It has become clear that a laboratory’s outreach program now depends on electronic medical record (EMR) connectivity for survival. Because the installation of the EMR in medical offices has proliferated recently, it is necessary for the laboratory that hopes to gain or keep the business of those offices to accept orders generated by the EMR and return results to it.

This can become a complicated proposition, however, because the laboratory information system (LIS) must be able to exchange data reliably with the EMR. Because 50 EMRs are now certified interoperable, many variations on the EMR theme may be encountered in the physician’s office; because there are so many different LIS types in place, both commercial and homegrown, the laboratory’s side of the equation may be no less complex.

The broad adoption of communications standards has improved connectivity, of course, but Health Level 7, which serves as the common language of the hospital information system (HIS), LIS, and EMR, exists in several versions that are not always mutually understood. For this reason, laboratories that lack high-level institutional resources for information management (or that choose not to wait their turns for the attention of these often-overwhelmed services) call on EMR connectivity providers to link them with the medical offices and other facilities that send outreach business to them.

Because much of what was once inpatient testing has shifted to outpatient care in recent years, outreach business can be what keeps a laboratory in sound financial health. Increasingly, laboratories compete for outreach referrals not only through the range of testing that they make available and the high quality of their customer service, but through the ease of use that they can provide to the referring facility.

Where EMR connectivity is concerned, that ease of use, to confer a competitive edge, must be comprehensive on the referring side. If a choice exists, a physician will generally choose to send work to the laboratory that provides trouble-free communication with the office EMR. An even larger advantage favors the laboratory that can set up that EMR connectivity without disrupting the fast-paced daily operations of the referring office or, particularly, without requiring the staff at that office to undergo any training or change any operational habits.

For these reasons, the most valuable kind of EMR connectivity does all the adapting itself, requiring no changes on the part of the medical office. The products that follow do just that, promoting physician use of the laboratories providing such trouble-free EMR connectivity.

EMR CareConnect

CareEvolve, Inc, Elmwood Park, NJ, provides EMR CareConnect as an Internet solution to EMR connectivity. “The state of the market is such that if you do not provide a Web portal and EMR interfaces to physicians, you will not be able to compete with national laboratories, as these features have become more of a requirement in today’s market,” says Brian T. Jones, vice president of sales. “Further, implementing an EMR interface provides for client retention better than any other sales or marketing plan.”

EMR CareConnect is unusual in that it grew out of a laboratory’s own successful implementation of EMR connectivity capabilities, rather than being developed for laboratory use by an external information-technology provider. CareEvolve is a subsidiary of BioReference Laboratories Inc (BRLI), which started the company in 1999 after creating its own thin-client system for order entry and results reporting. That system has been in place for years at more than 500 of BRLI’s own customer locations (including the patient-service centers, nursing homes, and prisons that send work to BRLI).

“We noticed that EMRs were going to be a mainstay of the physician community,” Jones recalls. “We implemented our first EMR bridge 4 years ago in an attempt to ensure that a national laboratory could not take a very large client from one of our customers. The strategy worked, and this inspired us to create a separate product line and market this service to all of our customers.”

EMR CareConnect has the expansion of users’ physician-outreach programs as one of its main goals. CareEvolve uses its internal outreach experts to help clients introduce the idea of EMR connectivity to the laboratory’s customers; then, the outreach experts handle connectivity implementation. They also ensure the full use of the new capability by promoting it among referring physicians.

Connectivity retains existing customers and attracts new ones, Jones says. This is particularly true because most physicians do not want to set up connectivity between their EMR systems and a laboratory more than once. The laboratory that installs the first EMR bridge to a medical practice, therefore, becomes difficult for any competing laboratory to replace (and then profits from this exclusivity).

So far, CareEvolve has built 231 bridges to the EMRs of 50 vendors, and 16 more EMR interfaces are being developed. EMR bridges are in place from medical offices to a $240-million clinical laboratory, as well as from 20-bed hospitals with outreach programs to their physician clients. Jones notes that the company uses unique translation and mapping tools that bring the time needed to go live with an interface down to only a few weeks, even when planning and implementation time are included.

EMR CareConnect decreases the laboratory’s costs, Jones reports, because it eliminates most telephone calls (both incoming and outgoing) and it reduces the need to purchase paper reports, preprinted forms, and related supplies.

Interface Technology Framework

Halfpenny Technologies Inc, Blue Bell, Pa, handles what it describes as the overall interface project through its Interface Technology Framework. “Halfpenny Technologies takes an interface-engine technology built specifically for the complexities of laboratory and pathology work and combines it with the expertise of over 100 collective years of clinical interfacing services,” says Curt Zeberlein, vice president of business development.

Labs using Halfpenny’s interface services are assigned a project manager and a technical liaison. If necessary, medical technologists can also help them through the implementation of EMR connectivity. “Halfpenny can become the laboratory’s interface department,” Zeberlein says. “This provides laboratory and pathology administrators with the ability to offer their clients high-end integration services confidently, without draining internal resources.”

