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Will the Federal Government’s Newly “Aggressive” Agenda Bring True Lab Results-Based Interoperability?

March 13, 2013
by Mark Hagland
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Robin Raiford believes that one element in the federal healthcare agenda for 2013 could dramatically improve patient care delivery

A number of important news developments took place at HIMSS13, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information & Management Systems Society, and held March 3-7 at the Ernest N. Morial Convention Center in New Orleans. One of the more important developments was the announcement by Marilyn Tavenner, R.N., acting administrator of the Centers for Medicare & Medicaid Services (CMS), that the federal agencies supervising healthcare—CMS, its parent agency, the Department of Health and Human Services (HHS), and the healthcare IT-focused agency under its aegis, the Office of the National Coordinator for Health IT (ONC), were pushing a very “aggressive” agenda around healthcare IT during 2013.

One area that has proven to be particularly challenging has been how to incorporate clinical laboratory results into the flow of electronic health records (EHRs) in a way that is practicable and sustainable. As HCI’s Senior Contributing Editor David Raths noted in a blog report on Feb. 4, “[A]t the Jan. 29 joint hearing of the federal HIT Policy Committee and HIT Standards Committee, attendees were reminded that sending structured lab data is a bigger challenge, in part due to the highly fragmented nature of the laboratory market.”

Raths quoted Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and chair of the HIT Policy Committee’s Information Exchange Work Group, who noted at that meeting the large percentage of lab results still delivered via fax and paper. Tripathi had cited survey data from the Watertown, Mass.-based AthenaHealth that found an extremely low percentage of lab results being conveyed electronically using LOINC-encoded results (based on the Logical Observation Identifiers Names and Codes, or LOINC standard).

This week, HCI Editor-in-Chief Mark Hagland spoke with Robin Raiford, R.N., research director for the IT Strategy Council at the Washington, D.C.-based Advisory Board Company, about federal healthcare officials’ aggressive policy push, as announced at HIMSS13. Below are excerpts from that interview.

Were you at the HIMSS Conference session at which Marilyn Tavenner articulated the federal government’s overall healthcare strategy on Wednesday morning, March 6, based on the announcement that had just been released that morning about that same strategy?

I wasn’t at the Tavenner session, but I have seen the HHS announcement, and I went to a subsequent town hall Thursday with Farzad [Farzad Mostashari, M.D., national coordinator for health IT]. That was a packed session on Thursday.

Robin Raiford, R.N.

What is your perspective on the level of “aggressiveness” of CMS and ONC in terms of their announced policy agenda for 2013? Do you believe that they are putting just the right level of pressure on healthcare providers right now, or perhaps too much or too little pressure?

I think they’re making their point clearly. And way back in the day when Tony Trenkle was speaking for the government, they said, we don’t have to put all the MU ornaments on one Christmas tree. And they also said they were interested in sharing the benefits of MU with non-acute care, and that was a good intention, though most of those organizations don’t yet have EHRs. But the big news was if they’ve decided to manipulate CLIA [the federal Clinical Laboratory Improvement Amendments of 1998] for the labs. One of the things that CMS kind of controls is the CLIA clinical lab regulations. And so a while back, they said, yes, you’re going to have to put in the director and address of the place that did the lab into the EHR, and you have to put that into your lab system so the lab system could send it to the EHR, and that was kind of a big thing.

But the other thing is that the EHR could absorb this coded lab value via the LOINC standard. So if they require labs to include the code, that’s what should happen, because that’s been a missing link. We often get asked, can our lab send the public health reporting? Well, they could get certified as an EHR module, but the intent is that it’s supposed to come out of the EHR. Well, their labs didn’t have to comply with that, but if they changed the regs [based on a newly aggressive policy agenda this year], that would be big. So for example, what if you had the horrible bug MRSA, someone might code it as “M_R_S_A,” and someone else might type in “M.R.S.A.” And no amount of standardization [of information systems] is going to work unless you have coded values. That’s why that area could prove to be a major development.

There are some potentially large public health and biosurveillance implications of this, if the federal healthcare agencies do end up pushing the industry towards LOINC-based coded lab results, then?