Electronic medical records (EMRs) and electronic health records (EHRs) are fast becoming the rage in physicians’ practices. For the clinical laboratory, using an EMR/EHR is a quick, easy, less error-prone way to send patient results to physicians. Laboratories, however, seem to be among the last to embrace this technology. We asked industry leaders to give us the current scoop on how well EMRs and EHRs have been introduced into laboratories and what the near future holds.
What can a physician do?
“Recent federal programs are increasing the pressure on physicians to get hands-on with electronic lab ordering, such as the recent Centers for Medicare and Medicaid Services (CMS) Signature Rule and the American Recovery and Reinvestment Act (ARRA) ‘EMR meaningful-use’ initiatives. This means that lab-outreach solutions must pay closer attention to the physician workflow. Often, the physician decides which lab to do business with — lab ordering/reporting software factors into that decision. From the physician’s perspective, usability translates into a few key questions: Is it easy for me to order lab tests without leaving my familiar EHR? Can my EMR automatically route the order to the right lab depending on my practice’s preference and the patient’s insurance? Whether using an EMR or a Web-based computerized physician order entry (CPOE) program, can I use the same order/review process, regardless of where the test will route? Do I have to spend precious minutes switching applications and navigating through different screens — instead of paying attention to my patient?
Lab managers need to consider this perspective carefully when assessing a new or existing lab-outreach system.”
—Pat Wolfram
Vice President, Marketing and Customer Services
Ignis Systems Corp.
Provider of EMR-Link for EMR/lab connectivity
The trends most travelled
“Two trends will continue over the next 24 to 36 months, each revolving around integration. The first trend is ARRA/Health Information Technology for Economic and Clinical Health Act (HITECH), which is driving increased demand for electronic integration between the EMRs and laboratory information systems (LIS). As we prepare for Stage 2 meaningful-use criteria, there will be an increased need for results in a discrete data format to be transmitted to public-health organizations, Health Information Exchange, and EMRs. The second trend is the evolution of diagnostic disciplines — clinical pathology, anatomic pathology, and molecular — becoming more integrated. Laboratory workflow is changing and has a huge impact on how information systems are being used and how they generate discrete information which must be communicated to providers to improve patient healthcare and reduce costs. Disseminating lab results for electronic integration and having products in place to simplify EMR integration for laboratories allows them to benefit from reduced costs and increased efficiency.”
—Curt Johnson
Vice President, Sales and Marketing
Orchard Software
Provider of Orchard Harvest LIS
HITECH requirements spur quick implementation of EMR interface
“Industry trends this quarter seem to be focusing on facing and overcoming challenges. The big focus is on meaningful use and reimbursements, which just became available as of January 2011.
Labs are trying to keep up with their clients’ adoption of EMRs. This results in many requests to interface their LIS to different systems. Depending upon the size of the lab’s customer base, that can literally amount to numbers in the hundreds.
The challenge of complex interface mapping schemes can be overcome by the adoption of testing standards, such as LOINC coding, which will help ease and speed the time to connectivity.
Keeping up with rapid adoption and the need to implement quickly has caused a backlog of implementations for even the largest EMR vendors, slowing down the process of their customers meeting HITECH Act requirements.”
—Brian Keefe
Clinical Marketing Director
Psyche Systems Corp.
Provider of LabWEB and EMR Internet Interface
Assembly-line streamlined, open-interface engine, fast setup time
“The wave of EHRs has approached our industry. Gone are the old days when interfaces were established for only large-volume clients. Now, clients of all sizes are demanding bidirectional EHR interfaces with support for rich report formatting and embedded images. Traditionally, successful interfaces were handled by expensive interface engines requiring large teams for implementation and support, and affordable only to large organizations. Today, laboratories cannot successfully market themselves without an appropriate interface strategy that includes smaller clients. We offer an efficient assembly-line mode of operation and a large library of existing interfaces to address this growing challenge. By utilizing a streamlined process and an open interface engine with a wide array of connectivity and formatting options, our company is reducing average setup time from months to weeks.”
