Posted by: Nirpath
Interoperability and health information exchange, Lab Results, LIMS
Interoperability is increasingly recognized as necessary strategy for a high performing, effective health care system. State and national initiatives that use interoperability strategies have gained momentum with the passage of American Recovery and Reinvestment Act (ARRA) of 2009.
Some 70% to 80% of data contained in a medical record consists of Laboratory records and results and approximately 70% of clinical decision making is based on laboratory test results. Laboratory results are proving to be a critical data element for making Health Information Exchange (HIE) initiative successful, even though the policies guiding the result sharing creates its unique challenges.
The present way of Laboratory test result exchange: Physician writes down the tests to be carried on for the patient. Some write their NPI / UPIN or some notes miss the vita information. The patient searches for the nearest lab station and takes an appointment. The results are sent to the ordering doctor’s office by fax / mail. The results are scanned to the EMR and attached to the patient’s chart / documents for review. The test results discrete data items are keyed into the physician’s EMR manually.
The above business process has lots of disadvantages, not to mention data entry mistakes, patient care cycle. In electronic exchange form a lab requisition form is written by the provider on behalf of the patient and delivered (typically by the patient) to the lab draw station. The specimen is drawn and transported to the lab for analysis. The results will be transmitted electronically in HL7 standard to the ordering provider’s EHR system where they can be reviewed with the rest of the patient’s history, including past lab results. The discrete data can be directly sent to the EMR with the standard LOINC Codes and abnormal result alerts making it faster for a physician to prioritize the patient flow either manually or automating similar cases to the next level of alerting to the hospital staff electronically.
Similar data exchange process can be utilized to send data between multiple EMR systems or between a laboratory and a RHIO (Regional Health Information Organization) to give the patient the quality care and help in prioritizing patient flow in any hospital.
The implementation of such a system is very easy –
- Coordinating the communication mechanism with the diagnosis lab IT system on figuring out data delivery channel and mandatory data items required to identify a patient and provider.
- The Lab should have facility with interface engines to process the HL7 order messages and delivering HL7 result (ORU) messages – most of the time the results are either pushed or pulled by the EMRs using web services.
The EMRs parse the HL7 ORU message, LOINC codes then generate the PDF or report from the discrete result data and implementing the alert mechanism for different result types – normal, high, abnormal cases and mapping logics to the patient chart, document and other business processes.
From this simple automation, if we think on a larger scale – it not only automates physician’s process helping the patient receiving quality care, it also helps us getting one step closer to implement HIEs smoothly.