The Secret Sauce Revealed: Discrete Outside Lab Results in the EMR

As you've likely seen in prior HealthyData blogs, our software does an excellent job of pulling discrete lab result data from faxed/scanned documents and filing them into EMR via HL7. People often question how this is possible...

How do we map to the correct patients,  
orders, procedures, and components?

How is the result routed to the
appropriate person in the EMR?

How are the results trended in the
EMR alongside internal results?

Is the lab team okay with this?

Is the source document
linked to the order?

Can the source document be stored in our
Document Management System (such as OnBase)?

Step right up! I will reveal some of the secrets in the sauce!

NOTE: A very high proportion of the organizations using our product are integrating it with the Epic EMR, so for easy reference I've included some Epic-specific terminology below. However, these secrets apply to most downstream systems (EMR or best of breed).

Patient Mapping

We support incoming ADT and Orders interfaces from the EMR, which allows us to leverage the patient demographic data found in the unstructured document to tie it to a specific patient's medical record number.

Procedure/Component Mapping

We work with each organization to define the procedures and components (Epic EAP and LRR records) that should be retrieved from lab documents. With our experience, we have a starting baseline and make the mapping process relatively painless.

How you want the data to display in the EMR will dictate how this mapping is handled. For example, in Epic our customers often want the results to trend on separate rows in places like Results Review, but also want the ability to trend them on the same row in places like Synopsis and Review Flowsheets for specific departments. This is made possible by leveraging existing results components or creating new ones that are configured appropriately based on your common name/base name strategy and results review tree.

Order Mapping

The orders interface from your EMR gives us the ability to track a patient's open lab orders and easily retrieve them when a fax comes in for a specific patient and procedure combination. If the order doesn't exist, users can either submit them as unsolicited orders or release the order in Epic to trigger the mapping.

In our Epic installs, we've found that this has made the Overdue Results folder in the In Basket actually usable!

Other Mapping Tables

Providers: we leverage a database of your providers (Epic SER records) to facilitate the automated population and data entry verification of ordering providers and routing providers to improve results routing once the result hits the EMR.

Laboratories: we leverage a database of your laboratories (Epic LLB records) to facilitate the automated population and data entry verification of the resulting agency field.

AKAs: our standard set of result component AKAs (synonyms) is very extensive, but we know that occasionally the way a result component is sent from the lab will result in it not being successfully mapped to one of the standard set. As users correct these result components, we track it behind the scenes and provide administrators the tools to approve these user-specified AKAs prior to them being leveraged by the rules to make the system more intelligent.

Custom Mapping Tables

Our user-friendly interface is entirely customizable and can leverage other custom database tables to facilitate additional fields and validation on those fields.

For example, if you use Epic you may want to have a field that displays a list of In Basket pools for Results Routing purposes.
 

Source Document and Document Management Systems

When a result comes through our software and then lands in the EMR, the source document comes with it. So not only are the results discrete, but the source document is only a click away (supported by Epic and most other EMRs).

In addition, we are able to fully integrate with major Document Management Systems such as OnBase so you're not stuck filling up your blob server. We can facilitate this integration in a number of ways including HL7 and flat file transfer. The images can be dropped in a specific location or sent as an embedded image.

Universal RuleSet

We have seen a LOT of faxed lab documents with a huge variety of qualities and formats. We have taken that knowledge and folded into our Universal RuleSet so that every organization across the country can benefit from the lessons learned at only one.

Machine Learning

We have incorporated a learning machine into our most recent software release that will pave the path for a system that becomes more intelligent over time and reacts to changes in document formats and patterns.
 

 

Do you think your EMR could use Extract's secret sauce? 
Contact us now for more information!

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About the Author: Rob Fea

Rob Fea spent 12 years partnering with IT teams and clinicians at major hospitals and clinics worldwide during his tenure on the technical services team at Epic. Rob supported Epic's Phoenix product, playing a major role in project kickoffs, installation, data conversions, ongoing support, and optimization. Rob watched the Phoenix customer base expand from 0 to 55 live and installing transplant organizations. This experience gave Rob expansive insight into the healthcare world, especially the solid organ transplant industry. Rob has spent countless hours on the floor in transplant departments observing multidisciplinary visits, committee review meetings, data entry, data trending, reporting, medication dosing, and more.