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The Role of Laboratory Reports in the The Role of Laboratory Reports in the Adoption of Electronic Medical RecordsAdoption of Electronic Medical Records
LIS – Laboratory Information Systems
Most currently used laboratory information systems have their origins in systems that emerged in the late 1980s and early 1990s to manage the flow of clinical data generated by a medical laboratory.
These systems are designed to
1) reduce transcription errors,
2) increase reimbursements due to automated medical necessity checking and insurance rules for order routing,
3) eliminate costly paper storage, and
4) Provide instantaneous access to both present and historical results, among other capabilities.
Preventable medical errors are the fifth-leading cause of deaths in the US, with up to 98,000 deaths annually.
"This is the equivalent of losing one commercial jumbo jet airliner full of about 270 passengers each day,"
EMR – Electronic Medical Records
• Refers to a software system for recording the medical record in digital form for a doctor’s office or medical or surgical group practice.
• The electronic medical record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.
A day in the life of Sally, physician office receptionist
Web portal (from one hospital)
Web portal (from one hospital)
Courier just dropped off
moreenvelopes
Courier just dropped off
moreenvelopes
Unopened mail
Unopened mail
Fax machine with results from one lab
Fax machine with results from one lab
Unsorted results
Unsorted results
About to ring with
stat results
About to ring with
stat results
“Hey Sally! Where is
Mrs. Jones x-ray?”
“Hey Sally! Where is
Mrs. Jones x-ray?”
Low EMR adoption:
HIT Activity in Bush administration:
In his January 2004 State of the Union Address, President George W. Bush highlighted the importance of information technology in health care when he stated,
“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
In April 2004, the President issued Executive Order 13335, calling for widespread adoption of interoperable EHRs within 10 years, and established the position of National Coordinator for Health Information Technology.
2004 Budget - $50 Million to promote EMR adoption
2005 Budget - $100 Million to promote EMR adoption
AHIC Committee Recommendations:
May 2006: AHIC submits recommendations to Health Secretary Michael Leavitt:
• The need to support all of the necessary steps in the evolutionary path toward a patient-centric flow of laboratory results data
• The urgent need for endorsed, adopted, and interoperable vocabulary, messaging, and implementation standards that can be applied to enable the exchange of laboratory results data
• The potential barriers posed by the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations that may hinder electronic laboratory results data exchange in a patient-centric manner, particularly in States that have more stringent privacy laws
EMR adoption via e-Labs
“Promote the creation/adoption of standardized inexpensive tools for physicians to securely send and receive standardized labs electronically (not fax & not email).
The achievement of this exchange results in offices reorganizing workflows around EDI instead of phone, fax, email, etc. This step is often under rated, but is critical towards EHR migration”
Scott Young, M.D.
Director for Health Information Technology
Agency for Healthcare Research and Quality – www.ahrq.gov
HIT Activity in Obama administration:
February 2009: President Barack Obama this week signed a 1,071-page economic stimulus bill into law, which includes approximately $20 billion for healthcare IT and establishes new rules to protect the privacy of patients' health information.
The bulk of the funding will go to Medicare and Medicaid providers as incentives to use EMRs, beginning in 2011.The providers will be penalized if they do not adopt EMRs by 2014 or 2015, reported Government Health IT.
Additional provision will give hospitals as much as $11 million and doctors between $44,000 and $64,000 per provider for using EMRs.
Lab Report
HL7 Format Results
MSH|^~\&|LIS|LAB|EMR|EMR|20060828140807||ORU^R01|43833|P|2.3|||AL|NE|US||
PID|1|4199800|4199800|191808161|Smith^Adam||19300504|M|||8433 Elm Road^^Fishers^IN^77777||(317) 559-2826||||||555808161|||||||||||
PV1|1||^^^PSC5||||80^Sehe^Regina||||||||||||52120|||||||||||||||||||||||||20030402114500||||||
ORC|RE||52120||||||||||||20060828140807
NTE|1||A copy of this report will be printed for: Cameron, Shelby; Ellis, Mark
OBR|1||52120|55676^Comprehensive Metabolic Panel|R||20030402114500|||||||200304021341||80^Sehe^Regina||||||200304021453|||F||^^^^^R|199^Cameron^Shelby^^^^M.D.~261^Ellis^Mark^^^^D.O
NTE|1||This is a panel level comment.
