The Tech Doctor: Evaluating Paperless Labs

Depending on your specialty, how much time you spend reviewing labs can vary. Regardless, it’s critical to keep a handle on the inbound stream of lab results from your external lab partners. Whether your facility is sending labs to a nationally recognized lab services provider, or just across the street to your affiliate hospital, electronic lab results could make your life easier. With a little focused exploration, you may be able to eliminate that sense of dread every morning, when you see your office fax machine flashing “low toner,” buried under a pile of faxed labs…while you wonder if any got “lost in transmission.”

How you implement electronic lab results is largely contingent on your current information technology infrastructure. If your practice has an EMR system in place, integrating electronic lab results is less daunting. For the purposes of this article, let’s assume that your facility has some type of networked computer system; a practice management software solution; some form of basic EMR software functionality; and the ability for computers on your network to connect externally via Internet, dial-up modem, or some other method.

Talk the talk

The first thing to remember when pursuing an electronic lab result solution is where you fall in the food chain. Remember that you are the customer and your lab is the vendor. Vendors should assist you with improving your practice and, they should go to great lengths to make you happy. Some groups with close ties to affiliate hospitals handling their labs, or in areas with limited laboratory options, may feel pressured (read: bullied) to concede to the alternative position where the vendor tells you the customer what they will and will not do. Don’t fall for it. Let’s look at the nuts and bolts.

In the healthcare IT industry, you will hear the term “interfaces” used to describe the software/hardware system that allow one computer system to transmit data to another system. These systems can be single direction (data flowing only one direction), or bidirectional (data flowing in both directions). For instance, a single-direction interface might only send lab results from the lab’s system into your system after a patient shows up with a paper lab order in hand. But a bidirectional system might allow you to send lab orders from your computer system to the external lab via the interface, and the lab results would return to your computer system via that same interface.

In healthcare IT, when you hear people talking about these interfaces, you undoubtedly will also hear the term “HL7” thrown about. You can safeguard yourself from this iconic piece of techno-babble by just remembering HL7 is simply the “language” in which interfaces talk to your computer system. You will hear magical things about HL7, its complexities, its faults, and its strengths … but unless you want to become a programmer, let it be sufficient that you know that LabSystem X talks to LabSystem Y in messages formed in HL7.

Ask questions

When you begin to talk about healthcare lab interfaces to IT people, depending on your facility size, and their expertise, you may get varying responses about cost estimates and vendor willingness to participate. To wade through those responses, ask your IT resource/EMR software vendor the following:

• What do I have? Does your current EMR software support receiving labs electronically? Regardless of interfaces, if your software doesn’t have a place to put the labs (in some software, this may be part of a separate lab module application), then you may need to purchase such a lab module, for your EMR application.

• Who do you know? Does your EMR software have an existing relationship with the lab you are currently using? In many cases, if you are using a large, well-known lab service, your vendor may have already developed an interface to that lab vendor. If that’s the case, your EMR vendor may be able to simply pull the pre-written interface from their software library, and deploy it onto your system.

• Can I see it? If a relationship between the lab and your EMR vendor already exists, ask for reference sites currently using the interface in their offices. Try to arrange a site visit, or at least a conference call, to a few of those sites to get a feel for how the system performs, what work flows surround implementation of the system, what problems that facility experienced, and what type and volume of labs their facility is seeing on a daily basis.

• What is the timeline? Ask your vendor about their historical experience in turnaround once you agree to go forward.

But you’re not finished with the questions. Here’s what you should ask your external laboratory sales/client representative:

• Who do you know? Although it might seem redundant, ask your lab sales representative if they have an existing relationship with your EMR vendor. Their answer should match your EMR vendor’s response, but you may be able to glean additional information, such as other facilities in your area that are already using the interface you are considering.

• How much will it cost? Pricing is where remembering your relationship with the vendor comes in handy. Approach labs with the assumption they will be covering the costs of your interface, both on their end, and on the end of your EMR vendor. An aggressive haggler should argue that by virtue of their desire to retain your business, they should see a short-term capital outlay (such as paying for your interface implementation costs) as small potatoes compared to getting your lab business for the indefinite future. Additionally, electronic results often are more reliable than fax, and should reduce overhead by eliminating calls for additional copies of missing or lost lab results.

Make it a “go”

In a best case scenario, your lab vendor and your EMR software vendor will have danced this dance many times before. You will drive to a nearby facility and be mesmerized at the efficiency of physicians approving labs with the click of a mouse, and viewing them online with the patient. Your lab vendor will cover 100 percent of the implementation costs, and you will begin receiving your labs electronically within 60 calendar days of signing the agreement. Be aware, some labs might expect you to sign a new contract extending your agreement with them, for the courtesy of them covering your implementation costs.

In a worst case scenario, your lab either is too small, too technologically unsophisticated, or simply unwilling to allocate resources to pursue an interface. An alternative worst case is if your EMR vendor makes implementation of their lab module so cost prohibitive, that it becomes unrealistic to pursue the interface, from a costs perspective.

No matter what your scenario, be sure to follow up with your vendors regularly about advances in their lab interface deployments. A vendor (on either side) may develop a new product for the interface that could benefit you, but unless you stay in close contact with your partners, you might miss out on the upgrade.

Jonathan McCallister is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via kellie.rowden-racette@cmpmedica.com.

This article originally appeared in the November 2008 issue of Physicians Practice.