To solve this problem, clinical laboratories can contract with best in class vendors that will put screens on orders and results that filter out inconsistencies
In recent weeks the Department of Health and Human Services announced that more than 50% of doctors and 80% of eligible hospitals would be using electronic health record (EHR) systems by the end of 2013. Although federal officials are celebrating this accomplishment, for the clinical laboratory testing industry, EHR adoption, at best, has been problematic and, at worst, is a financial burden.
Despite increased connectivity, clinical laboratories have had create interfaces between their laboratory information systems (LISs) and the EHRs of their client physicians and hospitals. The federal officials who designed the financial incentives foster meaningful use among all clinicians for EHR adoption, but have not reimbursed labs for the substantial time and expense needed to establish these interfaces.
Medical Labs and Pathology Groups Fighting Inconsistency of Many EHRs
And, even after building these interfaces, medical laboratories and anatomic pathology groups face inconsistencies in how different EHR systems generate lab test orders. This inconsistency requires more time and expense for labs to resolve when serving client physicians using different EHR systems.
“Even though EHRs and computerized provider order entry (CPOE) systems were designed to eliminate inconsistency in lab orders, almost counter-intuitively, these systems have exacerbated the problem,” explained Michele Judge, Senior Director of Clinical Services, for Emdeon in Nashville, Tennessee
As Many as 500 Different EHR Products Are In Marketplace Today
“Complicating the issue is the fact that the Office of the National Coordinator for Health Information Technology estimates that more than 500 EHR system vendors operate in the United States today, and many have different ways of managing lab test orders and lab test results,” she added.
Eric Reynolds, Vice President of Ambulatory and Clinical Services at Emdeon, agreed, saying, “It’s not unusual for a lab with many physician clients to connect to 20 different EHR vendors, meaning as many as 20 different requisitions coming into the lab for processing every day. Those different EHRs may or may not have all the clinical and billing information medical labs need to process every sample.”
Unwilling to create electronic requisitions for each lab their physician clients use, EHR vendors essentially replaced lab requisitions with generic requisition forms and called it CPOE, Judge added.
“At one time, clinical labs developed Web portals specifically to enable physician clients to order lab tests and get results electronically,” noted Reynolds. “But that changed with physicians adopted EHR systems, because physicians would prefer to use an EHR and not have to use a Web portal too. That means EHR vendors have essentially won the battle for the physicians’ desktops, and lab portals are dwindling in number and efficacy.”
Medical Laboratories Dealing with More Complexity
“For these reasons, CPOE has actually increased the complexity that clinical labs face when processing orders,” Judge added. “And, more widespread use of CPOE doesn’t mean labs save money either. Because each EHR and CPOE system is different, developing point-to-point connections to each one is so costly that labs get no return on that investment.
“One market response to the inconsistent way EHRs handle clinical lab test orders is the development of what some call a universal hub approach,” she continued. “Certain integration vendors are writing lab test order/result reporting interfaces with multiple EHR vendors. This makes it easier for clinical laboratories to build one interface to the hub and then connect multiple EHR products. However, it is still a point-to-point approach, and the extra labor is simply being done by the vendor at the end of the day.”
Building Lab Test Ordering/Results Reporting Inside the EHR
Reynolds notes that the latest technological approach, whereby integration vendors and robust lab ordering screens are actually inside their partner EHRs, offers the most promise to efficiently solving this interface conundrum. “By making all the lab test requisitions look virtually identical, these embedded screens essentially standardize all information needed for each order,” added Reynolds. “That means that the lab’s LIS can process orders quickly and accurately without the need for an operator to intervene or a customer service person to call the physician’s office with questions.”
Most importantly, this new technological approach does not require the logistical and financial resources that the aforementioned point-to-point or hub approaches require.
“These screens work in reverse too,” he added. “Therefore, physicians can see lab test results in a standard format regardless of which labs they use. Plus, if a lab wants to deliver specific content to its physicians, such as enhanced test information or phlebotomy optimization, these screens can do that regardless of the EHR system the physicians use.
How Clinical Labs Are Helping Doctors Meet Stage Two Meaningful Use
“Significantly, these systems help EHR vendors and physicians comply with stage two of the meaningful use rules, while making sure the labs can enforce their clinical and billing rules in real-time when the order is entered” concluded Reynolds.
Recognizing the importance of these issues for clinical laboratories, The Dark Report and Dark Daily have published a new white paper on these topics, “CPOE and Meaningful Use Stage Two: How the Adoption of Cloud-Based CPOE Can Ease the Burden of Satisfying Meaningful Use Requirements for Your Lab and Your Physicians.” The report is available as a free download by clicking here.
As more physicians and hospitals adopt EHRs and CPOEs, the stakes will increase for clinical labs and anatomic pathology groups. To perform ordered tests properly, labs need complete information on each electronic test requisition. Otherwise, they cannot submit clean claims to public and private health insurers.
For these reasons, the emergence of a class of vendors offering dual-pronged integration within EHR’s and to clinical laboratories is a welcome development in the lab-testing marketplace. Such clinical exchanges are an example of vendors stepping up to help clinical labs solve an expensive and frustrating problem associated with physician use of EHR systems.