Many goals and challenges exist to achieving and maintaining a successful, profitable laboratory outreach program. Some of these include:
• maintaining efficient, effective operations;
• maintaining regulatory and accreditation compliance;
• staff satisfaction;
• timely access to management operational and financial data;
• competitive pricing with value added; and
• maximizing revenue and profitability while maintaining high levels of quality, service and fostering client loyalty.
Connectivity to physician's electronic health/medical records EHRs/EMRs and/or practice management systems (PPMS) is widely recognized as a key element in a successful lab outreach program. Laboratories wish to incent clients to order tests from their laboratory and make it easy to "do business with their lab." Physicians are incented both monetarily and from a productivity standpoint to use their own EHR/EMR or PPMS as the "gateway" to and from laboratories. The easier it is to set up and use the connectivity to your laboratory information system (LIS), the greater chance that the physician will send more testing to your laboratory.
Today's Communication Standards
Just a few years ago, Web connectivity via a unique "lab portal" was deemed sufficient; but today, direct two-way communications between an LIS and EHR/EMR/PPMS has become the de facto standard.
A user survey study conducted by Washington G-2 (now G2 Intelligence) in 2009 indicated that hospital/health system laboratories, independent laboratories, physician office laboratories already using bi-directional communications with clients via the Web responded overall that:
• their expected payback of their connectivity investment would be less than 5 years (69%);
• major revenue gains were primarily from new business with new clients (68%);
• Web connectivity helped sales and marketing get new clients (46%);
• results reporting was the most common service provided (65%);
• physician lab order entry was being used (42%); and
• the most common benefits were improved client retention (36%) and fewer phone calls (34%).
In 2009, the main reasons cited by laboratories for not using the Web for client connectivity were "too costly" or "not in the budget." Since the EHR incentive/meaningful use programs monetary allocations were established, there has been a veritable tsunami of connectivity implementations. Also, since 2009 major strides have been taken to improve all aspects of laboratory-client integration and system-to-system connectivity. Emphasis has been on new or improved products, a concentration on direct two-way communication between LIS and physician EHRs/EMRs/PPMS, easier inter-system interfacing and improved communications standards.
What do physicians expect from this office-to-laboratory link? They wish to deal with only one system and one way of doing things. Acceptance will require quick, easy setup at little or no cost. Flow sheet views, test order catalogs, test information (including handling and routing) and custom lists should be available. Operations should be "transparent" and transactions and displays should appear to the user as their own EHR/PPMS.
As well, there should be only a single test order list, tests should be routed automatically to the appropriate testing laboratory and results should be incorporated into the EHR/PPMS standard reports or flowsheets.
On the Market
Many systems and services available today provide lab-physician office connectivity. Vendors include most LIS systems companies and Atlas, Bostech, CareEvolve, Halfpenny, Ignis Systems, Lifepoint, Laboratory Data Systems, Mitem/Blue Iris, 4Medica, among others. Of the 23 vendors offering connectivity between the laboratory and its clients, 18 provide remote Internet software-as-a-service (SAAS) at a fixed or transaction-based monthly fee.
A recent major movement is to provide laboratory connectivity to physicians' mobile devices, including iPhone, iPad, Android, Blackberry and other PDA devices. Services provided on a mobile basis include:
• lab order entry,
• inbox presentation of lab results,
• AP reports,
• radiology reports and clinical messages,
• on-the-go lab results,
• visual and audio alerts of critical values,
• ready-to-view results,
• physician configurable alerts and result filters,
• HIPAA-compliant security model,
• dynamic result value trending,
• the ability to add physician notes to test results and
• secure forwarding of test results.
New Standards, Resources
Although integrating with the EMRs of outreach clients is rarely easy, certain resources are emerging to help with the process. One impediment to proliferation of LIS to EHR/PPMS inter-operability has been the lack of definitive standards dealing with laboratory data interchange, e.g., ordering and resulting, in ambulatory EHR settings. A new standard addressing that need is ELINCS, for EHR-Lab Interoperability and Connectivity Specification. Based on the HL7 version 2 messaging protocol already in use at many healthcare enterprises, it standardizes the formatting and coding of electronic messages exchanged between clinical laboratories and ambulatory electronic health record (EHR) systems. ELINCS is an example of a clinical data standard-an agreed upon set of rules that allow information to be shared and processed uniformly, thereby providing a common language for patient care. Adopting these standards helps healthcare providers interoperate with their outreach laboratory vendors more quickly, easily and cost effectively. As such, ELINCS helps bring lab-to-EMR interfacing closer to a "plug-and-play" process.
In collaboration with healthcare providers, software vendors, commercial laboratories, health information organizations, government agencies, professional associations and nonprofit organizations, the California HealthCare Foundation (CHCF) sponsored the development, testing and enhancements of ELINCS. The ELINCS standard for lab result reporting has been adopted by Health Level 7 (HL7), the internationally recognized standards development organization for health information. HL7 has assumed responsibility for the ongoing maintenance and further development of this standard. CHCF is completing the ELINCS standard for lab test ordering, which is scheduled to be available for implementation later this summer.
Achieving Desired Outcomes
Some of the projected benefits to physicians of efficient electronic interchange of laboratory data to and from their EHRs/EMRs/PPMS include:
• Improved practice efficiency. Eliminates the need for physicians or office staff to send paper lab orders, manually enter lab data, scan paper lab reports or track down missing results.
• Easier implementation of EHRs. Reduces the time and cost required to build electronic interfaces between lab information systems and EHRs.
• Improved quality of care. Allows clinicians to compare results over time, graph trends, identify patients requiring interventions and prevent unsafe or unnecessary treatment.
• Faster delivery of test orders and results in a reliable and cost-effective method. Helps prevent errors and reduces costs.
• Achieve meaningful use. Enables physicians to more easily incorporate structured lab data into their EHRs.
A number of prominent EMR vendors, such as eClinicalWorks and Epic, have already adopted the ELINCS standard for receiving test results. Interfacing with practices that use these EMRs can be simpler for labs that have also adopted ELINCS. Currently, these labs include Quest Diagnostics and LabCorp, as well as a number of hospital and clinic labs. CMS is considering a requirement that EMRs use ELINCS for lab result processing as a criterion of its meaningful use incentive program for outpatient physicians.
If your outreach program doesn't incorporate LIS to client EHR/EMR/PPMS connectivity to most of your largest clients, your laboratory is at risk. Even if such a system is already in place, it will be worthwhile to investigate approaches to more easily and quickly connect to any new EHR/EMR/PPMS that your prospects may be using.
Dennis Winsten is president of Dennis Winsten & Associates, Inc. (DWA)., a healthcare systems consulting firm specializing in LISs in Tucson, AZ (www.dwinsten.com, email@example.com). He also is an ADVANCE editorial advisory board member.