup(responses, (v) => v.length, (d) => d.consent); const hatchedCountries = d3.sum(d3.group(filtered, (d) => d.countryId).values(), (list) => d3.max(d3.rollup(list, (v) => v.length, (d) => d.lis[discipline.key]).values()) < MIN_CELL ? 1 : 0 );39:T12e0,function countryStats(rows, disc) { const stats = new Map(); for (const [id, list] of d3.group(rows, (d) => d.countryId)) { const counts = d3.rollups(list, (v) => v.length, (d) => d.lis[disc]).sort((a, b) => d3.descending(a[1], b[1])); stats.set(id, {n: list.length, counts, share: (vendor) => (counts.find(([k]) => k === vendor)?.[1] ?? 0) / list.length}); } return stats; } function vendorMap(rows, disc, region) { const stats = countryStats(rows, disc); // Small-cell suppression: color a country only when its leading vendor has at least MIN_CELL labs. const hidden = (f) => suppressed(stats.get(f.id).counts[0][1]); const describe = (f, i) => { const s = stats.get(f.id); const c = s.counts[i]; return !c ? "—" : suppressed(c[1]) ? `hidden (fewer than ${MIN_CELL} labs)` : `${c[0]} (${pct(c[1], s.n)})`; }; const id = hatchId(); const plot = Plot.plot({ width: mapWidth(region), style: PLOT_STYLE, projection: projectionFor(region), color: {type: "ordinal", domain: GROUPS, range: GROUP_COLORS}, marks: [ hatchDefs(id), Plot.geo(countryFeatures.filter((f) => !stats.has(f.id)), Plot.centroid({ fill: BLANK, tip: {format: {x: false, y: false}}, channels: {Country: (f) => f.properties.name, Status: () => "No responses yet"} })), Plot.geo(countryFeatures.filter((f) => stats.has(f.id) && hidden(f)), Plot.centroid({ fill: `url(#${id})`, tip: {format: {x: false, y: false}}, channels: { Country: (f) => f.properties.name, "Labs responding": (f) => fmtCount(stats.get(f.id).n), Status: () => `Hidden: no vendor here has ${MIN_CELL} or more labs` } })), Plot.geo(countryFeatures.filter((f) => stats.has(f.id) && !hidden(f)), Plot.centroid({ fill: (f) => vendorGroup(stats.get(f.id).counts[0][0]), tip: {format: {x: false, y: false, fill: false}}, channels: { Country: (f) => f.properties.name, "Labs responding": (f) => stats.get(f.id).n, "Most common": (f) => describe(f, 0), "Runner-up": (f) => describe(f, 1) } })), Plot.geo(borders, {stroke: "white", strokeWidth: 0.6}) ] }); return html`

${swatchLegend([ ...GROUPS.map((group, i) => [group, GROUP_COLORS[i]]), ...(publicView ? [[`Hidden (fewer than ${MIN_CELL} labs)`, HATCH_CSS]] : []), ["No responses yet", BLANK] ])}${plot}

`; } function vendorSmallMultiples(rows, disc, region) { if (!rows.length) return emptyNote(); const stats = countryStats(rows, disc); const covered = countryFeatures.filter((f) => stats.has(f.id)); const cols = W >= 720 ? 3 : W >= 440 ? 2 : 1; const gap = 18; const w = Math.floor((W - (cols - 1) * gap) / cols); const color = {type: "linear", domain: [0, 1], interpolate: d3.interpolateRgbBasis(SHARE_RAMP), tickFormat: "%", label: "Share of responding labs in the country"}; const maps = MULTIPLE_VENDORS.map((vendor) => { const id = hatchId(); const count = (f) => stats.get(f.id).counts.find(([k]) => k === vendor)?.[1] ?? 0; // Hide a country when it has too few labs overall, or too few on this vendor. const hidden = (f) => suppressed(stats.get(f.id).n) || (count(f) > 0 && suppressed(count(f))); return html`

${vendor}

${Plot.plot({ width: w, style: PLOT_STYLE, projection: projectionFor(region), color, marks: [ hatchDefs(id), Plot.geo(land, {fill: BLANK}), Plot.geo(covered.filter((f) => !hidden(f)), Plot.centroid({ fill: (f) => stats.get(f.id).share(vendor), tip: {format: {x: false, y: false, fill: false}}, channels: {Country: (f) => f.properties.name, [`On ${vendor}`]: (f) => pct(stats.get(f.id).share(vendor), 1), "Labs responding": (f) => stats.get(f.id).n} })), Plot.geo(covered.filter((f) => hidden(f)), Plot.centroid({ fill: `url(#${id})`, tip: {format: {x: false, y: false}}, channels: {Country: (f) => f.properties.name, Status: () => `Hidden: fewer than ${MIN_CELL} labs`} })), Plot.geo(borders, {stroke: "white", strokeWidth: 0.4}) ] })}

`; }); return html`

${Plot.legend({color: {...color, width: 300}, style: PLOT_STYLE})}${publicView ? swatchLegend([[`Hidden (fewer than ${MIN_CELL} labs)`, HATCH_CSS]]) : ""}

