Ken Willett

Healthcare IT, integration, and making patient care better

Upcoming Changes in Data Requirements Will Challenge Laboratory IT Capabilities

Besides the onslought of new EHR installations that is resulting in a great increase in the number of connectivity requests for lab results, there are additional requirements coming from a variety of directions that will present further challenges to already stretched lab IT resources:

  • The ICD-10 conversion which was going to happen by 2013 has been pushed out to 2014 but will still require considerable work.
  • HHS is considering requirements for labs to send electronic results directly to patients.
  • Meaningful Use Stage 2 will require specific coding standards to be used (specifically ICD and LOINC). In Meaningful Use Stage 1, there were requirements for structured data but the actual code sets were unspecified. The Stage 2 requirements are still in process but a proposal has been publicized.
  • Meaningful Use Stage 2 may also require use of the Lab Results Interface (LRI) Implementation Guide developed as part of the ONC-sponsored Standards and Interoperability (S&I) Framework project.
  • New Regional and State HIE initiatives expect to receive lab results from labs; in addition public health reporting will become a stronger requirement for Meaningful Use.
  • The S&I project has now turned its attention to standardizing orders from EHRs, which has been a notoriously difficult area.
  • All of these standardization efforts are based on HL7 version 2.5.1, but most lab systems are still generating HL7 v2.3. Upgrading the HL7 version will require requalifying existing intefaces to the new standard level, and will depend on the HL7 capabilities of data partners (practices and HIE vendors).

A number of these initiatives have incentive funding or other funding sources directed to providers and hospitals as part of ARRA, but none of the funding is directed to independent labs (and little of it benefits hospital labs). In the meantime business pressures are increasing on labs. Hospitals are under pressure to reduce redundant testing and readmissions, and these will result in lower test volumes for hospital labs. Outreach and commercial lab business is under pressure from larger national competitors as well as new competitors (physician office labs and perhaps even drugstore chains).

Many labs continue to address data exchange with their customers via software packages purchased from their LIS vendor, coupled with add-on packages such as integration engines and LIS front-end products. This approach leaves the lab’s IT team to do much of the technical work of establishing secure communications, mapping formats and data from the lab system to a variety of EHRs, maintaining and upgrading existing interfaces, and providing technical support to practices. They may have the perception that outsourcing lab integration is expensive, but the combination of predictable costs, much more rapid response, and expertise in dealing with the variety of integration scenarios can result in substantial savings to the lab over the long run.

A successful lab integration relationship requires a partner with significant lab expertise in both orders and results; a scalable data distribution infrastructure; a variety of integration capabilities including web and mobile orders and results; and the implementation and customer support resources to understand the practice’s workflows and bring clients live quickly and predictably. And that partner is in a better position track and respond to the variety of standard activities impacting the lab.

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