The Paperless POL

Tips to laboratory data integration are revealed

By Steward Macis

A great number of physician office laboratories (POLs) are still operating without a data management system. This results in numerous hurdles for those practices, such as increased human resources costs, the challenges of manually organizing and mining data and disseminating laboratory test results in an efficient and formatted report.

Jumping Hurdles

Most POLs encounter the same issues as hospital-based laboratories, which range from effectively mining laboratory data to distributing this data in a secure and efficient method. Getting the laboratory results to the appropriate person in a timely fashion is a key factor for the success of the POL.

The first hurdle, therefore, is getting the data from the clinical analyzers to a data management system. Without an interface from the analyzers to the management system, a significant amount of manual data entry is required.

Data Management Issues

In most cases, POLs use a laboratory information system (LIS) as their data management system due to the comprehensive features and functionality specific to the needs and operations of a laboratory. However, the data management system could also be the electronic medical record (EMR). Key issues must be addressed when choosing the appropriate path of data integration for your practice.

The type of testing performed in your laboratory, for example, will guide you toward the solution that best fits your integration needs. Will your POL be performing tests used for screening, diagnosing or the monitoring of patients?

The speed in which results need to reach the doctor or patient also is a consideration of the most effective data integration path. In many cases, doctors are able to deliver test results to a patient during a routine office visit.

If you are considering the EMR path, the following questions and concerns must be addressed:

• Can your EMR directly connect to your laboratory instrumentation?

• Does the EMR application provide the basic laboratory tools needed to address quality control (QC) and many of the standard operating procedures required to license your laboratory practice?

• Can the EMR execute actions based on diagnostic rules established by the practice?

  In many cases, middleware is required to achieve data integration from the laboratory analyzers to the EMR. Essentially, middleware provides messaging services that allow different applications to communicate, or the systematic "tying together" of disparate applications.

The EMR Path

Also of importance is the connectivity of the EMR system. The EMR must be able to comply with industry standard HL7 interfacing. Items to be considered, therefore, are:

• Can the EMR communicate with your billing system?

• Can the EMR interface with regional reference labs?

• Does it differentiate the send-out reference lab orders from the in-house test orders?

If your EMR does not comply with HL7 standards, make sure the vendor has the technical expertise to modify the software to communicate with other vendors. You don't want to place your practice inside a box with no ability to communicate with other software applications.

The LIS Path

If you choose the LIS path, be sure to investigate the communication capabilities of the LIS. For example, can it send billing information to the billing system? Can it accept orders from an EMR and send results to an EMR?

Also ensure that the LIS can exchange data via HL7 messaging protocols. If the LIS has experience in this area, check vendor references to get a better feel for the vendors' capabilities. If the LIS of choice does not have a great deal of experience in HL7 data exchange, it doesn't necessarily mean you must rule them out, but you should be more aware of the system's communication capabilities before moving forward.

Verify, too, that the LIS has experience interfacing with most of the industry's standard clinical laboratory analyzers and delivers a comprehensive QC package. Consider the different ways you want to disseminate data in your practice and measure the LIS's communication capabilities, specifically:

• Do you fax or e-mail results routinely?

• Do your clinicians use the Web frequently and would they benefit from a Web portal that allows them to review results via the Internet?

• Do your physicians prefer having reports printed to remote printers?

Be sure to assess your needs and fit the right LIS to those needs. The best case scenario is a marriage of both the LIS and EMR. This is the most comprehensive and cost-effective solution a POL can choose. The integration of these two systems will have the greatest return on investment. Taking on a project like this can be very challenging but delivers great rewards. See the accompanying Table for helpful advice.

Proceed With Caution

As you proceed down this road, consider implementing one system at a time. It can be overwhelming to the practice to implement both, as learning two new software systems at the same time could be counter-productive.

In most cases, it is best to implement your LIS first, then proceed with the EMR. The majority of data in the EMR comes from the laboratory and plays a significant role in patient care and safety. Once the LIS is in place, validated and the staff is fully trained, proceed with the EMR implementation. The rewards your practice will realize will be experienced through better workflow, improved data deliverability, better healthcare by elimination of transcription errors and improved profitability via practice efficiency.

The last thing to consider is the ability of the LIS and EMR to integrate with your reference laboratory. Most POLs utilize a reference lab so they can offer a more comprehensive menu of tests for their patient population. In the absence of an LIS or EMR, the logistics of sending sample orders and receiving results is a labor-intensive, manual process.

The reference lab interface can be accomplished three ways:

1. EMR/reference lab interface,

2. LIS/reference lab interface or

3. MR/LIS/reference lab interface.

Research each scenario and decide which one benefits your practice. You have an opportunity to greatly improve workflow with a comprehensive bi-directional reference lab interface. Make sure both your LIS and EMR can accommodate an HL7 bi-directional reference lab interface.

In the best case scenario, your system will have the ability to place in-house or reference lab orders in the EMR, electronically forward orders to the LIS, then send orders from the LIS to the reference lab. Once testing at the reference lab is completed, the LIS will receive results and disseminate them to the EMR. With this interface, your providers can view both reference lab and in-house lab results in the EMR and the laboratory professionals can review the in-house and reference lab results in the LIS. Not all regional reference labs have the ability to communicate via HL7 messaging, so you will need to determine if your vendor has the technical ability and resources to accommodate this more complex interface.

Moving your practice to a paperless environment is the safest and most secure and effective way to integrate your lab data. You will decrease the cost of healthcare and benefit through a better managed and more efficient medical practice.

Steward Macis is director of Products and Support Services, Antek Healthware.

Tips to Successful Evaluation, Implementation of Data Management Systems

Form a committee and designate a project manager.

Involve staff in your practice from all relevant areas in the evaluation.

Allocate sufficient time for research and implementation.

Consider the change in workflow and how it will affect patient care.

Document goals for integration for each vendor.

Keep in constant contact with both the LIS and EMR vendor to ensure smooth implementation of both products.

information/courtesy Steward Macis