${maps}

`; }3a:T4c4,function installedBase(rows, disc) { if (!rows.length) return emptyNote(); const data = d3.rollups(rows, (v) => v.length, (d) => d.lis[disc]) .map(([vendor, n]) => ({vendor, n, hidden: suppressed(n)})) .sort((a, b) => d3.descending(a.hidden ? 0 : a.n, b.hidden ? 0 : b.n) || d3.ascending(a.vendor, b.vendor)); return Plot.plot({ width: Math.min(W, 640), height: data.length * 26 + 16, marginLeft: 150, marginRight: 90, marginTop: 8, marginBottom: 8, style: PLOT_STYLE, x: {axis: null}, y: {domain: data.map((d) => d.vendor), label: null, tickSize: 0}, color: {domain: GROUPS, range: GROUP_COLORS}, marks: [ Plot.barX(data.filter((d) => !d.hidden), { x: "n", y: "vendor", fill: (d) => vendorGroup(d.vendor), insetTop: 3, insetBottom: 3, rx2: 4, tip: {format: {fill: false, y: false}}, channels: {Vendor: "vendor", Share: (d) => pct(d.n, rows.length)} }), Plot.text(data, {x: (d) => (d.hidden ? 0 : d.n), y: "vendor", text: (d) => (d.hidden ? `fewer than ${MIN_CELL}` : `${d.n} · ${pct(d.n, rows.length)}`), dx: 6, textAnchor: "start", fill: (d) => (d.hidden ? MUTED : INK2)}), Plot.ruleX([0], {stroke: AXIS}) ] }); }3b:Teaa,function migrationSankey(rows, disc) { const movers = rows.filter((d) => d.status !== "Stable"); if (!movers.length) return emptyNote(); const flows = d3.rollups(movers, (v) => v.length, (d) => d.lis[disc], (d) => d.newVendor ?? UNDECIDED); const allLinks = flows.flatMap(([from, tos]) => tos.map(([to, value]) => ({source: `from:${from}`, target: `to:${to}`, value}))); // Small-cell suppression: leave out moves made by fewer than MIN_CELL labs in the public view. const links = allLinks.filter((l) => !suppressed(l.value)); const hiddenLabs = d3.sum(allLinks, (l) => (suppressed(l.value) ? l.value : 0)); if (!links.length) return html`

Every move in this view involves fewer than ${MIN_CELL} labs, so none are shown.

`; const ids = [...new Set(links.flatMap((l) => [l.source, l.target]))]; const nodes = ids.map((id) => ({id, name: id.slice(id.indexOf(":") + 1), side: id.startsWith("from:") ? "from" : "to"})); const tallest = Math.max(...["from", "to"].map((side) => nodes.filter((n) => n.side === side).length)); const w = W; const h = Math.max(340, tallest * 40 + 28); const marginL = 170; const marginR = 200; const graph = d3Sankey() .nodeId((d) => d.id) .nodeWidth(12) .nodePadding(14) .nodeSort((a, b) => (a.name === UNDECIDED) - (b.name === UNDECIDED) || b.value - a.value) .extent([[marginL, 28], [w - marginR, h - 8]])({nodes, links}); const wrap = html`

${hiddenLabs} more labs are in moves made by fewer than ${MIN_CELL} labs each, which the public view leaves out.

`); return wrap; }3c:T777,function breakdownChart(rows, key, title) { const movers = rows.filter((d) => d[key]); if (!movers.length) return emptyNote(); const data = d3.rollups(movers, (v) => v.length, (d) => d[key]) .map(([label, n]) => ({label, n, hidden: suppressed(n)})) .sort((a, b) => d3.descending(a.hidden ? 0 : a.n, b.hidden ? 0 : b.n) || d3.ascending(a.label, b.label)); return Plot.plot({ width: Math.min(W, 640), height: data.length * 28 + 16, marginLeft: 230, marginRight: 90, marginTop: 8, marginBottom: 8, style: PLOT_STYLE, x: {axis: null}, y: {domain: data.map((d) => d.label), label: null, tickSize: 0}, marks: [ Plot.barX(data.filter((d) => !d.hidden), {x: "n", y: "label", fill: GROUP_COLORS[0], insetTop: 4, insetBottom: 4, rx2: 4, tip: {format: {y: false}}, channels: {[title]: "label"}}), Plot.text(data, {x: (d) => (d.hidden ? 0 : d.n), y: "label", text: (d) => (d.hidden ? `fewer than ${MIN_CELL}` : `${d.n} · ${pct(d.n, movers.length)}`), dx: 6, textAnchor: "start", fill: (d) => (d.hidden ? MUTED : INK2)}), Plot.ruleX([0], {stroke: AXIS}) ] }); } // Consolidation versus everything else: how often the lab wasn't part of the decision. function decisionNote(rows) { const movers = rows.filter((d) => d.decider); const share = (v) => ({n: v.length, outside: v.filter((d) => !LAB_AT_TABLE.includes(d.decider)).length}); const consolidation = share(movers.filter((d) => CONSOLIDATION_REASONS.includes(d.reason))); const rest = share(movers.filter((d) => !CONSOLIDATION_REASONS.includes(d.reason))); if (consolidation.n < MIN_CELL || rest.n < MIN_CELL) return ""; return html`

When consolidation (EHR or merger) drove the move, ${pct(consolidation.outside, consolidation.n)} of decisions were made without lab leadership at the table. For every other reason, ${pct(rest.outside, rest.n)} were.

