LIS Upgrades: A Mission to Transform Healthcare

How are LIS upgrades affecting modern healthcare?

Well, they’re going far beyond laboratory interoperability of patient registration, orders, specimens, results, and reports. Impacted by many other systems in the health IT ecosystem, the use of LIS is growing beyond in-patient care to involve ambulatory care as well.

As Meaningful Use (MU) requirements evolve, CPOE and lab reporting are becoming required by MU 2 and laboratories are starting to attend to interfacing problems. These difficulties will continue to be met by the regulations of MU 3. The interoperability challenges of managing and synchronizing the test catalog across the network, mapping it correctly to LOINC, identifying patients across multiple client electronic medical records (EMRs), and reporting distribution across multiple systems are vital issues for the organization, compliance, and most importantly the patient’s safety.

Regulations oblige current interfaces to upgrade to 2.5 and above, and MU 3 may require upgrading to HL7 3 and above. The software and information design of system interfaces, though well-established, is not plug-and-play, and the development of additional standards is underway.

LIS Upgrade Strategies to Achieve MU Goals

An LIS administrator should develop a strategy based on overall functionality, compliance, and federal reimbursement. As a result of wider implementation of EHR, the healthcare industry faces dramatic increases in expectations for LIS-EHR interfaces to meet MU requirements. Those involved in this process should be proactive, as there is a limitation on EHRs in lab test orders and result handling. Lack of control or involvement in the EHR management will create significant issues and poor process designs, resulting in lab testing problems being blamed wrongly on the lab.

More and more physicians have implemented certified EHR and therefore will be less likely to get paper results, as they receive data via the interfaces in the form of incorporated and structural data. EHR must incorporate LOINC for test names and SNOMED for non-numerical results such as microbiology.

In a healthcare ecosystem, if a lab wants to keep its accounts with its affiliated physician practices, it must provide all appropriate LOINC/SNOMED data via interfaces as incorporated and structural data. The order will not go through if the LOINC data is defined one way and the receiving system defines it differently, as this leads to interoperability issues. On a broader scale, if coding is not implemented uniformly across all data providers, it may limit how generally the information in that dataset may be used.

If LOINC for protime is not mapped the same way as the other protime in an EHR at an ambulatory practice, it might get caught up in the query of a large data set.

The 2014 edition of MU encourages hospital-based laboratories to help ambulatory providers and their EMRs meet the MU criteria through a new menu item: Transmission of Electronic Laboratory Tests and Values/Results to Ambulatory Providers 170.314(b)(6). Laboratory administrators should develop a strategy for certified ambulatory results whether or not the eligible hospital intends to use the menu item 170.314(b)(6). Eligible client providers using certified ambulatory EMRs must have certified results from an appropriate hospital. Commercial labs that have been outside of the MU umbrella will also feel the pressure.

In addition, all reference labs will have to provide LOINC to their recipient system. Each result that is not MU certified will dock the receiving physician’s MU goal. While the criterion is a “menu” option for hospitals, it is essential for ambulatory EMR providers, and therefore a customer satisfaction issue and a competitive differentiator.

It is likely in futures stages of MU that the laboratory will play an increasingly critical role and that objectives related to laboratory interoperability will be extended. An ONC workgroup is already establishing standards for laboratory orders. By engaging the laboratory in MU planning and utilizing LIS to meet laboratory-based objectives, the administrator integrates MU into existing workflows. Facilitating the integration of resources, providers, and EMR data makes the organization better able to achieve its MU goals and to capitalize on the potential value of its laboratory.

Certification Challenges for Meaningful Use Stage 3

Another area to think about is the certification challenges for MU 3. The interoperability issues are not limited to EHR or providers, but also include vendors. According to one survey, there are 980 interfaces certified with stage 1, but just 79 EHR products that survived MU stage 2. Stage 3 will be a challenge for everyone, including vendors and providers. The following list compares the design aspects of versions 2 and 3. Features in version 3 are more likely to gear themselves toward themes for improved outcomes in developing MU 3 regulations. 

HL7 Version 2

• Defines message types for medical events:
  • Admission/Registration/Discharge/Transfer
    
  • Queries, Orders, Results, Clinical Observations
    
  • Billing, Medical Records, Etc.
    
• Defines transaction model for using the messages (initiation, response, error handling)
  
• Defines message structure (data fields), but limited requirements for content
  
• Pragmatic standard that predated terminology standards
  
• Incorporates LOINC for test names, SNOMED for non-numerical results including microbiology
  

Goals for HL7 Version 3

• Substantially reduce interface development time
  
• Clarify spec for messages
  
• Fully-defined information model for messages
  
• Method for conformance specification
  
• Support modern communications infrastructures
  
• Reference Information Model (RIM)
  
• Coherent shared information model
  
• Includes all content of HL7 messages
  
• Provides consistency to messages across usage settings
  
  

About the Author

Twinkle Patel is an LIS consultant with the HCI Group. Twinkle has more than seven years of progressive experience in health information system at various roles including Clinical Lab Scientist, Implementation and Support Specialist, LIS Coordinator, Independent LIS Consultant.