—Suren Avunjian
Vice President, Business Development
LigoLab
Provider of diagnostic information systems and outreach solutions
Kickin’ it with connectivity
“While the old manner of reference-laboratory connectivity centered around the volume of tests for a given laboratory and justified only connections for the high-volume, send-out laboratories, we focused on a transactional model for reference-lab connectivity and opened the door for an electronic connection to all reference labs, independent of the volume of work sent. Via our laboratory clients, we are working with reference labs of all sizes to connect with a provider of one standard electronic connection for orders and results to both our EMR and LIS clients. With the change to a transactional model where the reference lab pays a small fee per order, the barriers to entry are lowered for both our clients and the reference labs for this connection. The cost of the interface now aligns with the work being done over that interface. While we are starting with our clients who need connections to reference labs, we will be extending this concept to include new clients. This type of connectivity levels the playing field for reference-lab interaction and provides the perfect platform for enhanced concepts such as auto-updating of test catalogs, smart routing of tests, and public-health reporting.”
—John David Nolen, MD, PhD
Director, Laboratory Strategy
Cerner’s Reference Lab Network
Provider of one standard connection, eliminating need for point-to-point connection
between acute labs to contracted reference labs
ACOs and PCMHs: population-based, patient-centric
“Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) are front and center in recent discussions regarding the new Patient Protection and Affordable Care Act — disproportionate to the mere seven pages afforded them within the legislation. ACOs and PCMHs hold the promise of delivering coordinated, integrated, quality care across the healthcare continuum, while controlling or even reducing costs. Slated for implementation in early 2012, they are part of a population-based approach that is, at the same time, patient-centric. CMS is still in the process of defining the criteria and measures for ACOs. It is clear, however, that this approach relies heavily on meaningful use of health information technology to ensure measurable improvements in the quality and efficiency of care. While most discussions revolve around transition of care, medication reconciliation, and similar issues, informed medical decisions and measures of improvement often involve clinical laboratory data. For effective use of lab results, discrete data — normalized by LOINC codes — is required. Thus, the ACO trend presents a great opportunity to accelerate the use of currently fragmented patient data in an aggregated, normalized, and meaningful way.”
—Gai Elhanan, MD
Chief Medical Information Officer
Halfpenny Technologies
Provider of clinical data-exchange solutions, including ITF-Hub and ITF-GoDoc
Orders in, chaos out
“Laboratories are facing an avalanche of demand for EMR interfaces. They are struggling with interface requests from physicians eager to satisfy ‘meaningful use.’ Point-to-point interfacing between laboratories and EMRs is still the norm. Often, each interface is a custom-coded project which is time consuming, expensive, and resource intensive. The current ‘handcrafted’ approach is not scalable and, unfortunately, the extended time does not guarantee quality. Labs and EMR vendors are outstripping their capacity to keep up, and the EMR-adoption rate is accelerating. The reality is that EMRs often do not support lab workflow to ensure labs get clean orders and get paid for delivering results. Labs face an enormous challenge to get the orders in and keep the chaos out. Today’s approach is inefficient for everyone. Labs and EMRs need to leverage technology to develop efficient methods of supporting sophisticated workflow that can be deployed in an ‘instant on’ network model. Increase in demand for connectivity is forcing traditional business barriers to fall away. We believe that the future of connected healthcare depends on making this happen.”
—Robert S. Gregory
Senior Vice President, Corporate Strategy
ATLAS Development Corp.
Provider of Atlas LabWorks, the ordering physician computerized order-and-results
delivery systems for connecting clinical laboratories and healthcare providers
Our nation’s commitment to a national electronic health record
“In 2010, the Centers for Medicare & Medicaid Services clarified the criteria that hospitals, physicians, and physician groups need to meet to qualify for the financial incentives being offered for establishing electronic medical records within their institutions and offices. These incentives are expected to drive double-digit growth in the EMR-software market, facilitating our nation’s movement to a national electronic health record. While most anatomic pathology (AP) labs will not be eligible for these incentives, AP labs will be expected to provide the ability to deposit AP reports directly into the EMR-software systems that their clients adopt. Most AP-software LIS vendors have the ability to establish an HL7 interface directly to an EMR or to an ‘interface engine’ which connects their AP LIS to multiple EMRs. This, however, can potentially be a costly endeavor to the AP labs and their clients since there may be charges from the AP- and the EMR-software vendors associated with the establishment of these interfaces. An alternative to HL7 interfacing would be for the AP-software LIS vendor to deposit AP reports directly into EMRs without an interface. In fact, a growing number of EMR systems support this simpler method for receiving patient records. This less costly alternative is not provided, however, by all AP-software vendors. Identifying the vendors that have this capability could result in a significant avoidance of costs to pathology labs when they are searching for a full-featured AP LIS, while at the same time, contributing to our national commitment for an electronic health record.”