`; }3d:T530,function goLiveTimeline(rows, disc) { const live = rows .filter((d) => d.goLive && d.goLive >= utc(2026, 10, 1) && listable(d) && planShown(d)) .map((d) => ({...d, x: new Date(+d.goLive + 45 * 864e5), group: vendorGroup(d.newVendor), from: d.lis[disc], quarter: quarterLabel(d.goLive), lab: labelOf(d), place: placeOf(d)})); if (!live.length) return emptyNote(); const tallest = d3.max(d3.rollup(live, (v) => v.length, (d) => +d.goLive).values()); const step = 11; return Plot.plot({ width: W, height: step * (tallest + 0.6) + 66, marginTop: 16, marginBottom: 30, style: PLOT_STYLE, x: {type: "utc", domain: [utc(2026, 10, 1), utc(2031, 1, 1)], label: null, ticks: d3.utcYear.every(1), tickFormat: "%Y", tickSize: 0}, y: {axis: null, domain: [0, tallest + 0.6]}, color: {domain: GROUPS, range: GROUP_COLORS, legend: true}, marks: [ Plot.ruleX(d3.utcYears(utc(2027, 1, 1), utc(2031, 1, 1)), {stroke: GRID}), Plot.ruleY([0], {stroke: AXIS}), Plot.dot(live, Plot.stackY2({ x: "x", fill: "group", order: GROUPS, r: 4.5, stroke: SURFACE, strokeWidth: 1, tip: {format: {x: false, y: false, fill: false}}, channels: {Lab: "lab", Where: "place", From: "from", To: "newVendor", "Go-live": "quarter", Status: "status"} })) ] }); }3e:Tb44,function shareOverTime(rows, disc) { if (!rows.length) return emptyNote(); if (suppressed(rows.length)) return html`

Fewer than ${MIN_CELL} labs match these filters, so shares aren't shown.

`; const vendorAt = (d, date) => { if (d.goLive && d.goLive <= date) return d.newVendor; if (d.previous && date < d.previous.date) return d.previous.vendor; return d.lis[disc]; }; const dates = [...d3.range(2021, 2026).map((y) => utc(y, 12, 31)), TODAY, ...d3.range(2026, 2031).map((y) => utc(y, 12, 31))]; const data = dates.flatMap((date) => { const counts = d3.rollup(rows, (v) => v.length, (d) => vendorGroup(vendorAt(d, date))); return TRACKED.map((group) => ({date, group, share: (counts.get(group) ?? 0) / rows.length})); }); const past = data.filter((d) => d.date <= TODAY); const future = data.filter((d) => d.date >= TODAY); const wide = dates.map((date) => ({date, rows: data.filter((d) => +d.date === +date).sort((a, b) => b.share - a.share)})); const yMax = Math.min(1, d3.max(data, (d) => d.share) * 1.1); const height = 340; // Nudge end labels apart so they never overlap. const ends = future.filter((d) => +d.date === +dates[dates.length - 1]).sort((a, b) => b.share - a.share); const minGap = (14 / (height - 50)) * yMax; ends.forEach((d, i) => (d.labelY = i ? Math.min(d.share, ends[i - 1].labelY - minGap) : d.share)); return Plot.plot({ width: W, height, marginRight: 170, marginTop: 24, style: PLOT_STYLE, x: {type: "utc", label: null, ticks: d3.utcYear.every(1), tickFormat: "%Y"}, y: {domain: [0, yMax], grid: true, tickFormat: "%", label: "Share of responding labs", labelArrow: "none"}, color: {domain: TRACKED, range: GROUP_COLORS.slice(0, 3), legend: true}, marks: [ Plot.ruleX([TODAY], {stroke: MUTED, strokeDasharray: "2,3"}), Plot.text([TODAY], {x: (d) => d, frameAnchor: "top", dy: -14, dx: 6, textAnchor: "start", text: () => "Today; projected from scheduled go-lives →", fill: INK2}), Plot.line(past, {x: "date", y: "share", stroke: "group", strokeWidth: 2, curve: "monotone-x"}), Plot.line(future, {x: "date", y: "share", stroke: "group", strokeWidth: 2, strokeDasharray: "5,4", curve: "monotone-x"}), Plot.dot(ends, {x: "date", y: "share", fill: "group", r: 4, stroke: SURFACE, strokeWidth: 2}), Plot.text(ends, {x: "date", y: "labelY", text: (d) => `${d.group} ${pct(d.share, 1)}`, dx: 10, textAnchor: "start", fill: INK}), Plot.ruleX(wide, Plot.pointerX({x: "date", stroke: AXIS})), Plot.tip(wide, Plot.pointerX({ x: "date", y: () => yMax, anchor: "top-left", title: (d) => [`${d.date > TODAY ? "Projected, end of " : d.date < TODAY ? "End of " : "Today, "}${d.date.getUTCFullYear()}`, ...d.rows.map((r) => `${pct(r.share, 1)} ${r.group}`)].join("\n") })) ] }); }3f:T4e0,const networkLayout = (() => { const children = d3.rollup(responses, (v) => v.length, (d) => d.referrer); const hub = {id: "ASSOC", d: null, children: board.length, r: 9}; const nodes = [hub, ...responses.map((d) => ({id: d.id, d, children: children.get(d.id) ?? 0, r: 2.4 + Math.sqrt(children.get(d.id) ?? 0) * 1.5}))]; const links = [ ...board.map((b) => ({source: "ASSOC", target: b.id, hub: true})), ...responses.filter((d) => d.referrer).map((d) => ({source: d.referrer, target: d.id})) ]; const simulation = d3.forceSimulation(nodes) .force("link", d3.forceLink(links).id((d) => d.id).distance((l) => (l.hub ? 34 : 9)).strength((l) => (l.hub ? 0.6 : 1))) .force("charge", d3.forceManyBody().strength(-12)) .force("x", d3.forceX().strength(0.03)) .force("y", d3.forceY().strength(0.045)) .force("collide", d3.forceCollide((d) => d.r + 0.8)) .stop(); for (let i = 0; i < 360; ++i) simulation.tick(); return {nodes, links, byId: new Map(nodes.map((n) => [n.id, n]))}; })(); const networkStats = (() => { const degrees = filtered.map((d) => d.degree); return {n: degrees.length, median: d3.median(degrees) ?? 0, max: d3.max(degrees) ?? 0, withinSix: degrees.filter((k) => k <= 6).length}; })();40:T16e1,function referralNetwork({nodes, links, byId}, visible) { const w = W; const h = Math.round(Math.min(640, Math.max(420, w * 0.6))); const [x0, x1] = d3.extent(nodes, (n) => n.x); const [y0, y1] = d3.extent(nodes, (n) => n.y); const k = Math.min((w - 60) / (x1 - x0 || 1), (h - 60) / (y1 - y0 || 1)); const sx = (x) => w / 2 + (x - (x0 + x1) / 2) * k; const sy = (y) => h / 2 + (y - (y0 + y1) / 2) * k; const rOf = (n) => Math.max(2.2, n.r * Math.min(k, 1.6)); const isVisible = (n) => !n.d || visible.has(n.id); const fillOf = (n) => (n.d ? DEGREE_COLORS[degreeBin(n.d.degree)] : INK); const chainOf = (n) => { const chain = []; for (let cur = n; cur; cur = cur.d?.referrer ? byId.get(cur.d.referrer) : cur.d ? byId.get("ASSOC") : null) chain.push(cur); return chain; }; const wrap = html`

