Lab's HIE solution connects LIS to EMR and HIS

Dec. 1, 2009

ith the increasing adoption of electronic medical record (EMR) systems,
Winchester, VA-based Piedmont Medical Laboratory (PML) knew it needed to
find a secure and reliable way to interface with the various practice
management and EMR systems used by its physician practices. While many
larger national labs are offering connectivity services (e.g.,
electronic test ordering and results reporting) to their physician
practices, PML did not have the internal resources required to develop
and manage the integration process — a significant competitive
disadvantage that was resulting in revenue shortfall and potential loss
of clients.

“With more physician practices making the move
from paper-based records systems to electronic systems, physicians
expect to be able to easily access all patient information, including
clinical and pathology test results, in a central location,” says Joe
Skrisson, CEO of PML, an independent clinical lab owned by eight
hospitals and two pathology groups. “As a hospital-based regional lab
going toe-to-toe with the national labs, we quickly realized that to
remain competitive, we not only had to find a way to establish
interfaces from our laboratory information system (LIS) to the leading
physician EMR and practice-management systems but also achieve
connectivity with hospital information systems.”

Because clinical data is typically the largest
component of the EMR, its timeliness and accuracy are critical to the
physician decision-making process and to ensuring positive patient
outcomes. While establishing connectivity between the physician EMR and
LIS is crucial, Skrisson says, this is a daunting task due to the
numerous EMR systems available and their inherent lack of
interoperability. The difficulty is further compounded, he adds, by the
idiosyncrasies of each EMR vendor's implementation of the HL7 standard.
Because there is no one-size-fits-all solution, labs must develop
interfaces with physician EMRs on a case-by-case basis.

“One of our biggest challenges was that we did
not have the budget or infrastructure to support the development of the
multiple interfaces necessary to move lab data back and forth to our
various physician clients,” says Skrisson. “Although we had been using
lab order entry and results software, it did not provide us with the
functionality we needed. Ultimately, we wanted to be able to deliver
electronic laboratory results to physicians in real time.”

In particular, PML wanted to create a shared
lab-testing environment, which would require development of a multiway
interface between Piedmont's LIS, the hospital information system (HIS)
at one of PML's owner hospitals and PML's Web-based outreach software,
which the lab offers to physicians to enable them to electronically
order tests and receive results. The goal was to be able to split all
lab orders originating from the physician group into tests that could be
performed at the hospital and tests that needed to be performed by PML —
based on rules such as payer, test type, or time of test.

The orders would then be routed to the
appropriate destination; and, upon completion of testing, results would
be transmitted to both the outreach software and to Piedmont's LIS so
the patient could be billed. PML also hoped to be able to provide
physicians with a health information exchange (HIE) hub that would allow
them to view consolidated results from their particular EMR.

Utilizing flexible integration

keep up with the growing demand for connectivity, Skrisson realized the need
to find a vendor that would provide not only the HIE technology but also the
project-management skills required to address the lab's complex integration
requirements. PML invited multiple integration vendors to submit proposals
outlining their approach to the lab's connectivity challenges. PML then
asked selected vendors to complete a test project.

“We hoped to find a company that would really
take the time to assess the challenges within our operation and think
about innovative ways to address them,” says Joe Litten, technical
director at PML.

After a thorough evaluation, PML chose a
company's with a flexible integration platform and strong
project-management skills. Its HIE solution allows labs to integrate
with a wide variety of legacy information-management systems without the
need to develop costly and labor-intensive code-based interfaces or hire
additional IT staff.

Since a direct connection to a practice's network is never
established, the potential for security breaches is eliminated.

The implementation process commenced with an
on-site visit by the company's representatives to collect the necessary
information regarding PML's operations and existing IT infrastructure,
including software, hardware, and network configuration. The company
then defined and documented the project deliverables, and identified the
requirements and features of each of the associated components.

