What is the future impact of electronic health records on the LIS?

Aug. 1, 2011

It is clear that most reference laboratories will not be eligible for the American Recovery and Reinvestment Act (ARRA) incentives related to the Health Information Technology for Economic and Clinical Health Act (HITECH).

It is equally clear that other labs will be impacted by Congress’ 2009 passage of ARRA with HITECH’s broad requirements for adoption of health information technology (HIT) in an attempt to reduce healthcare costs, improve patient outcomes, and improve access to medical records under the Health Insurance Portability and Accountability Act (HIPAA) guidelines.

ARRA provided more than $19 billion in incentives for providers demonstrating meaningful use of HIT utilizing their certified electronic health records (EHR). ARRA has favorably impacted vendors specializing in software-program development that allows for capture, archiving, retrieval, and modification of individual healthcare information.

The Act has ramifications for U.S. anatomic pathology (AP) and clinical pathology (CP) labs and their clients. Independent pathology, hospital-based reference, and in-house specialty labs need to adapt. Electronic medical records (EMR) vendors have not developed a comprehensive LIS, which makes it incumbent on the provider applying for the financial incentive (your client), to prove his lab information is properly managed and contained in his electronic health records (EHR). AP and CP labs in competitive market areas have — or soon are likely to have — their clients insisting that the lab have the ability to receive electronic information from, as well as the capability of depositing structured data back into EHRs.

Check with your vendor to understand the capability inherent in your existing AP LIS. Some AP LIS vendors can inexpensively receive electronic requisitions and transmit structured lab data back to the care provider’s computer or EHR, perhaps the least costly alternative. Validate this capability with references before investing in upgrades to the existing system.

Often, interface development costs emanate from both the LIS and EMR vendors. One interface to one EMR could cost $10,000 to $40,000 (depending on the vendors). If an existing AP LIS system cannot transmit structured data via the Web, the lab may be forced to investigate the costly development of bidirectional LIS interfaces to each of its clients’ EMRs.

With a broad lab outreach program, such associated costs could be prohibitive. An alternative purchase is an interface engine; develop interfaces to the engine and send results through it to each client’s EMR — also costly and time consuming.

Last — and perhaps not the most costly in the long run — is to consider the purchase of an AP LIS that is certified as an EMR module. The criteria specific to the laboratory for certification as a module are:

170.302(h) – incorporate laboratory test results;

the capability of the EHR to electronically receive AP test results in a structured format and display results in human readable format and, incorporate results to a laboratory or patient record;

170.306 (g) – reportable laboratory results; and

the capability of the EHR to electronically record, retrieve, and submit lab test results containing LOINC codes in HL7 v2.5.1 format to public health and other agencies.

Consider an AP LIS that has a client-hosted core application (rather than Web-based one) as well as the capability to receive and transmit results inexpensively over the Web onto the lab-client’s unattended computers. (If the lab’s AP LIS has not been upgraded in the past few years, the capability of a few today’s AP LIS vendors may be a surprise.) This approach provides any lab the ability to support its clients’ efforts to comply with the meaningful-use criteria, and it could provide added features and functions to market to lab prospects or to defend the lab’s business from competition.

Several deadlines for a lab’s clients to qualify for financial incentives are approaching quickly, putting undue strain on labs providing clients the ability to demonstrate compliance to meaningful-use criteria.

A key date to keep in mind is Oct. 1, 2011, the last day for eligible providers to begin the 365-day window to demonstrate meaningful use of EHRs in fiscal year 2012 for incentive payments to 2015. Those clients eager to demonstrate meaningful use could earn up to $44,000 over the period of five years.

So, act immediately on these recommendations. It may not be too late for labs to help in their clients’ qualification processes. If providers decide not to adopt a qualified EHR system, there are penalties in the form of reduction of Medicare reimbursement payments. These reductions could range from a 1% in 2015 (second key date) up to as much as a 5% reduction in 2019.

The HITECH Act appears to be here to stay. Over the next several years, laboratory clients will need to comply and demonstrate meaningful use. Consider an immediate strategy to confirm that the lab’s AP LIS is going through the certification process or, at the least, can assist its clients in demonstrating meaningful use as defined by the HITECH Act.

Novice when it comes to EMR and EHR?

Marketplace vendors and laboratory consultants toss around the terms electronic medical record (EMR) and the electronic health record (EHR) as if people understand what the two acronyms mean.

The electronic medical record, or EMR, is used by healthcare clinicians and practitioners keeping track of all the details about their treatment of patients seen in their offices or in hospitals were they practice. The EMR is a collection of a patient’s medical history and serves as a legal record for his physician. The EMR may consist of other types of patient support, aside from examination data, like order entry, a pharmacy link, and order entry, just to name a few applications.

On the other hand, the electronic health record (EHR) belongs to the patient and allows patient input and access to care records from any and all healthcare delivery sites within his community, his region, his state, or his country. At this point, in the United States, an EHR will be part of a proposed national health information network. The EHR can only exist if the patient’s care professionals have an EMR that can support the exchange of information with the EHR. To date, that type of information exchange support is limited, not only patients but also to healthcare professionals.

Rick Callahan, VP of Sales and Marketing at Princeton, NJ’s NovoPath, has more than 30 years of sales and marketing experience, some 15 of which have been spent in the medical IT solutions niche directed toward pathology and radiology market segments.