`; const tip = tooltip(wrap); const svg = d3.create("svg").attr("width", w).attr("height", h).attr("viewBox", [0, 0, w, h]).style("max-width", "100%").style("height", "auto").style("font", "12px system-ui, -apple-system, 'Segoe UI', sans-serif"); const link = svg.append("g").attr("stroke", AXIS).attr("stroke-width", 0.8).selectAll("line").data(links).join("line") .attr("x1", (l) => sx(l.source.x)).attr("y1", (l) => sy(l.source.y)) .attr("x2", (l) => sx(l.target.x)).attr("y2", (l) => sy(l.target.y)) .attr("stroke-opacity", (l) => (visible.has(l.target.id) ? 0.9 : 0.25)); const node = svg.append("g").selectAll("circle").data(nodes).join("circle") .attr("cx", (n) => sx(n.x)).attr("cy", (n) => sy(n.y)).attr("r", rOf) .attr("fill", fillOf) .attr("stroke", (n) => (n.d?.board ? INK : SURFACE)) .attr("stroke-width", (n) => (n.d?.board ? 1.5 : 0.8)) .attr("opacity", (n) => (isVisible(n) ? 1 : 0.15)); const hub = byId.get("ASSOC"); const labelled = [hub, ...nodes.filter((n) => n.d && visible.has(n.id) && (!publicView || n.d.consent === "named") && !n.d.board).sort((a, b) => b.children - a.children).slice(0, 3)]; svg.append("g").selectAll("text").data(labelled).join("text") .attr("x", (n) => sx(n.x) + rOf(n) + 4).attr("y", (n) => sy(n.y)).attr("dy", "0.35em") .attr("fill", INK).attr("stroke", SURFACE).attr("stroke-width", 3).attr("paint-order", "stroke") .style("font-weight", (n) => (n.d ? 400 : 700)) .text((n) => (n.d ? n.d.name : "The Association")); // Nearest-node hover, so small dots are easy to hit. const delaunay = d3.Delaunay.from(nodes, (n) => sx(n.x), (n) => sy(n.y)); svg.on("pointermove", (event) => { const [mx, my] = d3.pointer(event); const n = nodes[delaunay.find(mx, my)]; if (!n || Math.hypot(sx(n.x) - mx, sy(n.y) - my) > 24) return reset(); const chain = chainOf(n); const onChain = new Set(chain.map((c) => c.id)); node.attr("opacity", (m) => (onChain.has(m.id) ? 1 : 0.12)); link.attr("stroke-opacity", (l) => (onChain.has(l.target.id) && onChain.has(l.source.id) ? 1 : 0.08)).attr("stroke", (l) => (onChain.has(l.target.id) && onChain.has(l.source.id) ? INK : AXIS)); if (!n.d) return tip.show(event, "The Association", [[`${board.length}`, "board members seeded the survey"]]); // The referral chain from the board down to this lab, shortened in the middle when long. const stepLabel = (d) => `${labelOf(d)}${!publicView || d.consent === "named" ? `, ${d.country}` : ""}${d.board ? " (board)" : ""}`; const steps = chain.slice().reverse().filter((c) => c.d).map((c, i) => [`${i}`, stepLabel(c.d)]); const shown = steps.length > 6 ? [...steps.slice(0, 2), ["…", `${steps.length - 4} more labs`], ...steps.slice(-2)] : steps; tip.show(event, labelOf(n.d), [ [`${n.d.degree}`, n.d.degree === 1 ? "hop from the board" : "hops from the board", fillOf(n)], [`${n.children}`, n.children === 1 ? "lab referred" : "labs referred"], ...(steps.length > 1 ? [["", "Referral chain:"], ...shown.slice(0, -1)] : []) ]); }); const reset = () => { node.attr("opacity", (n) => (isVisible(n) ? 1 : 0.15)); link.attr("stroke-opacity", (l) => (visible.has(l.target.id) ? 0.9 : 0.25)).attr("stroke", AXIS); tip.hide(); }; svg.on("pointerleave", reset); wrap.append(html`