—Wally Soufi
Chief Executive Officer
NovoVision
Provider of NovoPath, a complete platform for AP Laboratories
Healthcare IT and the Diagnostic EMR: IT’s getting personal
“New healthcare IT innovations — like the Diagnostic EMR — seek not only to improve diagnosis but also to bridge the gap between diagnosis and the proper treatment plan. The Diagnostic EMR delivers relevant disease-specific data and initiates workflows based on specific rules and parameters. This ensures that existing available data are actually leveraged and delivered to the caregiver as usable, real-world data throughout the care lifecycle.
Providing the integration of information and decision support is necessary for the development and management of personalized patient treatment plans — including genetics testing and family history. Patients, physicians, and labs all benefit from this diagnostic tool, which supports integration of information and decision support by eliminating ineffective treatments and inefficient workflows, thereby saving valuable time and money, all while leveraging data and best practices that already exist within the enterprise.
Robust integrated clinical pathology, anatomic pathology, and genetics software solutions are specifically designed for diagnosticians to correlate relevant disease-based results to patients’ genetic composition, allowing appropriate therapy. Rapid discovery of clinical evidence can now be corroborated with genetic profiles, giving doctors faster turnaround times in patient treatment. Furthermore, tissue and other patient samples can be stored in biobanking information systems and correlated with genetic information for future genetics research and discovery into personalized gene therapies.
We are seeing a move to a more open, patient-driven research process, and the embrace of a more research-driven clinical practice of medicine. As a result, the field of genetics is enabling researchers and clinical diagnosticians to develop new pharmacogenomic drugs and gene therapies to treat and — in some cases — cure hereditary and gene-related illnesses for which no treatment previously existed.”
—Gilbert Hakim
Founder and Chief Executive Officer
SCC Soft Computer
Maker of SCC’s Genetics Information Systems Suite
Lost orders, lost test — problems of the past
“In the near future, all laboratory and radiology orders and results will seamlessly flow to EHR systems at every physician office. Workflow problems of finding faxes, dealing with multiple copies of the same results, and all-too-common ‘lost order slip’ will dramatically ease. Even better, the orders and results will be available immediately when speaking with the patient at the point-of-care. Showing patients, for example, their trended data in an easy-to-understand manner will do more for getting them to recognize the importance of reaching their healthcare goals than just telling them to do so. The key in making this happen is having an open-source standard (e.g., LOINC), and an easy way to transmit this information between providers and their ordering facility to ensure that we are all speaking the same language and avoiding the ubiquitous ‘lost orders and tests’ in our current system.”
—Jonathan Bertman, MD, F(AAFP)
Founder/CEO
AmazingCharts.com
Provider of Amazing Charts EHR systems
EMR/LIS integration means error-prone cessation
“The federal government’s stimulus package as defined in the ARRA is surely stimulating the implementation of EMRs in physician offices and hospitals. Stage-1 criteria include 15 objectives for providers and 14 for hospitals. Then, five out of 10 objectives from a menu must be met. One of the 10 objectives is to document clinical-lab test results as structured data. This means that labs will need to get its laboratory data into the EMR, which is typically done via HL7 interface to the LIS. Many current customers are implementing EMRs and, therefore, are required to interface their LIS with the EMR. Pam Ansardi, a medical tech from Urology Centers of Alabama, states: ‘We were hand typing everything into our EMR. It was taking us at least two hours a day, and we were prone to typing errors. With an EMR/LIS integration, we were able to eliminate these errors, and the data was sent to the EMR instantaneously.'”
—Edward Nesbitt
Vice President, Laboratory Implementation and Support
Antek HealthWare — a CompuGroup Medical Company
Provider of LabDAQ with EMR/LIS functionality for reviewing lab results,
ordering lab tests, and managing patient records
Survey shows half of office-based physicians using EMRs
The results of a survey conducted by the CDC’s National Center for Health Statistics show that 50.7% of office-based physicians are using EMR/EHR systems, and 10.1% have “fully-functional” systems, which include features such as drug-interaction warnings, medical history, and guideline-based interventions. The study reveals 24.9% have “basic” systems, which include features such as capturing patient history and demographics, computerized orders for prescriptions, and the ability to view lab and imaging results.
