CEO SUMMARY: A new trend is emerging in outreach laboratory IT systems. Labs are linking to the electronic medical record (EMR) systems in their physician clients’ offices. Delivering lab results to these systems is already common. Enabling electronic order entry is the next wave. Clinical labs and anatomic pathology practices will need to offer effective “Lab-EMR Gateways” to maintain their competitive position.
REMEMBER THE FIRST EFFORTS by laboratories to offer Web browser-based lab test ordering and results reporting to office-based physicians? Back in 1997, that was a radical concept. Yet today, it is a widely used arrangement.
It was also an information technology change “pushed” by laboratories onto office-based physicians. Laboratories generally initiated such arrangements.
Now the tables are about to be turned. As physicians install electronic medical record (EMR) systems, they are “pulling” their laboratory provider to supply an electronic interface with the EMR to enable seamless lab test ordering and results reporting.
It is a developing trend that has serious implications for clinical laboratories and anatomic pathology group practices that provide testing services to office-based physicians. This trend involves connecting the lab operation to the physician-clients’ EMR systems for both electronic order entry and results delivery.
THE DARK REPORT is first to identify this trend and provide insights. One expert who is on the front lines of this development is Robert S. Gregory, Senior Vice President, Corporate Strategy at Atlas Development Corporation. Gregory’s software company, based in Calabasas, California, was an early player in offering Web browser- based solutions that supported lab test ordering and results reporting between labs and office-based physicians.
“Some physician office connectivity vendors are building more capability into their systems, creating what we call ‘Lab-EMR Gateways’ to bring this integration to a higher level,” stated Gregory. “Although these gate- ways will be important for all labs, the unique requirements of anatomic pathology practices may find them particularly useful as EMR integration becomes the norm. Pathology labs that adopt solutions to address this need now will be a large step ahead of their competition.
“Moreover, the ability to interface with physician EMR systems is going to become a necessary requirement for any clinical laboratory and anatomic pathology group that wants to remain competitive within the healthcare community it serves,” added Gregory. “Laboratories that cannot support EMR interfaces will find themselves at competitive disadvantage to those labs which can.
“While the number of office-based physicians seeking an EMR interface from their anatomic pathology provider is relatively small today, the demand is there and growing,” observed Gregory. “In fact, the growth level currently feels much like the market of four to six years ago—when labs were just beginning to install Web browser-based systems into doctors’ offices that connected to the practice management systems and supported Web-based order entry and results reporting.
“Back then, this trend was so compelling that it became a necessity for labs,” Gregory added. “Laboratories had to show they could do this before they could get a foot in the door. At that time, there was also a lot of debate in the lab industry about whether doctors would order electronically.
“Now, of course, electronic ordering is no longer a question. Physicians order electronically, or they have someone in the office who does it for them,” he noted. “To support this function, laboratories needed an interface with the physician’s practice management system.
Anatomic Path Groups Face Extra Challenges
“PATHOLOGY PRACTICES FACE unique challenges when seeking to enable electronic test ordering with electronic medical record (EMR) systems in physicians offices,” observed Robert S. Gregory, Senior Vice President, Corporate Strategy at Atlas Development Corporation.
“The highly specialized requirements of pathology labs demand added control over the order entry workflow,” noted Gregory. “Typically, the order entry capabilities of an EMR will not deliver everything that is needed. For the pathologist to realize all of the benefits of electronic ordering, the use of a Lab-EMR gateway can augment the EMR ordering capability and bridge this gap.
“Order entry can be enabled by either using a direct interface or by using a lab ordering platform that enhances the onboard order entry capability of the EMR,” he continued. “The key to the second approach is the ability of the lab to apply its specialized business and clinical rules to an order to ensure that it fully conforms to the lab’s requirements.
“These systems basically reside on central servers,” he said, “and the soft- ware is the gateway between the laboratory information system (LIS) and the physician’s EMR and practice management program. These systems are the outerwear pieces that connect the internal lab operation with the external world of the laboratory’s customers.”
Full Interface To Doc’s EMR
“In today’s competitive marketplace, we see the same adoption curve almost repeating with EMRs,” added Gregory. “My prediction is that, within a relatively short number of years, it will be essential for labs to provide a full electronic interface to the EMRs of the client physicians.”
Gregory identifies four factors that laboratories must incorporate into their strategic response to this trend. “First, the interface system between the laboratory and the physician’s EMR must be highly flexible and configurable,” he advised. “It must match the physician’s workflow and not disrupt the processes the physician has in place.
“Electronic interfaces give the laboratory the ability to customize to meet the different needs of different physicians,” Gregory stated. “For example, today, our company is approaching almost 1,000 configurations. That demonstrates how we are configuring and managing virtually every aspect of the way the ‘Lab-EMR Gateway’ behaves.
Quality of Data Improves
“The second factor to consider is that electronic order entry improves the quality of the data your lab receives for billing purposes. That benefit supports a demonstrable return on investment,” added Gregory. “Some of our lab clients tracked return on investment (ROI). For labs moving from paper-based orders to an electronic system, it is possible to see an ROI within a year. That’s because electronic ordering through the physician’s EMR improves medical necessity verification and ABN printing, verifying patient demographics, and getting the right insurance information.
“The third factor is very important and gives substantial competitive advantage to the laboratory,” observed Gregory. “Delivering results electronically binds the physician customer to your laboratory. Seamless integration with the physician’s EMR and practice management system allows your laboratory to deliver a complete solution set. Experience with our laboratory clients demonstrates that electronic interfaces allow these labs to deliver a higher level of attention to the client physician.
“This type of enhanced customer service is why I believe most national laboratory companies view IT solutions as a key component of their overall competitive strategy,” said Gregory. “The IT solution installed by the laboratory allows it to improve its responsiveness and turnaround time. National lab companies also recognize an indisputable fact: once an electronic system is in place between the lab and the physician client, then the physician’s cost to switch to a new laboratory provider increases significantly.”
Gregory points out that, if a local laboratory is already delivering services within its community, it starts with all the competitive advantages that come from being local. “When a local lab or pathology group offers this IT solution to client-physicians, it improves responsiveness and turnaround time,” he said. “That allows the local laboratory to forge a very tight relationship with clients.
“The fourth factor is a fundamental advantage of any effective, new information system,” explained Gregory. “The laboratory gets increased functionality. Just as important, the more accurate information generated by use of the system leads to increased reimbursement rates and fewer overall errors. It is one reason why these systems contribute to economic efficiency and improved patient outcomes.”
Develop A Strategy Now
THE DARK REPORT recommends that laboratory directors and pathologists put physician-client EMR connectivity systems—including what Atlas calls the “Lab-EMR Gateway”—on their strategic radar screens. Physicians are under increasing pressure to acquire and use EMR systems in their daily practice. So there is time for most lab- oratories and pathology groups to develop interface capabilities and maintain their competitive advantage.
Keep in mind that the every laboratory in the world produces only one product: information. Therefore, it would be wise for laboratories to develop a timely strategic response to the growing use of EMR systems by physicians. Physician acceptance of EMRs can trigger a paradigm-shifting effect on both the operations and the finances of the laboratory.