The company focuses on EMR integration for clinical and pathology laboratories of any size. The Interface Technology Framework is highly flexible in other senses, as well. For example, the company can use Internet-based services to connect the laboratory with virtually any legacy system in a physician’s office (and will often have worked with the relevant EMR vendor previously). This can certainly affect outreach business favorably because the office staff can continue to use the system to which it is accustomed; avoiding the investments in technology or training that might otherwise be needed to order tests and retrieve results is naturally popular among physicians.

Additional flexibility for the laboratory client is achieved through Halfpenny’s pricing model, Zeberlein reports. What he calls fair, balanced pricing lets laboratories purchase Halfpenny services according to their needs. Some may choose to have the company handle all their interface needs, while others may prefer to spend less by calling on Halfpenny for help only with the most difficult interfaces. Because the Interface Technology Framework is intended to fill each laboratory’s individual needs for interface services, the company will tailor its services to suit the client.

Labtest.EMR

Lifepoint Informatics (formerly Labtest.com), Midland Park, NJ, offers Labtest.EMR, which makes data from the LIS (as well as anatomic pathology and radiology information systems) available to the EMR in its preferred form of HL7. This gives laboratories a marketing advantage for their outreach services because the workflow in the referring medical office does not need to change. Kristen Mitchell, Labtest.EMR product manager, says, “The dramatic increase in the adoption of the EMR is forcing laboratories to rethink how to sell their services and support their needs.”

The key to ensuring the referring physician’s adoption of EMR interfacing with the laboratory is the ease of use that Labtest.EMR provides, the company says, along with the high efficiency that is promoted by preserving the office’s workflow unchanged.

Physicians’ enthusiasm for Labtest.EMR is also likely to be high because any Web browser can be used to enter orders and retrieve results. Both the laboratory and the referring office can benefit financially from Labtest.EMR’s order entry because requisitions are prescreened for medical necessity, smoothing reimbursement.

“We have seen a broad spectrum of understanding clinical-laboratory processes from the EMR vendors, especially in their understanding of the clinical laboratory’s electronic order-entry needs,” says Preston Law, vice president, development. “Furthermore, many of the EMR systems have distinct requirements, such as needing their order control and patient numbers on the result record. Thus, we play an integral role in being the information hub from the EMR to the laboratories’ respective information systems.”

Labtest.EMR is made available as part of a complete information suite, as a separate module that can operate independently, and as a pass-through engine that works with the order-entry system of any third party. If the target EMR’s business rules support it, Labtest.EMR can deliver both partial and final results, enhancing the physician’s ability to make rapid clinical decisions.

For clinical laboratories operating at multiple sites, Labtest.EMR can be configured to route orders to particular facilities; routing can be based on the patient’s insurance provider, for example, or on the business practices of the referring physician (as well as on the laboratory’s division of advanced testing procedures among its operating sites). Orders that originate outside the EMR are also supported. Some EMRs are unable to accept unsolicited laboratory results, but Labtest.EMR can be set up to overcome this obstacle to fully automated distribution of results.

Novius Lab

Siemens Medical Solutions, Malvern, Pa, has built EMR connectivity into Novius Lab, its comprehensive LIS. David Brumbach, MT (ASCP), product manager, says, “It was important to us, during development, to make sure that our LIS could properly interface with other information systems that feed data to the EMR.”

Interfacing support is part of many information systems and solutions from Siemens, and EMR systems are often set up to support the LIS and similar systems through interfacing options (in essence, extending connectivity from the EMR to the LIS instead of beginning at the other end in those cases). “Today, Novius Lab interfaces with clinical repositories and many other kinds of systems, providing information at the point of need,” Brumbach says.

The Novius Lab approach to EMR connectivity has flexibility because it can use multiple methods of accepting orders from referring physicians and returning test results to them. In the most sophisticated settings, Novius Lab is integrated with a Siemens health information system on the enterprise level. Whenever test results are ready, they are transmitted to a central data repository. This is the system with which the physician’s EMR interfaces for results distribution.

In settings that lack one or more components of the most advanced systems, however, Novius Lab can still accept orders and return results. Orders can be accepted from an interfaced EMR, an HIS, or even through manual data entry. This permits the same system to be used as a laboratory progresses through the implementation of various information-handling strategies over time.

The internal rules-based engine of Novius Lab makes it possible for the laboratory to control transmission of results through the HL7 results interface to the HIS and to multiple EMRs; rules set up by the laboratory determine how the data are transmitted, where they are sent, and when they are cleared to go.

Connectivity Now

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For the laboratory that has not made EMR connectivity available to its referral base, the time to act was yesterday. The physician’s office without an EMR will soon be unable to obtain full reimbursement from some health plans and from federal and state payors, and may have problems complying with regulatory requirements, as well.

Once the EMR is in place, the medical office must often take advantage of the efficiencies that it creates in order to pay for the system. Ordering tests and obtaining results through the EMR are basic components of the productivity boost that offices need, so the laboratory that does not provide EMR connectivity simply cannot hope to gain or retain referrals in the current health care climate.

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Kris Kyes is technical editor of CLP.