Meaningful connections: Linking the LIS to EMR systems

Dec. 1, 2010

In an effort to take advantage of the financial incentives introduced by the HITECH Act, hospitals and physician practices are steadily making the transition to electronic medical record (EMR) systems. In fact, it is estimated that by 2015, approximately 350,000 physicians will have implemented an EMR system within their practices.

This wide-scale adoption of EMR systems brings with it new challenges for labs. In order to meet the legislation’s meaningful-use requirements, physicians require the ability to interface their EMR applications with their lab service providers’ laboratory information systems (LIS) for electronic lab test ordering and results reporting, as well as for public-health reporting. With more than 300 EMR vendors currently in the market, the large array of EMR platforms alone makes this prospect daunting for laboratory administrators.
Administrators must also ensure, however, that their LIS systems — many of which are older, legacy systems — can accommodate the transition to HIPAA 5010 in 2011 and the conversion from ICD-9-CM to ICD-10-CM the following year.

If labs are to remain competitive within this sea of change, it will become imperative that they find innovative and cost-effective ways to meet the technology demands of their physician clients.

Assessing the challenges

To help ensure that labs can meet HIPAA 5010 and ICD-10-CM compliance deadlines, the majority of LIS vendors will develop, test, and roll out updated software to their lab clients. These labs then must quickly get up to speed on the use of the new transaction types and code sets, and test not only their own LIS but also every other affected system within the hospital or lab. In cases where legacy systems are no longer supported, labs will have the added challenge of developing special interfaces that support the new transaction types and code sets. It will be crucial that these tasks are successfully accomplished if a lab is to continue to function effectively.

Adding to the perfect storm that labs face is the fact that, at the end of the day, all labs must also find a way to connect with the diverse EMR systems used by their physician clients. Unfortunately, the capabilities of EMR systems vary widely and many deficiencies exist, from an inability to distinguish between test codes from different laboratories … to the inability to collect and transmit third-party payer information so the lab can get paid … to the inability to accept discrete versus formatted results data. And, the list goes on.

Due to the meaningful-use criteria and reimbursement incentives, physicians will increasingly expect these connections from their service providers and, ultimately, choose those providers that can best address their needs. Accordingly, labs need to be at the ready with solutions that will enable them to compete.

Since most labs do not have sufficient IT resources or the in-house expertise to accomplish these tasks, they will naturally look to their LIS vendors or neutral third-party service providers to help them navigate the new requirements and build the functionality required by their physician clients.

While legacy LIS vendors may be capable, theoretically, of providing effective integration services, the implementation time frames associated with this approach can be lengthy — especially when considering the additional work that will be associated with HIPAA 5010 and ICD-9-CM to ICD-10-CM conversion — making it difficult for labs to keep up with physician demand.

IT consultants can also be employed to establish the required LIS to EMR connectivity. Consultants, however, ma lack infrastructure experience with the broad variety of available EMR systems and, therefore, encounter significant learning and technology curves when developing interfaces to systems with which they are unfamiliar.

As an alternative to these approaches, a growing number of labs are opting to employ middleware solutions offered by vendors who specialize in the integration of LIS and EMR systems.

Stepping into the middle of things

Labs choosing to go the middleware route should not only look at the vendor’s ability to create secure interfaces to a variety of physician EMR systems but also should make sure that the vendor has in place an integrated clinical data exchange platform, or “hub,” to facilitate the interface process and eliminate the need for point-to-point connections.

A hub model essentially provides a comprehensive lab clearinghouse that enables distribution of orders from any capable physician EMR system to any hospital or laboratory, and then delivers results into the EMR system, where the results are automatically indexed into the patient record. As a result, labs are not required to update interface specifications whenever a physician transitions to another EMR system or upgrades to a new version of their current system — significantly simplifying the integration process.

In addition, centralized hubs should be designed to provide universal requisition capability, thereby allowing the creation of multiple, or “split,” requisitions from the orders collected during a single physician EMR entry. This is important because most physicians utilize multiple labs and route test orders to different labs, depending on the patient’s insurance, type of tests required, and proprietary technology.

