CEO SUMMARY: As physicians deploy electronic medical record (EMR) systems, they quickly ask their laboratory for electronic results reporting directly into the EMR. Later, these doctors will ask for electronic test orders from their EMR. Savvy labs are using this opportunity to develop closer business relationships with their clients. Two experts in the EMR field offer insights about how to succeed with this strategy.
PHYSICIAN ADOPTION of electronic medical record (EMR) systems is changing the way many doctors order their laboratory tests and receive lab test results. A new company is ready to exploit this fast-moving trend by linking physician EMRs with their laboratory providers.
The new company is Ignis Systems Corporation, based in Portland, Oregon. Its founders are Pat Wolfram, Vice President of Marketing and Customer Services, and Ken Willett, President and Chief Technologist. The goal of their company is to help independent labs and hos- pital laboratory outreach programs achieve bi-directional electronic test ordering and lab test reporting that is fully integrated within the EMR workflow of physician-clients and their staff.
Before joining Ignis Systems, Wolfram was the Global Product Manager for EMR Interoperability at GE HealthCare Information Technologies in Beaverton, Oregon. An expert in EMRs, Wolfram told THE DARK REPORT’S Executive War College in May that about 60,000 to 70,000 physicians have EMRs installed today. He also predicted that, “in the coming years, EMR adoption will proceed steadily so that about 200,000 physicians will have them installed by 2011.”
Wolfram’s participation at the Executive War College’s full-day session on creating interface gateways between the laboratory information system (LIS) and the physi- cians’ EMR led directly to the current strategy of Ignis Systems. “There were 250 lab directors in attendance and presentations were made by most of the software companies installing interface gateways between physicians’ EMRs and their laboratory provider,” observed Wolfram. “It made us realize the business opportunities that already exist to help physicians and labs enable real time lab test ordering and reporting through the use of electronic links between the EMR and the LIS.”
In recent years, Willett has written interconnect software for the GE Centricity EMR to enable the system to place orders and accept results from ancillary service providers, particularly laboratories. “That EMR interface gateway seminar at the Executive War College inspired us to join forces at Ignis Systems,” stated Willett. “We already have a working interface gateway for this EMR product, which is currently used by more than 20,000 physicians. We are making swift progress on a more universal electronic interface gateway that will enable hospital laboratories to connect their LIS to the physicians’ EMR for direct lab test ordering and lab test reporting.”
Because Wolfram and Willett have actively worked inside an EMR company and helped physicians implement and operate their EMR system, THE DARK REPORT asked them to share their insights about how physician use of EMRs changes the daily relationship a doctor’s office has with its laboratory provider.
Meeting Clients’ Needs
“For pathologists and lab directors interested in developing interface gateways between their LIS and the EMR systems of their physician clients, three key elements are required to succeed,” said Wolfram. “First, physicians who have made the substantial investment in EMRs use the EMR as their cockpit for managing all aspects of patient care. The EMR facilitates clinical staff workflows, manages medications, trends vital signs, maintains family history, reviews lab/radiology/cardiology reports, and orders tests and treatment plans. Since labs account for such a large part of a patient’s clinical profile, physicians expect lab tests to be orderable and reportable within their EMR cockpit.
“Second, labs must understand the IT (information technology) strategy of their clients,” Wolfram added. “Every year, new surveys confirm that almost every physician group in the United States is thinking about an EMR strategy or is in some stage of deploying such systems.
“Here is where regional laboratories and hospital lab outreach programs will find plenty of opportunity,” he continued. “Every physician in the United States has either: 1) deployed an EMR already; 2) is deploying an EMR; 3) is budgeting for an EMR deployment; 4) or is creating a plan for EMR acquisition and use.
“A lab should approach its biggest clients and determine where they are on the EMR adoption curve,” Wolfram added. “Use this information to develop a proactive strategy to work with these clients on their EMR deployment. Become part of their EMR strategy.
Look For Existing Interfaces
“Third, leverage your hospital’s IT infra- structure,” he said. “Your hospital outreach strategy is so much more appealing to a physician group if you show them a roadmap that shows their EMR integrated to your lab services, followed later by access to your hospital’s radiology services (images and interpretations), cardiology ECGs, echocardiograms, perinatal discharge summaries, and so on.
“In your discussions with the hospital’s IT leadership, the lab should deter- mine which EMR vendors are already capable of interfacing directly with the hospital’s IT system and with your laboratory’s LIS,” Wolfram advised.
“Specifically, which EMR vendors are able to connect via the HL7 protocols? Which EMR vendors can already interface electronically with other clinical departments in the hospital? HL7 refers to Health Level Seven, Inc. [www.HL7.org], a nonprofit, standards developing organization that facilitates the exchange of health care data,” Wolfram said. “In that same vein, determine if the EMR vendors are active in improving and adopting interoperability standards. Complementing HL7 are IHE, ELINCS, and other standards bodies that will make the hospital integration challenge less foreboding.”
Wolfram and Willett next discussed how physicians want to use EMRs in their daily medical practice. “What physicians value is having results on screen alongside the patient’s medications, allergies, diagnoses, and vital signs,” noted Willett. “They want their EMR systems to be much like the paper charts they have used for years. Moreover, physicians insist that EMRs support the way they see and interact with patients. It is a work flow issue. The EMR must function in ways that are consistent with the physician’s personal work style.