${DEGREE_LABELS.map((label, i) => html`${label}`)}

`, svg.node()); return wrap; } function degreeHistogram(rows) { if (!rows.length) return emptyNote(); const counts = d3.rollup(rows, (v) => v.length, (d) => d.degree); const data = d3.range(0, d3.max(counts.keys()) + 1).map((k) => ({k, n: counts.get(k) ?? 0})); return Plot.plot({ width: Math.min(W, 460), height: 210, marginTop: 20, style: PLOT_STYLE, x: {domain: data.map((d) => d.k), label: "Hops from the board", labelAnchor: "center", labelArrow: "none", tickSize: 0, tickFormat: (k) => (k === 0 ? "Board" : k)}, y: {axis: null}, marks: [ Plot.barY(data, {x: "k", y: "n", fill: (d) => DEGREE_COLORS[degreeBin(d.k)], insetLeft: 1, insetRight: 1, ry2: 3, tip: {format: {fill: false}}, channels: {Labs: "n"}}), Plot.text(data, {x: "k", y: "n", text: (d) => d.n, dy: -8, fill: INK2}), Plot.ruleY([0], {stroke: AXIS}) ] }); } function topConnectors(rows) { const children = d3.rollup(responses, (v) => v.length, (d) => d.referrer); const top = rows.filter((d) => !d.board && listable(d) && children.get(d.id)).sort((a, b) => children.get(b.id) - children.get(a.id)).slice(0, 6); if (!top.length) return emptyNote(); return html`

${children.get(d.id)}
${labelOf(d)}
${!publicView || d.consent === "named" ? `${d.country} · ` : ""}${d.degree} ${d.degree === 1 ? "hop" : "hops"} from the board

`; }41:T5d0,const coverageCounts = d3.rollup(filtered, (v) => v.length, (d) => d.countryId); const blankSpots = countryFeatures .filter((f) => !coverageCounts.has(f.id) && (region === "All regions" || regionOf(f) === region)) .map((f) => ({name: f.properties.name, pop: POP_M[f.id] ?? 0})) .sort((a, b) => d3.descending(a.pop, b.pop) || d3.ascending(a.name, b.name)) .slice(0, 16); function coverageMap(rows, region) { const bins = publicView ? [COVERAGE_BINS[0], `Fewer than ${MIN_CELL}`, ...COVERAGE_BINS.slice(2)] : COVERAGE_BINS; const bin = (n) => (!n ? bins[0] : n < 5 ? bins[1] : n < 15 ? bins[2] : n < 50 ? bins[3] : bins[4]); return Plot.plot({ width: mapWidth(region), style: PLOT_STYLE, projection: projectionFor(region), color: {type: "ordinal", domain: bins, range: COVERAGE_COLORS, legend: true}, marks: [ Plot.geo(countryFeatures, Plot.centroid({ fill: (f) => bin(coverageCounts.get(f.id)), tip: {format: {x: false, y: false, fill: false}}, channels: { Country: (f) => f.properties.name, Responses: (f) => { const n = coverageCounts.get(f.id) ?? 0; return n ? fmtCount(n) : "0"; }, Status: (f) => { const n = coverageCounts.get(f.id); return !n ? "Blank: ambassador wanted" : n < 5 ? "Thin: needs a second push" : "Covered"; } } })), Plot.geo(borders, {stroke: "white", strokeWidth: 0.6}) ] }); }42:T67c,function rolloutCurve(rows, metric) { const sorted = rows.slice().sort((a, b) => a.submitted - b.submitted); const days = d3.utcDays(utc(2026, 8, 3), utc(2026, 10, 8)); const seen = new Set(); let i = 0; const data = days.map((day) => { const end = d3.utcDay.offset(day, 1); while (i < sorted.length && sorted[i].submitted < end) seen.add(sorted[i++].countryId); return {date: day, value: metric === "responses" ? i : seen.size}; }); const label = metric === "responses" ? "Labs responding" : "Countries covered"; const yMax = d3.max(data, (d) => d.value) * 1.12 || 1; return html`

${label}${Plot.plot({ width: Math.min(W / 2 - 20, 540) < 300 ? Math.min(W, 540) : Math.min(W / 2 - 20, 540), height: 250, marginTop: 26, style: PLOT_STYLE, x: {type: "utc", label: null, ticks: d3.utcWeek.every(2), tickFormat: "%b %-d"}, y: {domain: [0, yMax], grid: true, label: null}, marks: [ Plot.rect(PHASES, {x1: "start", x2: "end", fill: (d, i) => (i % 2 ? "#f4f3ef" : "#ecebe6"), fillOpacity: 0.8}), Plot.text(PHASES, {x: (d) => new Date((+d.start + +d.end) / 2), frameAnchor: "top", dy: -16, text: "name", fill: INK2, fontWeight: 600}), Plot.lineY(data, {x: "date", y: "value", stroke: GROUP_COLORS[0], strokeWidth: 2}), Plot.ruleX(data, Plot.pointerX({x: "date", stroke: AXIS})), Plot.dot(data, Plot.pointerX({x: "date", y: "value", fill: GROUP_COLORS[0], r: 4, stroke: SURFACE, strokeWidth: 2})), Plot.tip(data, Plot.pointerX({x: "date", y: "value", title: (d) => `${d.value} ${label.toLowerCase()}\n${d3.utcFormat("%b %-d, %Y")(d.date)}`})) ] })}

