Laboratory professionals are well-versed in how lab analyses are performed, how test results are reported, and the interpretation of test results, in providing quality patient care. Consequently, laboratory professionals can be valuable resources to Eligible Hospitals (EHs) and Eligible Providers (EPs) attempting to meet and attest to Meaningful Use Stage 2 objectives.
The Centers for Medicare and Medicaid Services (CMS) published a final rule in September 2012 that specifies the Stage 2 criteria that Eligible Providers, Eligible Hospitals, and Critical Access Hospitals must meet in order to continue to participate in the Medicare and Medicaid EHR Incentive Programs without receiving penalties in the future. All providers must achieve Meaningful Use under Stage 1 criteria before moving to Stage 2. Early adopters may begin collecting data for Stage 2 requirements as soon as October 1, 2013 for attestation in fiscal year 2014 for EHs and CAHs or calendar year 2014 for EPs.
New Goals Under Meaningful Use 2
From Stage 1 to 2, there are two major impacts that affect the lab and change the nature of EHR lab connectivity, according to Gai Elhanan, MD, MA, Chief Medical Information Officer, Halfpenny Technologies. First, clinical lab tests ordered by EPs or EHs entered into certified EHRs as structured data as a Stage 1 optional menu item will now be a mandatory core item under Stage 2. In addition, the threshold for compliance was raised from 40 percent to 55 percent. Second, computerized provider order entry (CPOE) became mandated for laboratory and radiology orders for both EPs and EHs with a threshold of 30 percent.
Additionally, Eligible Hospitals can choose an optional menu item option that requires their laboratories to provide structured lab results to the ordering ambulatory provider for more than 20 percent of electronic lab orders received. EPs can choose a menu item option that requires electronic submission of syndromic surveillance data to public health agencies.
While it is not mandatory for every laboratory to participate in the electronic exchange of laboratory results, those that do under Meaningful Use Stage 2 requirements will send them to certified EHRs that must be compliant with the new HL7 2.5.1 standards and able to accept LOINC® and SNOMED CT®.
Challenging Business Implications
Laboratory professionals who take an active role and perform a readiness assessment of their capabilities to work with EHs and EPs attesting for Meaningful Use Stage 2 can help to solidify their lab's position in the marketplace.
"Meaningful Use places a burden on all laboratories, whether or not the laboratory is eligible to receive MU incentive dollars as part of an Eligible Hospital," said Andrea Pitkus, PhD, MLS(ASCP)CM Senior Laboratory Informatics Consultant, College of American Pathologists (CAP) Consulting division. "If they're performing outreach testing for EPs and EHs, they're going to be asked to provide LOINC and SNOMED CT codes for their clients who want to attest. If they're not prepared, some providers or hospitals may take their business elsewhere."
In order to begin business discussions, laboratory professionals must know their hospital's overall timeline for completing their planning and testing for Stage 1 and Stage 2 Meaningful Use. Reference labs who serve multiple hospitals and clients will need to keep track of several timelines.
MU attestation data, including laboratory test results, can be collected 90 days prior to Meaningful Use 2 attestation. The earliest facilities may start collecting data for Stage 2 is October 1, 2013. Consequently, all LOINC and SNOMED CT coding necessary for attestation needs to be completed before then. Furthermore, LOINC and SNOMED CT encoded laboratory results need to be received by a 2014 certified EHR for Eligible Provider attestation and from a 2014 certified version of a hospital LIS and/or EHR for Eligible Hospital attestation. Upgrades to 2014 certified versions of EHR or LIS products by that date will likely be needed.
"The earlier they can start LOINC and SNOMED CT encoding, the better," Pitkus said. "If you're a small lab, you might have one person working on this; if you're a large medical center with thousands of items on your test menu, it might take more time, and you will need more resources."
Take the Community's Connectivity Pulse
Administrators of laboratories with outreach programs also should investigate the current level of integration and interoperability that is desired by their community, Elhanan suggested. For example, if health information exchanges (HIEs) and accountable care organizations (ACOs) are forming in the area, then EHR lab connectivity and the need for standardized data likely will be an immediate priority.
"As Meaningful Use becomes more popular in a sense, and more providers are jumping in, there will be an increased demand from your lab and your hospital organization to provide the connectivity that comes with it," Elhanan said.
Laboratory directors first must assess their laboratory information systems and IT department's capabilities. "Many old legacy LIS's will need to do new tricks," Elhanan said.
"If your community and your needs mandate that you need to deliver LOINC codes for your lab results, and your LIS cannot even allow you to store them, then what do you do?" Elhanan asked. "You either have to have a middleware solution or upgrade your LIS." And the latter is not an easy task, he said, because it can be expensive and disruptive.
Elhanan estimates nearly 80 types of LIS systems are in use today that will need to function with a wide variety of certified EHR products, most of which do not have an "out of the box" lab connectivity option for the ambulatory lab results provided by thousands of small community hospitals and independent labs throughout the country.
Laboratories in some areas can consider partnering with HIEs as a connectivity solution. Under this type of arrangement, a lab only has one connection to the HIE, which then can deliver the laboratory test results in the correct data format to its member providers. In a similar fashion, labs can build into one interface offered by a company that has middleware or cloud-based solutions, which eliminates the need for labs to establish a tangle of EHR connections on their own. "It simplifies the IT requirements and lowers the cost, if you don't have the bandwidth," Elhanan said.
Education Helps Ensure Labs Are Ready
"From a laboratory staff training perspective, any type of continuing education in healthcare informatics, the importance of mastering LOINC and SNOMED CT, and how vendors' laboratory information systems operate will be beneficial," Pitkus said. Not only can laboratory professionals use this knowledge to help expedite EHs' and EPs' initial attestation for Meaningful Use, but their expertise will be in continuous demand as LOINC updates are released and new instrumentation and methodologies are introduced or retired.
"Who in the laboratory is going to champion mapping laboratory results currently, and laboratory orders in the future, as well as maintain and update their maps to codes in future releases of LOINC and SNOMED CT which may be a better fit to their tests?" Pitkus asked.
The Lab Interoperability Cooperative (LIC), a partnership with the College of American Pathologists, the American Hospital Association, and Surescripts, has been creating such champions through a grant opportunity that extended into this year. The LIC provided education from the hospital laboratory perspective focusing on LOINC terminology and mapping skills which laboratory professionals can apply to Meaningful Use objectives. The LIC has supported more than 1070 hospital labs across the country through live workshops, recorded sessions, and other resources freely available on the LIC website.
Laboratory directors, well versed in Meaningful Use and the available technology to help meet the new MU requirements, should have a seat on their facilities' Meaningful Use committees to provide their unique insight about the complex lab order entry and results workflow process. Future Meaningful Use stages will continue to raise the bar for EHR laboratory connectivity, and laboratory professionals' knowledge and skills can be the stepladder.
Sharlene George is a former ADVANCE staff member.