CEO SUMMARY: Three speakers at the Executive War College last month in Miami, Florida, offered case studies on how labs are developing electronic interface gateways between their LISes and EMRs in the offices of client physicians. Physician clients frequently want lab data to be among the first links they develop. In many situations, it is critical for labs to dictate the specifications of the links between labs and physician offices.
ONCE PHYSICIANS INSTALL AND BEGIN TO USE electronic medical record (EMR) systems, they are quick to ask their laboratories to electronically enable reporting of results and lab test ordering. This fast-growing trend was the subject of a full- day program at the Executive War College on Lab and Pathology Management in Miami, Florida last month.
“Only about 20% of physicians have EMRs today, but that number should rise steadily,” said Pat Wolfram, Global Product Manager for EMR Inter- operability for GE Medical Systems Information in Beaverton, Oregon. “About 200,000 physicians will have them by 2011,” he said.
“Lab results are required in 90% of the EMR systems that go live today and the other 10% want lab results in their EMRs shortly thereafter,” Wolfram said. “But physicians do not use EMRs to send lab orders until they are very well adopted with the EMR.”
Saying labs have an opportunity to work closely with physicians who have installed EMRs, Mark Johnston, Chief Information Officer for Pathology Associates Medical Laboratories (PAML), in Spokane, Washington, explained how labs can position themselves for effective integration. PAML provides lab services in five states in the Pacific Northwest and has developed EMR interfaces to seven different laboratory information systems (LISs).
“In addition, PAML has developed interface gateways to the EMR products of 15 different vendors,” noted Johnston. “PAML has also created an enterprise master patient index (EMPI) that includes 42% of all the patients in our service area.
“We developed the EMPI to help on the billing end but it also has application on the clinical side,” Johnston explained. “We have 22,000 doctor customers, and our goal is have one patient with one bill, one record, and one address.
“The electronic links that exist between PAML and our physician clients mean that 55% of our lab requisitions are generated through the physicians’ EMRs,” observed Johnston. “Even offices with just one and two physicians are asking for EMR links.
“When physicians install EMRs, they will come to the lab first for an interface,” continued Johnson. “Lab test results are a fundamental requirement for an EMR system to deliver maximum benefit to physicians.
“As they recognize the value of getting patient information electronically, health plans are encouraging the development of extensive electronic systems to link physicians, labs, and other providers,” he added. “For example, Group Health Cooperative of Puget Sound, a large health plan in Seattle, transmits lab orders and patient information to PAML in real-time.”
The key to collecting data from health plans and physicians is a sophisticated interface engine that PAML developed. The system translates requisition data from a variety of physician offices so that PAML can interpret the requests and process the tests. “Then the interface engine translates the test results and sends them back to the physicians’ EMRs in its native format,” Johnston added.
Dictating Connection Terms
David Moore, CIO of Spectrum Laboratory Network, in Greensboro, North Carolina, agreed that connecting to physician offices can be challenging. “When physicians want to establish electronic links with Spectrum,” noted Moore, “Spectrum dictates the technical requirements. Doing so ensures that the lab can deliver the data physicians use in the form they need without compromising the lab test data.
“Spectrum is growing by 20% annually since 2001 and this growth is due, in part, to its efforts to capture and report lab data electronically,” added Moore. “We have interface gateways between our lab and 87 clients—who use EMRs from 14 different vendors. These clients represent 10% of our accession volume. One thing we have learned is that developers of EMR systems generally don’t have a good understanding about how to handle lab information.
“For that reason, we tell each client we will not electronically connect them to our system until they have all the requisite hardware and software in place,” Moore added. “They may need to upgrade the systems they have. We won’t connect until we’re convinced they can handle the information they will get from us.”
There is a primary benefit to this policy. By interfacing lab test orders along with electronic delivery of lab test results, Spectrum gets complete data at order entry. This allows Spectrum to successfully file a higher ratio of clean claims.
Still Relying on Paper
“In our market, while labs have electronic links with many physicians, less than 10% of physicians are both ordering and accepting results electronically,” said Eric Crugnale, CIO of Sunrise Medical Laboratories in Hauppauge, New York. “Further, in Metropolitan New York, only 17% to 24% of physicians have adopted EMRs.
“Sunrise has electronic links with 470 physicians’ offices and gets 60% of its orders electronically,” added Crugnale. “Demand increases for EMR interfaces, but predominantly, they ask only for electronic delivery of lab test results.
Problems are common. “Most EMR systems don’t have the ability to get the lab data back into the EMR,” Crugnale said. “There’s a lack of consistent implementation, mean- ing each physician installation is unique. And, typically, there is a lack of a physician champion in the doctor’s office.”
THE DARK REPORT notes that labs have an opportunity to lead the implementation of electronic links to EMRs. PAML, Spectrum, and Sunrise are examples of first mover laboratories that are at the leading edge of this trend—and enjoying solid growth and profitability in their respective markets.