To address cases where a physician’s EMR system does not fully support clinical data exchange — ordering, for example — some middleware vendors offer labs the ability to implement Web-based portals that allow physicians to electronically submit lab orders and receive test results. Some of these portals can be integrated with a physician’s practice-management system, eliminating the need for duplicate entry of patient demographic and insurance information.

Taking it a step further still, middleware vendors should be able to provide multiple capabilities beyond clinical to EMR connectivity. They should also possess expertise in clinical data mapping and have an effective means of mapping laboratory data to the component level — for example, through a universal code translator that maps local test codes to the logical observation identifiers names and codes, or LOINC.

This is crucial, as LOINC is increasingly being used and required by registries within the public-health sector to satisfy meaningful-use requirements. In addition, as a part of their contractual processes with service providers, payers are starting to require results that include LOINC in combination with the associated financial transactions. Very few LIS systems are capable of storing and transmitting this data. Middleware vendors are well-positioned to provide this service when the need arises.

Going beyond the flow

In addition to the many challenges accompanying EMR system integration, laboratories will soon be called upon to navigate the challenges associated with the required adoption of HIPAA 5010 and ICD-10-CM. It is worth noting that while ICD-9-CM holds approximately 12,000 codes, ICD-10-CM utilizes in excess of 100,000 codes. Nearly all clinical and financial systems will be affected by the transition to the new standards and the update effort has the potential to rival that of “Y2K” more than a decade ago.

Compounding the problem is the rapid trajectory of EMR system adoption and the role of labs in ensuring connectivity to these systems, especially considering that an estimated 70% of the data within a fully populated EMR is laboratory data.

To remain competitive within this environment, labs must seek a strategic approach to connectivity that will not only enable them to address near-term concerns but also will solidly position them to meet future challenges.

Mitchell Fry is executive vice president at Halfpenny Technologies in Blue Bell, PA.


Frost & Sullivan, Ambulatory EMR Market, 2010.

Learn more: Read this month’s Washington Report, “IICC aims to connect labs and clinicians,”

Integrated health record
can show meaningful use

By Ravi Sharma

While several current EHR systems may not certify as EHR technology under meaningful use largely due to limitations of the client-server architecture, a new type of application — an “integrated health record” (IHR) — may include all components necessary to demonstrate meaningful use.

The IHR shares a common platform between its different components such as lab and radiology ordering and results, electronic prescribing, and hospital results and other documentation, making it easy to correlate a patient’s data and present it at the point of care. When combined with the ability to normalize data from multiple sources and easily access it over the Web, the IHR enables providers to benefit from a complete, patient-centered record that creates a unified, continuously updated view of each patient-care episode.

While the IHR can be used on its own, it also can be used to augment an existing EHR system by supplying connectivity. In addition, the IHR can be used for patient referrals and is capable of supporting the continuity of care document, or CCD, a standard format for data exchange among healthcare providers and health information exchanges. Interfaces with practice-management systems also allow the automatic transfer of patient demographic and insurance information to the IHR, making it seamless for providers.

The IHR utilizes decision-support tools to help physicians choose the appropriate tests, furnish complete information required, create necessary forms and labels, and transfer orders electronically. This helps to avoid errors and delays associated with handling paper orders. The entire cycle of processing orders and return of results is faster and more accurate. Nothing is ever lost, and every test is tied to the correct patient.

Another key component of an IHR is its ability to produce census-based access to hospital data for physicians using the same Web-based platform. An IHR utilizes integration techniques to enable physicians to view encounter-based patient charts for their patients from any location at any time. Moreover, a truly patient-centric IHR uses a master patient index with a record locator to collect all regional data on a patient from multiple providers, if the proper authorizations are obtained.

What this means to the practicing physician is that it is possible to assemble the actionable data needed to make informed medical decisions quickly, because the IHR offers a patient-centric chart that incorporates data across multiple organizations to give physicians a complete view of the patient health record.

Ravi Sharma— is president and CEO of 4medica.