eLab Electronic Lab Test Ordering: DMDD's Danish Perspective

Pathology test orderingan International perspective

Erik JacobsenCEO DMDD

Pathology test ordering

o International perspective

o Denmark - background

o The requirements we needed to satisfy

o The achievements so far

o Briefly how it works

o What the future holds

Agenda

International perspective

o Electronic ordering in Europe and the US (early 90’s and now)

o What Denmark decided to do

o The organizations involved: DMDD, Medcom

Denmark - backgroundo A small country: 43.000 Km²

o Distances: West – East 300 km

South – North 400 km

o Inhabitants (total): 5,5 million

o Major cities: Copenhagen 1,25 mill

Århus 0,25 mill

Odense 0,17 mil

Ålborg 0,10 mill

o 5 regions: Region North

Region Middle

Region South

Region Zealand

Capital Region

Laboratories in Denmark

o Biochemistry (KKA) 44Immunology

o Microbiology (MIK) 17

o Histopathology (PAT) 19Cytology smearHematology

o Other special laboratories 3

• Nearly all are located at - or directly connected to - hospitals.

• Nearly all are directly government founded.

• All laboratories receive EDIFACT messages. Some also use web services.

Lab results in Denmark

• All lab results electronical by messaging• Biochemistry• Hematology• Immunology• Microbiology• Histopathology• Cytology smear

• All labs : 80 with 13 different LIS-systems• All GP´s and private specialists, 21 systems• All based on national MedCom standards• Many to many solution• Certified and approved systems

The ordering system: WebReq (eLab)

• Developed by DMDD A/S– Founded in 2004– Founded by 4 companies making electronic patient record

systems for the primary health care in Denmark– Made in cooperation with MedCom Denmark

The requirements we needed to satisfy

What patients want

o “I only visit my GP, my specialist doctor or the hospital once”

o “All ‘normal’ samples should be taken at that same visit, no matter how many different labs are involved” (some may be processed at the doctors clinic instantly)

o “No extra unnecessary visits to any other healthcare location”

o “Naturally I expect earlier lab results to be available to all relevant healthcare personal any time at clinics or at hospitals”

o “I want a trustworthy and reliable test procedure - no faults allowed”

o “Why do the same test again, when it was done recently somewhere ?”

What doctors wanto “Read my mind and make the order automatically”

o “Just one click and my requisition is finished”

o “The keyword is profiles “ (individual clinic, personal or patient)

o “All laboratories must be available and visible for all requestors – but all clinics have

their own default lab”

o “WebReq must support the different kind of workflow in different types of clinics”

o “WebReq must support the different kinds of requisition types”:

- Sampling in GP Clinic

- Ordering in GP Clinic (sampling at laboratories)

- Ordering in GP Clinic (sampling in patients home)

- Ordering in hospital or at private specialists (sampling in GP clinic or in lab - hotel function)

What laboratories wanto Minimize costs and improve quality requesting and receiving lab-orders, by:

- correct labeling and identifying of test-tubes - initially marked

- all information about all tests are available at requesting and sampling time

- no keying in any data at the laboratory when receiving tests

- reducing the possibility of faults

- guiding requestors to order the right batteries of tests for the actual purpose

- making it possible to prompt the requestor for the needed extra information

- making it easy to change analysis data - (takes effect immediately)

- not using special laboratory paper forms

o Manage the analysis repertoire and information for external requestors:

- changes of repertoire- and analysis data to take effect immediately

including all instructions of prompts for additional clinic information

- recommended profiles to be distributed immediately

- general laboratory news and information to be distributed immediately

What government and society expectso More healthcare benefits for less costs or same costs:

- national monitoring of the requestors use of lab-tests

- no unnecessary tests

- national guidelines and common disease profiles

- improving quality – check procedures of external devices

- running information and education of requestors

- possibility of scientific research on the fly

- making request- and result data available for all other healthcare personal

- healthcare should be ONE transparent system - just like Kaiser Permanente

o The citizens must use as less time as possible on healthcare, by: - avoiding visiting healthcare institution unnecessarily

- staying at work and pay more income tax

- getting well as quick as possible

o National codíng of analysis and national shortnames is a challenge

- Common coding of analysis and names - a benefit for all, even for laboratoris - “External” testsresults must also be available on central national labresult servers

The achievements so far

Electronic messaging in Denmark

•Prescriptions

•Discharge letters

•Lab results

•Lab requisitions

•Referrels

Benefits1. Mislabelling reduced

• 209,000/ year

2. Incomplete, unreadable• 325,000 reduced to 91,000

3. Registration, not necessary• Savings 32,500 hours

4. Reduced time for reception • Savings 43,000 hours

Benefits1. Implemented to 90 % in 2 years - (statement 2010)2. Fully financed by savings in preprinted forms3. Money reserved for further development4. Organised in a MedCom usergroup5. Cost app.

− 22 £ pr. GP clinic pr. month ( incl. 5 £ for development)− Webreq Form 0.025 cent/each

Quality improvements

0

5

10

15

20

% o

f all r

equis

itio

ns

18

2

Paper WebReq

WebReqTube labelling - failures %

WebReq Reduce Errors and Costs•http://www.hl7.org.tw/jith/

Briefly how it works

Central serversWebReq laboratory requisition

•WebReq

•MEDREQ•MEDRPT

•Web services

Getting down to earth!

o What is needed to start using WebReq:

1) PC with an updated browser - with or without an EMR - system

2) Laser printer with a paper magazine

3) Internet accesso You are on!

Lab results in a GP-system

National Lab result Health Portal

Lab results Health portal

• Using MedCom national webservices• Calling nearly all laboratories.• Access to all labresults from last 5 years• Based on Patient ID• Access using digital certificate

• Access directly from Webreq since 2012-01-20

Paper based requisition

GP-lab test orders

1. Sampling in GP Clinic2. Ordering in GP Clinic, sampling in lab3. Ordering in GP Clinic, sampling in patients home.4. Ordering in hospital outpatient or by private

specialists, sampling in GP clinic or in lab

5. Web Quality6. Web Scientific Research

WebReq e-orders

WebReq e-orders

WebReq e-orders

WebReq e-orders

WebReq universal nationalrequisition form

WebReq e-orders

Cooperation agreement about export to:

New Zealand (2010-2011)Australia (next 1 - 3 years)Canada (next 2 - 5 years)

Contact established: Germany

The Future