Ken Willett

Healthcare IT, integration, and making patient care better

Monthly Archives: October 2012

Lab Orders and HIEs

A recent posting on Michigan Health Connect indicates that while this state-wide HIE is handling 820,000 lab results per month, it is only handling about 5000 orders per month. This 160-fold disparity highlights the issues with trying to use HIEs for bidirectional lab communications.

Lab results distribution is a relatively straightforward problem for an HIE. The format standards are relatively mature, and technology exists for routing data through a network to the correct ordering provider, based on identifiers in the message itself. The results may or may not be mapped to a standard vocabulary; many EHRs have not made this a requirement for lab data. However, with LOINC adoption increasing, result code mapping will also become a straightforward exercise.

Standardizing orders is much more difficult, because it’s not just a data routing and formatting problem. Most EHRs don’t create a complete order that’s ready to send to the lab. And many legacy Lab Information Systems don’t accept unsolicited inbound orders, because they require manual patient registration before the order can be accepted.

Meaningful Use Stage 2 will at least require the EHR to be able to record the ordered tests in the patient chart. Many EHR vendors who are new to lab orders will probably limit their development to that basic capability; there are too many other conflicting priorities with MU2, ICD-10, and other mandatory requirements.

Recording the requested tests and associated diagnoses, as part of a patient’s assessment and plan, is only the first step in the ordering process. The remainder of the ordering workflow of capturing billing data, patient status at the time of the draw, specimen collection or scheduling, and transmission of the order to the lab require additional user actions beyond the basic order capture. This is complicated by order splitting requirements, routing to multiple labs based on insurance rules, future and standing orders, etc.

Well-designed lab ordering systems can greatly increase the electronic order-to-result ratio. Electronic orders not only make operations more efficient for the lab, but they greatly simplify the tracking and reconciliation process of orders at the practice. Some lab hub vendors have shown that the combination of good ordering workflow support and these operational efficiencies can raise the electronic order ratio to 60-70% or higher.

These ordering efficiencies are not going to result from an HIE alone. At best the HIE can provide the necessary communications link from the ordering system to the lab. And until there are certification requirements around generation and transmission of complete lab orders, it is unlikely that more than a few EHR vendors will create robust ordering solutions. Until that time, lab ordering applications that bridge the gap between the EHR and the HIE are likely to persist.