In my previous post, the fourth in a series of seven blog posts that discuss some of the misperceptions about lab interfaces and intelligent clinical data extraction software, I addressed the belief that if a hospital has an in-house laboratory, all test results will be integrated with the patient record in the EMR.
- We are implementing or already have an interface to Quest and/or Labcorp and no longer have to manually enter test results.
- 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.
- We have an in-house lab that handles our lab tests.
- All of our test equipment is interfaced with the LIS, which is integrated with our EMR.
- For non-interfaced test results we already have scanning software.
- Optical character recognition (a.k.a. OCR) isn’t accurate enough for clinical data.
We often hear that because the test equipment in the hospital lab is interfaced with the LIS (Laboratory Information System), which is integrated with the EMR, that all test results are integrated with the patient record. This situation is very similar to the one described in my previous post.
While it’s true that test equipment that’s integrated with the LIS will pass results to the LIS electronically and in a structured format and subsequently to an EMR that’s integrated with the LIS, it will only do so for tests performed with that equipment.
In the case of send-out tests, results are only reported electronically if the reference lab that performs the test has an interface (direct data link) to your hospital LIS and/or EMR that transmits results in a structured data format.
Send out tests from non-interfaced labs are typically reported to the ordering hospital via fax and will be received by hospital personnel on a fax machine, through a fax server or an e-fax service. Faxes received via a fax server or e-fax service are generally forwarded to an e-mail inbox. While fax is the most common method we encounter, unstructured test results documents can also be exchanged via a portal or Health Information Exchange.
Integrating these unstructured test results is a challenge since they don’t follow a pre-defined data model or format. Hospitals typically integrate these results as a scanned document that appears in the media tab in the EMR. Others have undertaken the additional task of manually entering the discrete test values from these scanned results into the EMR clinical labs view, which is superior to only scanning the test results documents but is considerably expensive to do. Most hospitals stop short of this step for the reason that it’s too labor- intensive and hence expensive. Unfortunately, it’s a decision that’s made at the expense of care quality and patient safety.
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. It’s also true that although send-out tests represent a smaller 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 previous post that discussed the practice of using marginal cost-benefit analysis, a method of making investment decisions based on comparing incremental benefits and costs that accrue to the hospital, to decide 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. 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.