Next, a project team was assigned to PML, with a
project manager responsible for interacting with PML's physician
clients, as well as with the relevant hospital, lab, EMR and HIS/LIS
vendors. The team also consisted of technical analysts, development
specialists, and medical technologists who worked with the lab's
internal staff to develop and support the interfaces.

As individual deliverables were completed,
integration testing was performed. Upon completion of the development
tasks for all of the deliverable components, a final acceptance testing
round was performed and the solution was available for deployment.

“With so many parties involved, the integration
process was complex,” says Skrisson. “If a delay or a roadblock came up,
our vendor would reach out to the appropriate parties in an effort to
resolve the issues in a timely manner, although this was often
challenging due to the competing priorities of the many vendors with
whom we were working.”

To develop the multiple interfaces required to
establish connectivity between the internal legacy systems and external
systems in the physician practice and hospital with which PML was
working, PML leveraged the integration vendor's interface engine.
Functioning as an HIE command center, the interface engine is able to
securely capture, transform, map and route clinical data to a large
number of EMR and LIS systems. The Web-based architecture supports a
variety of data formats and standards, including HL7, XML, X12, DICOM,
delimited files, and structured print output. This versatility was key
for PML, since the systems with which the lab would be interfacing do
not adhere to a single standard.

Because there is no one-size-fits-all solution, labs must
develop interfaces with physician EMRs on a case-by-case basis.

Creating clinical-lab connectivity

Due to the number of interfaces being created and
the multiple data transactions that would be processed via the interface
engine, ensuring data security was critical. The integration vendor's
solution was deployed to create connectivity within the shared testing

The solution provides the file encryption and
security of a hardware VPN but can be installed quickly and does not
require networking expertise — simplifying implementation and
streamlining work flow for the lab's IT resources. In addition, since a
direct connection to a practice's network is never established, the
potential for security breaches is eliminated.

PML has collaborated with the integration vendor
to establish interfaces to multiple EMR and HIS systems used by its
physician clients, including Allscripts, NextGen, eClinical Works, and
DigiCharts. “This integration among disparate systems has enabled us to
more effectively manage the flow of lab test orders, results, billing
data, and health plan reporting,” Skrisson explains, “which has resulted
in improved operational efficiencies and an enhanced bottom line. In
addition, because the integration vendor hosts the interface engine for
PML, the lab has been able to minimize the costs, implementation time
frames, and work flow typically associated with interface development.

“Since PML is a regional, community-based
laboratory, we lacked the deep pockets of our national lab competitors,”
says Skrisson. “Therefore, we needed to define a strategy that would
afford the development of multiple clinical-data interfaces without the
associated cost and expertise of creating them in house.”

Through the HIE interface engine, PML's physician
clients are now able to order lab tests via a secure Web-based
interface. Orders are transmitted from the physician's EMR or the lab's
outreach software to PML's LIS, which retrieves the orders, routes them
and waits for the results. The data then is transmitted through the
interface engine to the EMR or outreach software and is also
electronically submitted to PML's billing company for processing. For
physicians connected to the HIE, all results are consolidated and
available in a common view from their EMRs.

“The key to success in creating clinical-lab
connectivity lies in making the interface process as seamless as
possible,” says Litten. “With the interfaces in place, we can now
quickly set up our customers for electronic order entry and results
reporting, enabling them to meet security requirements, while also
providing timely and accurate results to their patients.”

The key to success in creating clinical-lab connectivity lies in making the interface process as seamless as possible.

PML plans to develop a data repository of patient
results for use in future data-mining activities — for example,
providing health plans with utilization statistics. “We would also like
to use the repository to develop a disease-management strategy that
could be provided to physicians,” says Skrisson. “By interpreting
patient data for physicians and suggesting follow-up testing for certain
disease states, we will enable physicians to provide better and more
focused care.

“It is essential to be able to anticipate and
respond proactively to clinical data-exchange requirements,” says
Skrisson. “Physicians expect clinical and pathology results to be
delivered electronically to their patients' EMRs, and we are now able to
do that.”

Philadelphia-based Halfpenny Technologies
consulted with PML to produce the laboratory's solution.