CEO SUMMARY: In Macon, Georgia, an innovative effort by a regional extension center and a health information exchange (HIE) will level the playing field for hospital labs and independent labs in the state. Their goal is to build a secure and flexible clinical integration platform known as a “lab hub.” This common interface will allow all physicians in the network to use their electronic health record (EHR) systems to order lab tests and receive structured lab test results directly into a patient’s health record.
TODAY, OFFICE-BASED PHYSICIANS send and receive electronic data in a wider variety of formats than ever before. But getting lab test results into their electronic health record (EHR) systems in a useful way continues to be a challenge for many physicians.
To further complicate this situation, health information exchanges (HIEs) are becoming operational in many regions across the country. They represent another “layer” through which lab test orders from physicians and lab test results from laboratories may need to pass.
To solve this problem, in Macon, Georgia, the Central Georgia Health Network (CGHN) and the Georgia Health IT Regional Extension Center (GA-HITREC) have teamed up with Halfpenny Technologies, Inc., of Blue Bell, Pennsylvania. To help physicians get lab test data transmitted seamlessly into their EHRs, CGHN has deployed a “lab hub” portal solution developed by Halfpenny.
In Georgia, all laboratories can participate in this lab hub, which is designed to enable the seamless and secure exchange of clinical data for the 700 CGHN physicians participating in the region’s HIE initiative. Halfpenny installed the system as part of a six-month demonstration project that started this summer.
CGHN has more than 700 physicians in 128 medical practices in and around Macon. The lab hub from Halfpenny will send all of the lab orders from these physician members to various commercial and hospital labs throughout Georgia. These same labs will transmit lab test results back through the lab hub and into the EHRs of the referring physicians.
Seamless Lab Data Access
Before sending the orders, the system assigns Logical Observation Identifiers Names and Codes (LOINC), a universal code system for sending and receiving laboratory and clinical data. LOINC is managed by the Regenstrief Institute, Inc., in Indianapolis, Indiana. Using LOINC to send orders and receive results allows both the physicians’ EHRs and the labs’ information systems to communicate easily.
This development is significant for lab directors and pathologists because it allows smaller laboratories to compete with large regional and national labs for physicians’ lab test orders without being at a technological disadvantage. Often, larger lab companies try to lock up physicians with proprietary information systems that smaller labs cannot provide.
If the Georgia demonstration project is successful, it could be expanded statewide,” said Dominic mack, m.D., mBA, Director of GA-HITREC and Deputy Director of the National Center for Primary Care at Morehouse School of Medicine.
“Most HIE platforms have generic pass-through systems that do not go the last mile to allow physicians to get structured lab data into their EHRs,” explained Jerry Baker, President and CEO of Halfpenny. “Recognizing the complexity of lab data, we built the lab hub to handle both the outbound order-entry side from a physician EHR system to a hospital or a reference lab and the inbound transmission of structured lab test results from labs back to the EHRs.
Two Big Advantages
“Our system has two significant advantages,” he added. “First, it is built around the workflow of the physicians and we ensure that everything we do is transparent to them. Physicians will generally use a new system only when it complements their existing workflow.
“Second, and perhaps more important, is the LOINC mapping we do,” Baker said. “The multiple hospitals and reference laboratories participating in the demonstration project have different test-naming nomenclatures and they use different methodologies to perform the tests.
“That means the values of the lab test results can mean different things to different physicians,” he noted. “Obviously, that approach won’t work in a lab hub serving all healthcare providers on the same system.”
The key to making it work is to provide structured lab test results to the EHRs, which is accomplished by Halfpenny’s team of medical technologists and programmers. “Our dedicated staff of credentialed medical technologists map all of the participating labs to the LOINC standard,” Baker explained. “when the data gets to the HIE, it has already been normalized.
“Normalizing the lab data is the crucial part of the process,” he added. “You don’t want different lab results to mean different things at the HIE level. You need apples to apples.”
Helping Local Labs
Baker observed that local labs will directly benefit from participating in the HIE. “In this way, we have leveled the playing field for interconnectivity,” he said. “It means that smaller labs can compete more successfully with larger national labs.
“Connectivity is one strategy that larger labs use to gain competitive advantage and try to own the transmission of these lab data,” Baker noted. “This is a very inefficient approach because each physician’s office must be connected and interfaced one at a time. The end result is hundreds and thousands of point-to- point interfaces, which the national labs must manage and maintain.
“The benefit of a lab hub, by contrast, is that all the participants need only one pipe to connect to the hub,” continued Baker. “This is far more efficient. It is also cost effective and easier to support.”
“Aggregating health data at the hub level is important for another reason,” stated Baker. “It allows health plans and the medicaid program to manage the care of a population for disease management and pay-for-performance programs.”
Solving a Major Problem
Mack stated that, for physician members of CGHN, the inability of their EHRs to get test results from commercial and hospital labs was one of their biggest problems. “whenever we implemented an EHR system, we needed to integrate the lab data with that EHR,” he said.
“We also wanted a connectivity vendor that would be neutral in two ways,” noted mack. “First, it would be neutral as to the lab providing testing services and second, it would be neutral to the EHR product the physicians use.
“GA-HITREC was established to help physicians with the selection and implementation of certified EHR systems,” noted mack. “This will include assisting physicians in achieving meaningful use so that they can qualify for federal reimbursement.
“Another major goal is to improve clinical outcomes and care delivery, particularly in under-served communities,” he said. “GA-HITREC is funded with a $19.5 million grant from the U.S. Department of Health and Human Services (HHS) that is administered by National Center for Primary Care.”
THE DARK REPORT observes that this Georgia HIE provides an early example of how new information technologies will make it easier for local labs and hospital laboratory outreach programs to serve office-based physicians. It will also help these physicians meet meaningful use criteria and qualify for federal incentives associated with EHR adoption.
Georgia Physicians Insisted on Getting Lab Test Results at the Point of Care
WHEN SURVEYED ABOUT WHAT THEY WANT from a health information exchange (HIE), physicians in the Macon, Georgia, area were quick to identify the importance of reliable access to laboratory test result data.
One primary objective of this HIE, which is called the Central Georgia Health Network (CGHN), is to allow participating physicians to send and receive data from their electronic health record (EHR) systems. According to Stephen Barry, COO of CGHN, physicians indicated that, at the point of care, they want speedy and accurate access to view lab test results and then to act upon that information.
To develop a lab hub that can deliver this access, CGHN partnered with the Georgia Health Information Regional Extension Center (GA-HITREC) and Halfpenny Technologies, Inc., of Blue Bell, Pennsylvania. The lab hub will be the interface engine that connects all Georgia labs with CGHN’s 700 physicians who run 18 different EHR systems.
“The biggest hurdle is getting different vendors to work with each other,” declared Barry. “During our four years of effort to become clinically integrated, if there has been a wrinkle, it has come from a disagreement between vendors.
“The 700 providers in 128 different practices use different EHRs and each practice is an independent entity,” he noted. “The lab component for the Georgia Health Information Technology Regional Extension Center (GA- HITREC) is one of the most important enhancements. We want a physician in the emergency room to be able to pull up a patient’s chart and see what happened with that patient in real time, perhaps even something that happened the day before, such as a lab test result.
“This system is important to us because it will also allow us to use the data for quality measures,” Barry added. “For example, take a patient who is 45 years old, is on a statin drug, and needs an enzyme check every six months.
“We want physicians or other caregivers to look at the data and be able to see whether that enzyme check was actually done,” he concluded. “If this test wasn’t performed, the physician knows he or she should order that test. Having that information readily available at the point of care allows us to deliver quality care.”