CEO SUMMARY: A growing number of laboratories have implemented Web-accessed lab test reporting for their office-based physician clients. Having participated in the design, sale and installation of many of these systems, Cory Fishkin gained valuable insights into the “do’s & don’ts” of Web-accessed lab test results reporting. In this first of several features, Fishkin identifies eight “must have” features.”
USE OF THE WEB BY PHYSICIANS to access laboratory test results is becoming more common throughout the United States and Canada.
“It should come as no surprise that Web-accessed lab test results reporting is an easier service to implement than Web-accessed lab test ordering,” said Cory Fishkin, President of the newly-formed Mostly Medical, Inc., based in New York.
“For that reason, Web-accessed lab test results reporting systems between labs and their physician office clients are more common than Web-accessed lab test ordering systems,” he added. “I believe this will continue to be true into the near future.”
Fishkin is intimately familiar with the market for Web browser-based systems for lab ordering and results reporting. He’s worked at a number of companies that pioneered such systems. Most notably, Fishkin was part of Abaton.com prior to, and after its acquisition by McKesson, Inc. (formerly called McKesson HBOC).
Now in his own consulting practice, THE DARK REPORT asked Fishkin if he would share his experience and insights on the subject of Web-accessed lab test ordering and results reporting. This first installment deals with the “must have” features for Internet-based lab test reporting systems.
Future installments will address order entry “must haves,” pricing arrangements, contracting strategies, and how physicians and their staffs react to these products. These briefings will provide clients and members of the Dark Intelligence Group with insider knowledge about issues that will help them make informed decisions.
Since most labs chose lab test reporting as the first Web-based service to implement, this series starts by looking at the functions that such systems should offer.
“Because these types of software systems are still new, labs must be careful to match the unique needs of their physicians’ office marketplace with the right product,” stated Fishkin.
POL Test Data Entry
“For example, many of the products offered by LIS vendors will not allow a physician’s office to enter POL lab test data into the system,” he explained. “Yet several of the connectivity vendors offer this feature. If many of the lab’s clients do lots of in-office testing, this capability may give the lab a competitive edge in that market.
“Based on my experience with labs to date, I believe there are eight ‘must have’ functions for an effective Web-accessed lab test reporting system,” Fishkin added.
“First on my list is the ‘inbox’ function. Basically, this presents, in one screen, all the test results received since the doctor last logged on,” he observed. “A well-organized inbox function is critical. Its primary benefit to doctors and their staffs is in preventing things from getting lost.
“A good inbox permits sorting by all factors: criticals, abnormals, stats, type of test, date, time, doctor, and more,” said Fishkin. “The inbox feature should allow fast toggling between the master patient list and individual patient results.
“It should also allow the physician to create an e-mail note and distribute it to his staff,” he added. “This avoids the sticky notes on charts and reports. This is also a feature demanded by physicians. As a result, about 75% of the lab test reporting systems now offer this feature.
Fast Screen Refresh Rates
“Number two is the system’s ability to perform within the unique setting of the individual physician’s office,” Fishkin stated. “The primary gauge of this is screen refresh, which should take no longer than eight seconds. If it takes longer than that, both doctors and their staffs will simply not use the system to its full potential.
“I must stress the importance of performance. There are studies which document the fact that, if people must wait more than eight seconds to get to the next step, they will stop using that method and seek a faster way,” explained Fishkin. “Also, if it takes too many screens to actually access test results, this discourages people from regularly using the system.
“So performance is critical. Some lab test reporting systems require broadband Internet access, like cable or DSL, to deliver acceptable screen refresh rates,” he said. “For labs in metropolitan areas like New York or Los Angeles, this might be okay. But in areas where most doctors’ offices use modem dial-up, that same system may not be acceptable.
“By the way, in the evenings, when doctors are dialing in from their homes, they tend to be more tolerant of slower systems than when they use it in their office,” added Fishkin.
“My third ‘must have’ function is the ability to deliver CLIA-compliant lab test reports,” noted Fishkin. “The lab industry has a definition of a legal, hard copy test report. Yet a number of Web-accessed lab test reporting systems currently available in the market cannot meet this requirement. You want to look for a system which has this capability. It should also be able to deliver an exact copy of that report in the future (without changing important information like the patient’s name if it changes because of marriage, etc.).
Fishkin’s List of “Must Haves”
HERE ARE THE EIGHT FUNCTIONS which Cory Fishkin, President of Fishkin Consulting Associates, identifies as “must haves” for a successful Web-accessed lab test reporting system.
1. Ability to function speedily in a physician’s office environment with a fast screen refresh rate.
2. “In-box” which is well organized and allows sorting by categories such as criticals, abnormals, type of test, patient, etc.