`; }43:T1a2d,function surveyForm() { const usa = countryFeatures.find((f) => f.id === "840"); const inputs = { institution: Inputs.text({label: "Institution name", placeholder: "e.g., Larkmoor University Hospital", width: 320}), country: Inputs.select(countryFeatures, {label: "Country", format: (f) => f.properties.name, value: usa}), type: Inputs.select(TYPES, {label: "Institution type"}), ap: Inputs.select(VENDORS, {label: "Anatomic pathology", value: "Cassandra Health"}), cp: Inputs.select(VENDORS, {label: "Clinical pathology", value: "Magrathea Labs"}), micro: Inputs.select(VENDORS, {label: "Microbiology", value: "Magrathea Labs"}), bb: Inputs.select(VENDORS, {label: "Blood bank", value: "Magrathea Labs"}), status: Inputs.radio(STATUSES, {label: "Switching status", value: "Implementing"}), newVendor: Inputs.select(VENDORS, {label: "New vendor", value: "Sirius Cybernetics"}), goLive: Inputs.select([2026, 2027, 2028, 2029, 2030], {label: "Go-live year", value: 2027, format: String}), announced: Inputs.radio(["yes", "no"], {label: "Are these plans public?", format: (k) => (k === "yes" ? "Yes: announced or under contract" : "Not yet: count them in totals only"), value: "yes"}), reason: Inputs.select(REASONS, {label: "Main reason"}), decider: Inputs.select(DECIDERS, {label: "Who decides"}), consent: Inputs.radio(CONSENT_LEVELS, {label: "How to show us", format: (k) => CONSENT_CHOICES[k], value: "named"}) }; const form = Inputs.form(inputs, { template: (i) => html`

Your lab

${i.institution}${i.country}${i.type}

Current LIS for each discipline

${i.ap}${i.cp}${i.micro}${i.bb}

Plans

${i.status}${i.newVendor}${i.goLive}${i.announced}${i.reason}${i.decider}

Visibility

${i.consent}

` }); const sync = () => { const s = inputs.status.value; const committed = s === "Selected" || s === "Implementing"; inputs.newVendor.style.display = inputs.goLive.style.display = inputs.announced.style.display = committed ? "" : "none"; inputs.reason.style.display = inputs.decider.style.display = s === "Stable" ? "none" : ""; }; // Keep keystrokes in the form from re-running the charts; only Submit does that. form.addEventListener("input", (event) => { sync(); event.stopPropagation(); }); sync(); const message = html`

`; const button = html``; const container = html`

${form}

${button}About 2 minutes. Demo only: nothing leaves this page.

${message}

`; container.value = []; button.onclick = () => { const v = form.value; const name = v.institution.trim(); if (!name) { message.replaceChildren(html`

Please enter your institution's name.

`); return; } const f = v.country; const country = COUNTRY_BY_ID.get(f.id)?.name ?? f.properties.name; const committed = v.status === "Selected" || v.status === "Implementing"; // Simulate arriving through the busiest referrer nearby: same country, else same region. const nearby = (test) => seedResponses.filter((d) => !d.board && test(d)); const local = nearby((d) => d.countryId === f.id); const regional = nearby((d) => d.region === regionOf(f)); const ref = d3.greatest(local.length ? local : regional.length ? regional : board, (d) => d.children); const record = { id: `NEW${container.value.length + 1}`, name, consent: v.consent, plansPublic: committed && v.announced === "yes", country, countryId: f.id, region: regionOf(f), type: v.type, lis: {ap: v.ap, cp: v.cp, micro: v.micro, bb: v.bb}, status: v.status, newVendor: committed ? v.newVendor : null, goLive: committed ? utc(v.goLive, v.goLive === 2026 ? 10 : 4, 1) : null, reason: v.status === "Stable" ? null : v.reason, decider: v.status === "Stable" ? null : v.decider, previous: null, board: false, wave: "Ambassadors", submitted: TODAY, referrer: ref.id, degree: ref.degree + 1, children: 0 }; container.value = [...container.value, record]; container.dispatchEvent(new Event("input", {bubbles: true})); const countryN = seedResponses.filter((d) => d.countryId === f.id).length + 1; const place = countryN >= MIN_CELL ? country : record.region; const appearAs = { named: `${name} will appear in the atlas by name`, unnamed: `Your lab will appear as ${articleFor(v.type).toLowerCase()} ${v.type.toLowerCase()} in ${place}`, aggregate: "Your lab will count toward the totals but won't be listed" }[v.consent]; const refLabel = ref.consent === "named" ? `${ref.name} (${ref.country})` : "a colleague's lab"; const plansNote = v.status === "Evaluating" ? " While you're evaluating, your plans count toward totals only." : committed && v.announced !== "yes" ? " Your plans count toward totals only until you tell us they're announced." : ""; const code = Math.random().toString(36).slice(2, 7).toUpperCase(); const link = `https://atlas.example.org/join?ref=${code}`; const copy = html``; copy.onclick = () => navigator.clipboard?.writeText(link).then(() => (copy.textContent = "Copied")); message.replaceChildren(html`

Thank you! ${appearAs}.${plansNote} Scroll up to see ${country} on the coverage map and your lab in the referral network.

