Docs Want EMRs to Match Lab Orders and Results

Physicians become more sophisticated in how they use EMRs to advance clinical care

CEO SUMMARY: At a national EMR users meeting, physicians indicated a growing interest in having their EMRs do more than electronically accept lab test results. On the want list are direct electronic ordering of lab tests and automatic matching of lab test orders and lab test results. Physicians are rapidly learning how to use EMRs to boost their productivity and generate operational efficiencies and cleaner claims that are paid quicker.

UPON IMPLEMENTING ELECTRONIC MEDICAL RECORD (EMR) SYSTEMS in their practice, physicians invariably approach their laboratory to request an electronic interface for transmitting laboratory test results directly into the EMR.

“That has consistently been true, but now physicians have begun to ask more of their laboratory provider,” stated Pat Wolfram, Vice President of Marketing and Customer Services for Ignis Systems Corporation, in Portland, Oregon. Ignis Systems helps independent labs and hospital laboratory outreach programs provide bi-directional electronic test ordering and lab test reporting integrated within the EMR workflow of the physician. “Now physicians want to electronically order lab tests and they want their EMR lab-interface systems to match lab orders and results seamlessly.

“Today, few EMR systems do both of these functions well,” Wolfram explained. “Physicians want EMR systems that, by design and function, support the way the physician practices medicine. The EMR must handle all functions, even the most complex, in ways that compliment and enhance the clinical and operational flow in the practice.”

These developments are based on Wolfram’s participation in a national meeting of EMR users which took place in Chicago last month. “This meeting attracts users of General Electric’s Centricity EMR—some of whom have used this EMR for more than 10 years,” he said. “It’s a great place to identify emerging trends in how physicians use EMRs.”

Informal Survey Results

“During my presentation, I polled the physicians in attendance and determined that 95% required direct electronic reporting of lab results as part of their EMR implementation,” noted Wolfram. “Notably, about 30% of respondents have more than one lab sending electronic results directly into their EMR. These results are telling.

“Next, there was high interest by physicians to enable electronic lab test orders directly from the EMR and to have lab test orders automatically matched with test results,” continued Wolfram. “This is for three reasons.

“First, when both orders and results match, the physicians are guaranteed to have a patient identification match and a physician identification match,” explained Wolfram. “This step is accomplished without manual intervention and the associated additional costs of staff time. That intervention is needed when, in the absence of an electronic order, the paper requisition is manually keypunched into the lab’s LIS, and simple spelling mistakes are made. A paper result is forgiving when this happens since a nurse will take the result off of the printer/fax and file it manually, recognizing the intended patient name. An electronic system (EMR) is less forgiving because it needs a match.

Second Benefit To EMRs

“The second benefit to electronic matching of lab orders and lab results is that the system automatically updates the test status, which further increases efficiency,” noted Wolfram. “Up until now, physicians had to manually ‘complete’ all test orders in the EMR. Once you close the order loop, you know which order was completed. That’s a significant benefit for physicians because they have to track the results of every test they order.

“A third important reason physicians want an EMR to initiate orders is for accurate and automated routing and billing. Insurance or location-based routing will always send the tests to the right test provider,” he explained. “As a physician, if I have a pass-through billing arrangement with one of my labs, I want the system to route tests to that lab as a preferred lab. Further, it should send an HL7 billing message to my practice’s practice management system, automating my billing process.

ABNs Handled By EMRs

“Physician groups associated with hospitals also want EMRs to handle advanced beneficiary notices (ABNs) to help ensure that providers will get paid,” added Wolfram. “If the EMR system doesn’t handle ABNs well, then there is a risk the provider will not be paid for a lab test—usually when there is no
diagnosis on the lab test order. Attendees at this EMR conference who cared most about having an EMR that can handle ABNs were those who represent hospitals and clinics together. If there’s no ABN, then the hospital often ends up writing off the loss. Conversely, if the EMR handles ABNs well, there may be incentive packages to the physicians if they abide by rules and have clean claims throughout the year.”

Wolfram’s observations demonstrate why physicians are rapidly becoming more sophisticated in how they utilize EMRs. These software systems can expedite the flow of clinical services and improve the productivity of the physicians and their office staff. For that reason, physicians place a high premium on the ability of their laboratory service provider to support electronic ordering of laboratory tests and direct reporting of lab results through the EMR.

Certified EMRs Must Handle Electronic Lab Orders in 2009

“Currently, the Certification Commission for Healthcare Information Technology (CCHIT) has certified 32 different EMR products,” said Pat Wolfram, Vice President of Marketing and Customer Services for Ignis Systems Corporation, in Portland, Oregon. “In 2009, CCHIT certification standards will require an EMR to be capable of electronically handling laboratory test orders.”

“This requirement may reduce the number of EMRs that are certified by CCHIT,” predicted Wolfram. “During 2006 and 2007, CCHIT set the bar relatively low for certification. That made it easier to qualify as a certified EMR. However, because of the complexities of supporting electronic lab test ordering, along with other criteria, there could be a reduction in the number of EMR systems which meet CCHIT certification requirements.”


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