Massachusetts CPOE, MountainStar, PAML, HCA, Ogden Regional Medical Center, HIPAA 5010, LabCorp, Mubadala Health, KLAS


EARLIER THIS YEAR, Massachusetts passed a law that requires all hospitals in the state to implement CPOE (computerized physician order entry) by 2012. The same law requires all hospitals in the state to adopt electronic medical record (EMR) systems by 2015.

There are 73 acute care hospitals in the state and only 13 currently have some form of CPOE in place. However, several of Massachusett’s main academic centers have been national leaders in establishing CPOE within their institutions. Thus, the major attention will be on how community hospitals find the money and resources to comply with this mandate.

The law was passed with the help of a broad coalition of stakeholders. The coalition included the Massachusetts Hospital Association and the Massachusetts Council of Community Hospitals. A study by MassTech and the New England Health Care Institute projected that potential annual savings from use of CPOE should be in the range of $2.7 million per hospital. The study noted that CPOE systems cost a hospital about $2.1 million and the costs of operating such systems run about $435,000 per year. Based on these numbers, it is estimated that hospitals will recoup their investment in CPOEs in about 26 months.

Once most hospitals in Massachusetts comply with this mandate, experts will be watching to see how CPOE improves patient safety and whether CPOE contributes to improved patient outcomes. At a minimum, widespread use of CPOE in Massachusetts hospitals will require physicians to accept the need to use a computer to place orders. That may help laboratories in the state by encouraging more office-based physicians to personally utilize electronic ordering of laboratory tests.

More interesting will be the fact that widespread use of both CPOE and EMR systems in acute care hospitals in Massachusetts is likely to generate a large volume of accurate data, collected in real time. This data will allow researchers to evaluate which treatment pathways are associated with better patient outcomes. In turn, that may lead to a large number of new evidence-based medicine guidelines.


AFTER JUST MONTHS IN OPERATION, the laboratory joint venture in Utah between MountainStar Health and PAML has already expanded. On October 31, 2008, it was announced that 239-bed Ogden Regional Medical Center (ORMC) had become part of MountainStar Clinical Laboratories, LLC.

That’s a sign that the laboratory outreach joint venture between MountainStar (a health system owned by Hospital Corporation of America [HCA]) and Spokane, Washington-based PAML has enjoyed a solid start. Administrators at Ogden RMC must have recognized the financial, operational, and community benefits of the lab outreach JV.

MountainStar Clinical Laboratories formally launched operations earlier this year. Two of MountainStar’s eight hospitals were first to participate in the joint venture. They are 297-bed St. Mark’s Hospital of Salt Lake City, Utah, and 116- bed Lakeview Hospital of Bountiful, Utah. PAML contributed its laboratory operation in Salt Lake City to the joint venture. (See TDRs, December 10, 2007 and March 3, 2008.)

Because HCA is a for-profit hospital corporation, it is likely to be keeping a watchful eye on the financial success of this lab joint venture. Thus, one consequence of the MountainStar/PAML pairing is that it may prove to be a business relationship that HCA finds useful to introduce into other cities where it operates multiple hospitals.


IT WAS AUGUST 22, 2008 when the federal Health and Human Services (HHS) Department published proposed rules to adopt updated HIPAA standards. Included were proposals to transition to HIPAA transactions version 5010 because the current version (4010) is incompatible with ICD-10.

In the proposed rules, HHS established April 2010 as the implementation date for use of version 5010. Implementation of ICD-10 is proposed for October 1, 2011. If the rule is published without amendment, that means laboratories and pathology groups will have just 16 months to prepare for implementation of HIPAA transactions version 5010.

For this implementation to succeed, lots of work must be done by payers and the Medicare program. The Blue Cross Blue Shield Association recently pointed out that “Version 5010 is a major re-write of the HIPAA transaction standards, with more than 850 individual changes.”


HERE’S A CLEAR SIGN of the internationalization of laboratory testing services. On November 4, 2008, Laboratory Corporation of America announced that it had agreed to participate with Mubadala Healthcare to establish the National Reference Laboratory in the Emirate of Abu Dhabi.

Mubadala Healthcare is a subsidiary of Mubadala Development Company and its sole shareholder is the Government of the Emirate of Abu Dhabi. Thus, LabCorp is partnering with the government to establish a state-of-the-art laboratory capability in the Emirate.

The objective is to establish a laboratory facility that will centralize lab testing services for the Emirate. It will provide routine, reference, and esoteric testing. Currently, Abu Dhabi sends some reference and esoteric tests to Europe and other countries.

Earlier this year, THE DARK REPORT traveled to Riyadh, Saudi Arabia, to participate in a pathology conference and visit several laboratories in the region. Flush with petrodollars, countries in the Gulf Region are spending heavily to improve healthcare services for their inhabitants and create the necessary infrastructure.

This is happening in the Emirates, like elsewhere in the region. However, Abu Dhabi and neighboring Dubai also have ambitions to become major players in global medical tourism. Expect to see Abu Dhabi announce more relationships and affiliations with leading healthcare providers and academic health centers as it works to achieve this goal.


HOSPITAL LABORATORIES CURRENTLY ASSESSING THE NEED to upgrade their laboratory information system (LIS) or purchase a new LIS might be interested in a new report expected to be published by KLAS Research of Orem, Utah, during November.

KLAS is preparing what it calls an “LIS perception report.” The focus of the KLAS report will be on the question of whether a “best of breed” LIS can be interfaced and function as effectively in a hospital as an LIS which is fully integrated with other hospital data systems. KLAS recognizes that laboratory directors tend to select “best of breed” LIS solutions, while hospital CIOs generally prefer enterprise (integrated) LIS solutions.


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