Connecting your LIS and EHR

Feb. 1, 2012

The integration of laboratory data with other departments has undergone a major evolution over the last decade. It was not long ago the interaction between the lab and the outside world was performed on paper requisitions, with lab reports being faxed, couriered, or mailed to the provider. Laboratory Information Systems (LIS) were originally designed to organize data by communicating directly with analyzers. The first commercial LIS were introduced and developed in the 1980s by clinical analyzer manufacturers. These first-generation systems were housed in the laboratory on a single centralized computer. They provided greater lab productivity and functionality, as well as the first automated reporting capabilities. Labs immediately realized an increase in efficiency and accuracy and an easing of regulatory compliance.

Even with these successes, administrators quickly recognized the inefficiencies and additional costs of having separate islands of information that did not speak to one another. Valuable time was wasted entering redundant patient information in different systems. Lab managers wanted the laboratory to have the ability to receive demographics and send charge information to the billing or practice management system electronically.

Electronic health records

Thus, the next phase of the evolution occurred with the creation of Electronic Health Records (EHR), initiating a new workflow. Electronic health records were designed to collect health information about patients in electronic format so information could be shared across the healthcare continuum. The shared data featured a range of information that may have included, but was not limited to, demographics, billing and insurance information, medical history, medication and allergies, immunizations, laboratory test results, radiology images, and vital signs. It served as a complete patient record of medical encounters and provided increased patient safety through evidence-based decision support and quality outcome reporting. Administrators expected the LIS to act as a central hub. They wanted the lab to receive orders and send laboratory results to the EHR, send orders to the reference laboratory (if the tests were not performed in-house), and then receive the results from the reference lab. These reference lab interfaces allowed the LIS to have virtually all patient results accessible for comprehensive analysis and to forward directly to the EHR. Figure 1, featuring CompuGroup Medica’s LabDAQ product, shows these interfaces.

Figure 1.

If the efficiencies in lab result access and reduced transcription time and errors were not sufficient to drive connectivity in physician offices, the American Recovery and Reinvestment Act of 2009 (ARRA) has certainly made an impact toward this connectivity. ARRA, which is commonly referred to as the “stimulus package” and was signed into law by President Obama on February 17, 2009, included the Health Information Technology for Economic and Clinical Health Act, also known as HITECH. HITECH allocates $19 billion to physicians and hospitals that demonstrate “Meaningful Use” of certified EHRs. This stimulus act provides incentive money for physicians to adopt certified EHRs and meet meaningful-use requirements. The goal of “Meaningful Use” is to improve patient care processes and outcomes.

Meaningful Use (MU): EHR incentive program

The Centers for Medicare and Medicaid Services (CMS) determines what constitutes a “meaningful user,” while the Office of the National Coordinator for Health Information Technology (ONC) defines what constitutes a “certified system.” See Figure 2.

Figure 2.

For those providers who meet requirements for Medicare, there is $44,000 in stimulus money available over a five-year period. For those providers who meet requirements for Medicaid, there is $63,750 available over a six-year period.

The MU programs are being presented in a phased approach and are being deployed in three stages as follows:

In order for facilities to meet requirements for Stage 1, there are 15 “Core Objectives,” five additional “Menu Set Objectives” from a set of ten objectives, and six total “Clinical Quality Measures.” While storing laboratory data is not part of the 15 “Core Objectives,” it is part of the “Menu Set Objectives.” An electronic interface between the LIS and a certified EHR will qualify a facility for a “Menu Set Objective.” To satisfy the lab results Menu Set Objective, a minimum of 40 percent of clinical laboratory test results must be incorporated into an EHR as structured data.1 In order to incorporate laboratory results as structured data, the LIS must be interfaced to the EHR. Incorporating the lab results as structured data is not required in Stage 1, but it is proposed as a core (required) measure in demonstrating “Meaningful Use” in Stage 2:

LIS and EHR Integration

According to an article recently published by David Blumenthal, MD, MPP, and Marilyn Tavenner, RN, MHA, in the New England Journal of Medicine, “Every year, around seven billion samples are tested in U.S. laboratories alone. It is a critical part of the diagnostic process, contributing to 70 percent of all medical decisions that are made.”2 Deploying an EHR without capturing laboratory data would be like trying to make a diagnosis with only 30 percent of the diagnostic data. In today’s physician’s office lab and clinic environment, the traditional methods of paper requisitions and printed lab reports are still employed. We are seeing a trend in the adoption rate of EHRs by clinicians to practice more efficient medicine and attain the Meaningful Use stimulus dollars. The IDC Health Insights completed a report in November 2011 that predicts the market for ambulatory EHRs will grow significantly in the coming years, moving from less than 25 percent adoption in 2009 to more than 80 percent by 2016.3 With the increasing adoption rate of EHRs, it is safe to say that LIS interfaces to EHRs will be in high demand for some time to come.

Establishing an interface

Fortunately, there is an industry standard specification that defines the format of data between multiple software systems to facilitate this dialogue. This specification, called Health Level 7 (HL7), is a major step to successful data sharing. However, the LIS-to-EHR interface is not a turnkey solution. A substantial amount of project management and testing is involved before an interface can go live. The CompuGroup Medical Laboratory Division has a dedicated systems integration team that manages those interfaces. The team is responsible for reviewing the workflow of each project by working with clients and EHR vendors to implement, validate, and train end users for each interface. This provides a comprehensive implementation process and facilitates the success of each project. When interfacing an LIS to the EHR, data workflow must be defined during the planning stages.

Consider the following questions before implementation:

  1. Networking/configuration: Is the LIS already part of the existing network, and how will the file transfer occur on the network?
  2. Procedure/workflow: Will my current workflow be altered, and how?
  3. Orders: Where will the orders be placed? Which system will barcode the specimen?
  4. Triggers for sending data: When are the results to be exported to the EMR?
  5. Implementation: Are the interfaces in sequence or combination? Is there a test environment?
  6. Quality Assurance: How will I validate the results in the EHR before releasing them to the providers?

Direct access to lab results in your EHR means improved patient safety, increased efficiency, and improved quality of healthcare in your facility. This initiative has pushed the LIS beyond its initial design. It will be interesting to see where technology takes us over the next 30 years.

Jim Kasoff’s experience in healthcare spans 25 years and includes several years as a laboratory administrator using LabDAQ Laboratory Information System. He also served as a Chief Operating Officer for a multi-site office practice with 56 physicians. He joined CompuGroup more than 10 years ago as the Director of Products and Services and is currently President of CompuGroup Medical’s Laboratory Division.

References

  1. Rasanen M. Specimen tracking: helping prevent misdiagnosis. Leica Microsystems. June 2011.www.leica-microsystems.com/?id=3621. Accessed December 23, 2011.