One of the most integral elements of clinical practice is the use of laboratory investigations for diagnostic and monitoring purposes. Ask any clinician what they need in an EHR and invariably; integrated laboratory data will top the list of desirable requirements.
When laboratory investigations are needed as part of a clinical visit, there are a number of steps in the process from the moment that the investigation is deemed necessary to the point that the result appears in the patient’s medical record.
At a high level, laboratory investigations go through an ordering phase and a reporting phase. When using an EHR, these two steps may occur either separately or in conjunction with one another. A paper-based workflow is as follows: The clinician completes a paper laboratory requisition, which is then given to the patient. Appropriate samples are taken (either at the practice or laboratory), labeled and processed. Results are collected and reported back to the ordering clinician via fax, mail or telephone if the result is deemed to be urgent. Each step is mission critical. A failure to correctly label, analyze or report on results could have dire consequences for the patient. Additional complexities relate to the fact that results can also be preliminary, final or amended. They can be copied to multiple individuals or locations and any changes or updates need to be reported to all individuals copied on the results as well as the ordering clinician.
When a practice uses and EHR, a lab interface is the piece of software that allows one system to talk to another system. A laboratory interface can be either uni-directional (allowing the lab to report the lab data directly to the EHR) or bi-directional (allowing the clinician to order the lab investigation and receive the reported data electronically in the EHR). In the case of uni-directional interfaces, the clinician must still order the lab investigation using a paper requisition. With a bi-directional interface, the entire process is electronic from the moment that the lab investigation is ordered to the time that the result appears in the patient’s electronic record.
In an ideal world, a single laboratory could complete every lab investigation with a seamless bi-directional interface to the EHR, however this is usually not the case. Most practices deal with more than one laboratory including local hospitals and private or state lab facilities. This results in a need for multiple interfaces, which are uni or bi directional. The result for the practice is that there is no single way to receive all lab test results. Complex workflows can result out of the need to manage paper and electronic requisitioning, paper and electronic reporting of results and manual data entry or scanning of paper results that arrived from non-interfaced labs.
While it is ideal to have an interface with all of the major labs your practice uses, this is frequently not possible either due to cost and/or technical issues. So it is important to come up with a strategy to deal with results from non-interfaced labs. Two ways to deal with these results are either to use a fax server (for results received by fax) or a manual scanner. Scanning is the easiest and cheapest solution but has several drawbacks. First, and most important, for those interested in using an EHR system for quality reporting/improvement, the data in scanned reports does not go in as structured data. This means that the results will not populate any of your EHR system’s flowsheats or data fields. As a result if you went to run a report on all of your diabetic patients with an HBA1C less than 8 you will either produce reports without any data or with data that does not include information contained in the scanned labs reports. Another option with non-interfaced labs is to have practice staff enter the results by hand. While this method gets the data into the system it is extremely expensive and is also prone to human error. The best option is probably a combination of scanning and manual data entry. Have staff enter results that are critical to your practice, such as HBA1Cs, and scan in the remaining information.
If you would like to add your thoughts or strategies for dealing with non-interfaced labs, click on the ‘Comments’ link below.
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.