You arrived through a link from ${refLabel}, so you are ${record.degree} ${record.degree === 1 ? "hop" : "hops"} from the Association board.

Your referral link${link}${copy}

Forward it to a colleague at another institution. Every lab they bring in becomes part of your branch.

`); }; return container; }44:[] 30:{"id":"ccdfdb089b94509a","slug":"lis-atlas","title":"Global LIS Atlas","thumbnail":"fc2f107a89767920997401c323df7040e1ea722698bb612d00c4462303db898d","access_level":"public","create_time":"$D2026-10-09T12:02:12.815Z","update_time":"$D2026-10-09T16:29:52.634Z","view_time":null,"first_public_time":"$D2026-10-09T12:04:58.902Z","has_unpublished_edits":null,"fork":false,"stars":0,"starred":false,"owner":{"type":"team","id":"e56d8fa96fa34192","login":"gershkovich","name":"","avatar_url":"https://avatars-next.observableusercontent.com/95607dcd24de81e48a9b731928bfedf2909587e365db643da966dfbb3055f131","tier":"starter_2024","bio":""},"version":286,"publish_version":286,"role":null,"authored":false,"authors":[{"type":"individual","id":"9f3052c8ed5ee8c4","login":"gershkovich","name":"","avatar_url":"https://avatars-next.observableusercontent.com/95607dcd24de81e48a9b731928bfedf2909587e365db643da966dfbb3055f131","tier":null,"bio":""}],"members":[{"type":"team","id":"e56d8fa96fa34192","login":"gershkovich","name":"","avatar_url":"https://avatars-next.observableusercontent.com/95607dcd24de81e48a9b731928bfedf2909587e365db643da966dfbb3055f131","tier":"starter_2024","role":"editor"}],"comments":[],"custom_thumbnail":false,"trashed":false,"lapsed":null,"subscribed":null,"forks":0,"collection":null,"type":"notebook","body":{"titling":"auto","title":"Global LIS Atlas","cells":[{"id":108,"value":"# Global LIS Atlas\n\n**An open, crowdsourced world map of which laboratory information system every lab runs, who's switching, to what, and when.** Published live on Observable and proposed to the Association.\n\n\n\nSource on GitHub: [OpenPathologyFoundation/lis-atlas](https://github.com/OpenPathologyFoundation/lis-atlas) · Live page: [openpathologyfoundation.github.io/lis-atlas](https://openpathologyfoundation.github.io/lis-atlas/) · Observable notebook: [@gershkovich/lis-atlas](https://observablehq.com/@gershkovich/lis-atlas)","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":109,"value":"$32","pinned":false,"hidden":false,"mode":"html","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":110,"value":"const disciplineInput = Inputs.radio(DISCIPLINES, {label: \"Discipline\", format: (d) => d.label, value: DISCIPLINES[0]});\nconst regionInput = Inputs.select([\"All regions\", ...REGIONS], {label: \"Region\"});\nconst typeInput = Inputs.select([\"All institution types\", ...TYPES], {label: \"Institution type\"});\nconst audienceInput = Inputs.radio(AUDIENCES, {label: \"Show as\", value: AUDIENCES[0]});\ndisplay(html`

${disciplineInput}${regionInput}${typeInput}${audienceInput}

`);\ndisplay(html`

The public view hides anything based on fewer than ${MIN_CELL} labs and lists labs only as their consent allows. How respondents are protected

`);\nconst discipline = Generators.input(disciplineInput);\nconst region = Generators.input(regionInput);\nconst instType = Generators.input(typeInput);\nconst audience = Generators.input(audienceInput);","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":111,"value":"html`

\n ${kpi(\"Labs responding\", fmtCount(summary.n), suppressed(summary.n) ? \"too few to show details\" : `from ${summary.countries} countries`)}\n ${kpi(\"Countries covered\", `${summary.countries} of 195`, `${195 - summary.countries} still blank`)}\n ${kpi(\"Changing LIS\", pctOf(summary.switching, summary.n), `${fmtCount(summary.switching)} evaluating, selected, or implementing`)}\n ${kpi(\"Go-lives scheduled\", fmtCount(summary.upcoming), \"Q4 2026 through 2030\")}\n ${kpi(\"Picking Sirius Cybernetics\", pctOf(summary.toSirius, summary.committed), `of ${fmtCount(summary.committed)} labs that chose a vendor`)}\n

\n ${breakdownChart(filtered, \"reason\", \"Reason\")}\n

Who drives the decision

\n ${breakdownChart(filtered, \"decider\", \"Decided by\")}\n ${decisionNote(filtered)}\n