3. Ability to deliver CLIA-compliant test reports which meet legal requirements and can be re-accessed in the future without change.
4. Cumulative test reporting.
5. Ability to enter and store results of tests performed in the doctor’s office, including POL interface capability.
6. Interpretive clinical information for physicians and patients; protocols for physicians.
7. Data base search capability that permits searching across all patients for specific test results and other attributes.
8. “Ease of use” as defined by intuitive screens, simple-to-execute functions.
Three classes of Vendors Offer Web Reporting Products
“IN THE LAST YEAR OR SO, vendors marketing Web-accessed lab test resulting systems have cleaved neatly into three categories,” commented Cory Fishkin, President of Mostly Medical, Inc.
“The first category is made up of the big healthcare information companies and LIS vendors,” he said. “These include companies like Cerner, Sunquest, McKesson, and the like.
“The second category are connectivity firms, aiming exclusively at the lab test ordering and results reporting market,” explained Fishkin. “Examples of these companies are Atlas Development Corporation, LabDat.com, Labtest.com, LabPortal.com, and others.
“Companies offering electronic medical record (EMR) systems have functionality for lab test reporting, but they are still building a market for their products and don’t have lab intensive experience for order entry,” added Fishkin. “That leaves home-grown lab solutions that may work only in the lab setting they were designed to serve.”
“The other reporting capability which is essential is automatic printing,” he added. “The system should periodically retrieve the currently available test results and print them out. This feature is a major issue for browser-based systems. Because a browser works in a thin client setting, generally it can’t tell a personal computer what to do. A separate software program must be installed on the PC’s hard drive to perform this function.
“Cumulative reporting is the fourth essential function,” declared Fishkin. “In my experience, this is the sizzle feature which impresses the doctors. However, once the test reporting system is installed, only a relatively small number of physicians actually use this feature in practice. But these doctors will use it continually and, over time, other colleagues in the office will begin to use this feature. With the growing emphasis on improving test utilization and disease management programs, I predict this will become a much more important function over time.
“Number five is compatibility with physician office laboratories (POLs),” he commented. “At its simplest, this involves a screen which allows the doctor’s lab tech to enter data from tests such as urine dipsticks and PTs. But it can also involve a direct interface with the information systems of larger POLs.
“The objective is to merge the physicians’ office test results so that the doctor only has to go to one place to see all the lab results on his patients,” Fishkin said. “This eliminates the paper jumble in the medical charts and brings a consistency to the test results which physicians quickly come to appreciate.
“I should point out that providing this lab data capture feature for POL testing may trigger legal and compliance issues,” added Fishkin. “Labs should do proper legal due diligence before offering this type of service to physicians’ office clients.
“The sixth ‘must have’ function is interpretive clinical information,” he noted. “Both doctors and patients should have appropriate information, accessed by hyperlinks from the lab test reports. If lab testing protocols are used by an organization, having them integrated into the application is a big plus. Don’t underestimate consumer interest in their lab tests nor the growing number of physicians who want fast access to relevant clinical information about the tests they are ordering.
“Number seven is the ability of the system to search across patients,” noted Fishkin. “For example, can I find all patients with a total cholesterol over 250? Which patients have not been tested during the past two years?
Physicians Will Use it
“A number of Web-based lab test reporting systems are beginning to promote this capability,” he explained. “How- ever, I believe that once physicians have this tool, they will use it. It will keep patients from slipping through the cracks in a busy practice and will allow physicians to identify patients who are appropriate for clinical trials. I also think laboratories which are first to offer this feature will have competitive advantage in the marketplace.”
“I saved ‘ease of use’ for the last of my eight ‘must have’ functions,” noted Fishkin. “I define this in a very specific way. For the doctor and his staff, the browser-based reporting system must be intuitive and require almost no training. Every window, label, and button in the system must be understand- able to the average person,” he said.
“As the user moves from window to window, it should be both obvious and simple for them to understand what they are to do,” noted Fishkin. “Doctors demand this type of simplicity. It is probably the number one attribute that doctors want from a lab test reporting system.
List Is A Starting Point
“I recommend using this list of eight “must have” functions as a starting point to review products your lab might be considering,” noted Fishkin. “Vendors have learned some important lessons since the first generation of these Web-accessed lab test reporting systems began to enter the marketplace.
“Vendors tried to make these systems be all things to all people, myself included,” he explained. “We spent lots of time, money, and energy and designed some good systems, but the end result was frequently not intuitive, nor was it simple to use in the typical doctor’s office environment. As a result, the physicians did not accept these systems and use them as quickly as we hoped.
“Many of the current vendors of lab test reporting systems have less ambitious goals,” stated Fishkin. “They incorporate the lessons of the past few years and stress basic functions which more closely emulate the workflow and needs of physicians and their staffs.