OBX|1|NM|5654^Na||143|mmol/L|136-145||||F|||20030402114500|MAINLAB
OBX|2|NM|8876^K||4.5|mmol/L|3.5-5.1||||F|||20030402114500|MAINLAB
OBX|3|NM|2321^Cl||107|mmol/L|98-112||||F|||20030402114500|MAINLAB
OBX|4|NM|0098^CO2||28|mEq/L|23-31||||F|||20030402114500|MAINLAB
OBX|5|NM|9878^Albumin||4.2|g/dL|3.4-4.8||||F|||20030402114500|MAINLAB
OBX|6|NM|4563^Ca||10.1|mg/dL|8.5-10.6||||F|||20030402114500|MAINLAB
OBX|7|NM|7765^BUN||13.0|mg/dL|8.4-25.7||||F|||20030402114500|MAINLAB
OBX|8|NM|9987^Crea||1.1|mg/dL|0.7-1.3||||F|||20030402114500|MAINLAB
OBX|9|NM|9980^Alk Phos||91|U/L|40-150||||F|||20030402114500|MAINLAB
OBX|10|NM|4456^T. Bili||0.4|mg/dL|0.2-1.0||||F|||20030402114500|MAINLAB
OBX|11|NM|5565^AST||14|U/L|5-34||||F|||20030402114500|MAINLAB
OBX|12|NM|1123^ALT||13|U/L|0-55||||F|||20030402114500|MAINLAB
OBX|13|NM|2345^GLU||95|mg/dL|83-110||||F|||20030402114500|MAINLAB
NTE|1||This is a lab test level comment.
OBX|14|NM|5543^TP||8.0|g/dL|6.2-8.1||||F|||20030402114500|MAINLAB
Indiana Health Information Exchange – Regenstrief Institute
Public HealthPublic Health
St. FrancisSt. Francis
St. VincentSt. Vincent Clarian Health Clarian Health PartnersPartners
Wishard Health Wishard Health ServicesServices
CommunityCommunity
Global Patient Global Patient IndexIndex
Concept Concept DictionaryDictionary
IUMG PCIUMG PC
IUMG SCIUMG SC
VAVA
MMGMMG
Global Provider Global Provider IndexIndex
Laboratory
Pharmacy
Radiology
ADT
Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3
Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3
Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3
Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3
Transcription
Other
IHIE is a centralized repository of clinical reports
from major Indiana Hospitals. IHIE distributes reports at no
cost to physician clinics.
Indiana Health Information Exchange – IHIE
Clarian Health Partners• Arnett HealthSystem Lafayette• Clarian North• Clarian West• Indiana University Hospital• Methodist Hospital• Riley Hospital for Children
Community Health Network• Community Anderson• Community East• Community North• Community South• Indiana Heart Hospital
Morgan Hospital
St. Francis Hospital & Health Centers• Home Hospital Lafayette• St. Clare Medical Center Crawfordsville• St. Elizabeth Medical Center Lafayette• St. Francis Beech Grove• St. Francis Mooresville• St. Francis South Campus
St. Vincent Health• Pediatric Rehabilitation Center Indianapolis• Seton Specialty Hospital Carmel• St. Vincent Carmel• St. Vincent Indianapolis• St. Vincent Mercy Elwood• St. Vincent Women’s Hospital
Indianapolis / Carmel• St. Vincent Stress Center Carmel
Wishard Health Services
Indiana State Department of Health
In Development:• Howard Regional Health Services• St.Joseph Kokomo• Saint Anthony Crown Point• Saint Anthony Michigan City• St. Margaret Mercy Hammond• St. Margaret Mercy Dyer• St. Vincent Heart Center• PA-Labs• Mid America Clinical Labs• Community Healthcare System (NW IN)
National Health Information Exchange
SmartLinkEMR – historical flowchart view
SmartLinkEMR – lab results graphical view
PHR – Personal Health Records
PHR is a health record that is initiated and maintained by an individual. An ideal PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources and making this information accessible online to anyone who has the necessary electronic credentials to view the information.
Contact
Thank You