`","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":122,"value":"## Upcoming go-lives\n\nEvery dot is one lab, placed in the quarter it plans to go live. ${fmtCount(summary.upcoming)} go-lives are scheduled between now and 2030, and ${pctOf(summary.toSirius, summary.committed)} of them are moving to Sirius Cybernetics. Hover a dot for the lab and its move. In the public view, the dots show only plans that labs say are announced or under contract, from labs that agreed to be listed.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":123,"value":"goLiveTimeline(filtered, discipline.key)","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":124,"value":"**Share of responding labs on the three largest vendors.** Solid lines cover past switches; dashed lines project forward from scheduled go-lives. The remaining labs run other systems.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":125,"value":"shareOverTime(filtered, discipline.key)","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":126,"value":"\n\n## Six degrees of the survey\n\nEach response arrives through someone's referral link, so the atlas also records how the survey spread. The Association sits at the center, linked to the ${board.length} board members who seeded the survey (dark dots with a ring). Every lab links to the colleague who invited it, and bigger dots brought in more labs. Hover a lab to trace its chain back to the board.\n\nThe median lab is **${networkStats.median} hops** from the board, the longest chain has **${networkStats.max} hops**, and **${pct(networkStats.withinSix, networkStats.n)}** of labs are within six degrees.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":127,"value":"referralNetwork(networkLayout, new Set(filtered.map((d) => d.id)))","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":128,"value":"html`

How far the survey traveled${degreeHistogram(filtered)}

Top connectors (labs referred)${topConnectors(filtered)}

Ambassador wanted (most populous countries with no responses yet; population in millions)\n

${blankSpots.map((d) => html`${d.name}${d.pop ? html`${d.pop}M` : \"\"}`)}

`\n : html`

Every country in this view has at least one response.

`","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":132,"value":"## Rollout\n\n1. **Pilot (Aug 3–24).** Association board and active members fill it in first, fix confusing questions, and seed the map so it isn't empty at launch.\n2. **LinkedIn wave (Aug 25 – Sep 14).** Leadership posts, members reshare, and everyone tags colleagues at other institutions.\n3. **Ambassadors (Sep 15 onward).** Regional ambassadors take ownership of their countries, and the blank areas on the map become the call to action.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":133,"value":"html`

${rolloutCurve(filtered, \"responses\")}${rolloutCurve(filtered, \"countries\")}

`","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":134,"value":"\n\n## Take the survey (demo)\n\nThis is the 2–3 minute survey. Submitting adds your lab to the charts above for this browser session only; nothing is sent anywhere.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":135,"value":"const submissions = view(surveyForm());","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":136,"value":"## The data\n\nEvery response the atlas shows, as a searchable table. ${publicView ? \"Labs that asked not to be named appear as their type and location, and \" + fmtCount(filtered.filter((d) => !listable(d)).length) + \" labs that chose totals only aren't listed. Switching plans show only where the lab says they're announced or under contract; elsewhere the plan columns read “—”.\" : \"Staff view: every response, with names, consent levels, and whether plans are public.\"}","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":137,"value":"Inputs.table(filtered.filter(listable).map((d) => ({\n Institution: labelOf(d),\n Country: placeOf(d),\n Type: d.type,\n AP: d.lis.ap,\n CP: d.lis.cp,\n Micro: d.lis.micro,\n \"Blood bank\": d.lis.bb,\n Status: planShown(d) ? d.status : \"—\",\n \"New vendor\": planShown(d) ? d.newVendor ?? \"\" : \"—\",\n \"Go-live\": planShown(d) ? (d.goLive ? quarterLabel(d.goLive) : \"\") : \"—\",\n Reason: planShown(d) ? d.reason ?? \"\" : \"—\",\n \"Decided by\": planShown(d) ? d.decider ?? \"\" : \"—\",\n Hops: d.degree,\n ...(publicView ? {} : {Consent: CONSENT_LABELS[d.consent], \"Plans public\": d.newVendor ? (d.plansPublic ? \"Yes\" : \"Not yet\") : \"\"})\n})), {rows: 14, layout: \"auto\"})","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":138,"value":"$33","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":139,"value":"## From prototype to live\n\n- **Survey.** Any form tool that exports CSV or has an API works (REDCap, Qualtrics, Google Forms). The referral link is a URL parameter (`?ref=CODE`) stored with each response.\n- **Data.** A scheduled data loader pulls the responses, removes names for labs that opted out, and publishes one cleaned CSV. The charts on this page read that file instead of the synthetic generator built into this notebook.\n- **Governance.** The Association owns the dataset. A small editorial group reviews new vendors and merges duplicates, and an open license lets members reuse the data.","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":140,"value":"$34","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":141,"value":"$35","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":142,"value":"const W = Math.min(width, 1100);\nconst mapWidth = (region) => (region === \"Latin America\" || region === \"Africa\" ? Math.min(W, 620) : W);","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":143,"value":"const world = fetch(\"https://cdn.jsdelivr.net/npm/world-atlas@2.0.2/countries-110m.json\").then((response) => response.json());","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":144,"value":"const countryFeatures = topojson.feature(world, world.objects.countries).features\n .filter((f) => f.properties.name !== \"Antarctica\")\n .sort((a, b) => d3.ascending(a.properties.name, b.properties.name));\nconst land = {type: \"FeatureCollection\", features: countryFeatures};\nconst borders = topojson.mesh(world, world.objects.countries, (a, b) => a !== b);","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":145,"value":"$36","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":146,"value":"$37","pinned":false,"hidden":false,"mode":"js","author":"$undefined","summary":"$undefined","providerMetadata":"$undefined","attachments":"$undefined","output":"$undefined","database":"$undefined"},{"id":147,"value":"const responses = [...seedResponses, ...submissions];\nconst filtered = responses.filter((d) =>\n (region === \"All regions\" || d.region === region) &&\n (instType === \"All institution types\" || d.type === 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