CEO SUMMARY: Office-based physicians in Michigan can use a program offered by the American Medical Association (AMA) to get assistance in adapting their electronic medical record (EMR) systems to utilize LOINC for lab test ordering and lab test results reporting. This service is offered by Amagine, Inc., which is a partnership between AMA and Covisint, a division of Compuware. Joint Venture Hospital Laboratories (JVHL), with its 130 hospital lab members, is collaborating with Amagine and Covisint.
IN MICHIGAN, A STATEWIDE PROJECT is about to launch that will use Amagine, Inc., a new portal service, to give 22,000 physicians in the Wolverine State an improved ability to use LOINC to handle laboratory test data. This portal enables the use of LOINC when the participating physician places laboratory test orders and receives back the lab test data.
Among other benefits, this standardization can help local clinical laboratories and pathology groups maintain and improve their access to office-based physicians in their communities. As well, this project is another step forward on the road to creating an information technology (IT) platform that automatically standardizes lab orders and results for physicians, payers, and health information exchanges (HIE).
Hospital laboratories are playing a key role in this project via an information technology relationship between Joint Venture Hospital Laboratories (JVHL) and Covisint, a business unit of publicly-traded Compuware. The new LOINC tool will be part of a package offered to physicians by Amagine, which itself is a collaboration involving the American Medical Association (AMA) and Covisint. Sponsoring the introduction of Amagine in Michigan is the Michigan State Medical Society.
All the collaborators involved in this project recognize how the expanded use of LOINC—Logical Observation Identifier Names and Codes—by office-based physicians can contribute to better integration of healthcare services. LOINC is a database that provides universal identifiers for lab test results and other associated data. LOINC is managed by the Regenstrief Institute, a nonprofit medical research organization at Indiana University in Bloomington, Indiana.
Benefits From Use of LOINC
“Amagine and Covisint have a LOINC solution that can directly benefit local clinical labs and pathology groups,” said Jeff Beamsley, who is Director, Partner Programs, at Covisint. “We are building a computerized physician order entry (CPOE) tool that orders in LOINC and can translate the local lab’s native nomenclature. In this way, labs can keep their local language while conversing in LOINC with their client physician’s CPOE tool.
“JVHL is a natural collaborator in this project because it already has the LOINC translation tables in place,” he went on. “JVHL actively and regularly uses LOINC with its 130 hospital laboratory members.”
By using LOINC for standardization of lab test orders and lab test results, Covisint and JVHL will allow a seamless exchange of lab data. In turn, this will help physicians meet the federal government’s meaningful use (MU) criteria. LOINC also gives the hospitals and participating physicians lab test data in a standardized electronic format that they can use in important ways.
For example, this standardized lab test data can be used to satisfy quality reporting mandates or help the provider qualify for performance incentives. LOINC-standardized lab test data makes it easier for providers to accommodate the shift to accountable care organizations (ACO), medical homes, and other collaborative care approaches.
LOINC offers a number of significant advantages for labs and for all providers. “The lack of standardization in the nomenclature and reference ranges for the same laboratory test is a major challenge,” stated Beamsley.
“Individual laboratories internally use different test codes and varying normal ranges for the same assay,” he noted. “This challenges care management systems that want a full and accurate picture of an individual’s care in the community.
“Similarly, take the example of a study to determine community-wide performance in managing a chronic disease—such as hypertension or diabetes—and compare that with how other communities in the country are managing the same disease,” continued Beamsley. “There is a need for an apples-to-apples comparison of the lab test data produced in these different communities.
Benefits From Use Of LOINC
“LOINC adds precision to these activities,” he added. “Lab test data in the LOINC format helps physicians and researchers understand the test results produced from different labs.
“The need for standardization in the naming of the laboratory tests and their reference ranges is becoming more of a priority as the integration of clinical care moves forward,” stated Beamsley. “Increasingly, we will want to know how one downtown Detroit clinic is doing in man- aging its population of patients with diabetes versus the national average.”
Jack Shaw, Executive Director at JVHL, recognizes the need for local laboratories to better utilize LOINC. “Historically, hospital labs have developed their own unique in-house codes,” he said. “This has restricted the utility of laboratory data outside each individual hospital’s environment.
“We expect this new IT initiative will help change that,” noted Shaw. “Utilizing LOINC as the universal lab test identifier will put Michigan ahead of other states because so few physicians and labs currently use LOINC routinely.”
JVHL is distinctive because it is one of the first multi-laboratory organizations in the nation to provide LOINC to the 130-member hospital labs in its consortium. “JVHL is an interesting model that allows a consortium of local and regional labs that appear to payers as one big lab,” Beamsley explained.
“As a result they compete very effectively against the national labs,” he said. “One reason they compete so well is they provide a pathway to LOINC.”
The first step in this project uses LOINC in lab ordering and resulting through the Amagine portal. Future enhancements could include a LOINC translation service for all EMRs, a step that could improve the ability of local labs to compete with national labs.
“Right now, EMRs are struggling to achieve effective point-to-point integration with medical laboratories,” explained Beamsley. “It requires significant time and expense for a laboratory to connect to a physician’s EMR.
“Laboratory Corporation of America and Quest Diagnostics Incorporated have an advantage over local labs when it comes to EMR integration,” he said. “That’s because many EMR vendors have already programmed the test compendiums of the national labs into their EMR products.
“By contrast, local laboratories that want to have their unique compendium of lab test codes loaded into the physician’s EMR and have that EMR tie into their LIS must typically pay between $2,000 to $20,000 per physician office for projects that may take six months to complete,” he said. “This time and expense adds up quickly for the local laboratory which must integrate with the EMRs for each of its office-based physician clients.
“We know that, when the physician’s EMR is able to use a standard set of LOINC codes that are either: 1) accepted directly by the labs; or, 2) there is some translation layer available that’s external, then both labs and physicians can more quickly achieve a workable interface between the lab’s LIS and the physician’s EMR,” stated Beamsley. “It also greatly reduces the time and expense typically required to achieve that function.”