Part four of a seven part blog series about EMR - lab results interoperability

Last week I published the third in a series of seven blog posts that discuss some of the misconceptions about lab interfaces and intelligent clinical data extraction software. 

Below is the list of misconceptions this blog series will cover in the span of seven weeks. 

  1. We are implementing or already have an interface to Quest and/or Labcorp and no longer have to manually enter test results.
  2. Only a small percentage (typically estimated to be 10 – 30%) of lab results don’t come through the interface so it’s not a high priority problem.
  3. We have an in-house lab that handles our lab tests.
  4. All of our test equipment is interfaced with the LIS, which is integrated with our EMR.
  5. For non-interfaced test results we already have scanning software.
  6. Optical character recognition (a.k.a. OCR) isn’t accurate enough for clinical data.

One comment we often hear, “We have an in-house lab that handles our lab tests” when discussing needs for automating data capture from non-interfaced lab results. The implication is that since the hospital has an in-house laboratory that very few diagnostic orders are sent out to reference labs and therefore even fewer results are received from non-interfaced reference labs from which results are received by fax or e-fax.

The case may be that the majority of routine lab test orders are processed by the in-house lab, a fact that is supported by the available research. However, it’s also true that although send-out tests represent a small percentage of the total test volume, send-out test services account for the majority of the hospital laboratory test menu and a disproportionate percentage of laboratory costs.

Similar to my last post that discussed the practice of using marginal cost-benefit analysis which is an approach of making investment decisions based on the comparison of incremental benefits and costs that accrue to the hospital, to decide whether to invest resources in capturing test results in discrete EMR fields is erroneous.

In many business contexts making investment decisions based on marginal cost-benefit analysis is perfectly rational. However, in the case of patient care, this kind of analysis ignores the impact of such a decision on individual patients.

Arguably, patients whose test results are still managed on paper, fax or in unstructured e-faxes and PDFs are placed at a higher risk than those whose test results are made immediately available to the ordering clinician in their electronic medical record. These higher risks are caused by:

  1. Automated alerts cannot take place when the results are still in the documents
  2. Clinical staff is forced to manage the documents differently which takes more time and involves a review process more prone to being delayed or with results actually loss
  3. Physicians are not able to easily see the results in the context of other clinical data in the EMR and need to hold the figures in their head as they look at other results from previous or other tests

As a result, these patients don’t receive the same high level of care.

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If you’ve already implemented a lab interface(s) and are still manually entering a lot of test results or you’re entering all of your lab results manually and haven’t yet implemented an interface, we encourage you to speak to one of our health information specialists for a no obligation assessment to determine whether an automated clinical data extraction solution is right for you.

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About the Author: Greg Gies

For 20 years in the software industry, Greg Gies has been helping businesses, government agencies and healthcare organizations achieve their goals and carry out their missions by making better use of information and automating business processes. Greg has held positions in sales, product management and marketing and holds an MBA from Babson College. He works and lives with his wife and three boys in the Boston area.