“When physicians see patients, they want to view all the diagnostic information they have on those patients,” said Willett. “They tell us they want the historical data, their notes, the images on each patient, and they want to see all this information at once. They sometimes spread a patient’s paper chart across the desk to get a complete view of the information. Of course, physicians want their EMRs to allow them to view the patient’s chart in the same way.”
“When physicians implement an EMR into their practice, the first outside clinical information they want to flow electronically into the EMR is laboratory test results,” observed Wolfram. “In my work with physicians, electronic reporting of lab test results into the EMR consistently tops the list as the major priority.
“I would estimate that 90% of the deployed EMR systems in this country today get lab test results through an electronic interface,” Wolfram observed. “It demonstrates the high value that physicians place on receiving and viewing lab results in their EMR.
“However, this is just one of two EMR integration phases that engage labs,” he continued. “The first phase involves viewing results directly within the EMR. The second integration phase involves ordering electronically. This is a win-win for the lab and for the physician. For the lab, tests placed electronically create a complete and accurate test request. When the EMR is the source of the data that populates the test request, it has the patient ID, the ordering provider’s ID, and other required information needed by the lab to perform the test and evaluate the results.
“For the physician, an electronic lab order creates a much better lab result, facilitating a guaranteed match to the patient’s chart, immediate notification to the ordering physician’s desktop, and the ability to automatically update the test order status from ‘in process’ to ‘closed,’ an important CLIA requirement,” Wolfram added. “Ignis’ goal is to make the orders phase as easy to deploy as the results phase, so you’ll see them both in phase one EMR deployments.
“The second stage of EMR-to-lab interoperability is about to commence because many physicians see the value that electronic orders bring to their EMR charts and to their staff workflow,” he added. “They’re ready to change their workflow once again to incorporate electronic lab ordering.
“When pathologists and lab directors think about services that will make them competitive and help them win business and retain business from physician clinics, they might put themselves in the shoes of that physician,” Wolfram continued. “It’s been our experience in working with physicians and labs on these types of interface gateways that collaboration between the lab and clinic staff in building the interoperability leads to stronger business relationships between the client and the lab,” stated Wolfram. “It also contributes to a tighter, more successful integration of the lab ordering and the lab resulting function between the EMR and the LIS.”
Resistance to Change
Willett warned that laboratories need to constantly maintain the physicians’ perspective on how the EMR supports existing workflow. “Remember a great truth about medical groups and doctor’s offices,” he advised. “Existing workflow has been optimized for the physician! That means if your lab offers a solution that disrupts a physician’s workflow, there will be resistance to that change,” he said.
“Office managers and staff tell us they will only make changes to workflow when they see a clear benefit from doing so,” noted Willett. “They weigh the cost of additional training, as well as how staff levels might change. That is why they evaluate thoroughly any EMR or new EMR modules that change the physician’s workflow.”
Still Using Paper Lab Orders
Wolfram agreed, saying, “To date, the majority of orders that physicians submit today are on paper. An order placed through an EMR must be as fast as using a pre-printed test requisition and checking boxes to order a CBC and a chemistry panel, then circling a diagnosis. Workflow is paramount to them. Electronic lab ordering must be fast, productive, and consistent with existing workflow in the physician’s office.
“Lab order entry in the GE EMR, complemented by our EMR-Link system, doesn’t require physicians to do anything differently from what they do already,” Wolfram added. “They click one additional button to check for medical necessity, then the order moves to the phlebotomist or nurse at the draw station. If the draw station activity is managed by another lab application, the order information (such as the patient ID, insurance, order codes, and diagnoses) is pulled by EMR-Link from the EMR and passed directly to that application in the format needed by that application. We have development projects underway supporting this workflow with lab ordering vendors such as Atlas Medical and Orchard Software.”
Lab directors and pathologists will want to track the uptake of EMRs by office-based physicians. This major trend promises deep changes to the daily working relationships between physician clients and their laboratory providers.
Existing LIS-EMR Solution For Hospital Lab Outreach
IGNIS SYSTEMS CORPORATION of Portland, Oregon, launched its business with a unique advantage. It is already a specialist in integrating GE’s ambulatory EMR within hospitals.
It has done this many times and is experienced in adapting this EMR to conform to the requirements of dozens of hospital environments. The principals of Ignis also have extensive experience with large reference labs which complements the work they have done for hospital laboratories.
The company’s product is called EMR- Link and it integrates within GE HealthCare’s Centricity EMR. It verifies lab orders for Medicare medical necessity, generates advance beneficiary notice forms, forwards electronic lab orders using HL7, and automates the closing of the EMR’s open lab orders. EMR-Link’s ability to handle medical necessity helps laboratories get reimbursed for lab work requested by the physician through the EMR.
“Hospital lab directors and pathologists will be interested to know that EMR-Link, by design, is tailored to be a natural extension of their physician clients’ EMR workflow,” explained Pat Wolfram, Vice President of Marketing and Customer Services for Ignis Systems. “At the same time, EMR-Link can be extended to connect the physicians’ EMR to other services in the hospital. As they learn about this capability, many hospital administrators want to first use EMR-Link to connect their hospitals’ LIS to the EMR of client physicians. Once that is accomplished, EMR-Link then becomes an integration interface for other clinical services between their hospitals and the physicians’ EMR.”