When asked which features they'd find most valuable in an electronic health record (EHR), the majority of physicians put lab data high on their list.
Ambulatory EHRs and laboratory information systems, however, tend to speak different languages. Linking them usually involves translating proprietary lab system codes to a separate set of codes established by the provider.
But the December 2006 announcement that health IT standards group Health Level Seven of Ann Arbor, Mich., would adopt and maintain the ELINCS (EHR-Lab Interoperability and Connectivity Standards) data standard offers hope that vendors will be able to move closer to plug-and-play interoperability.
"As EHRs increasingly include clinical decision support tools, the information physicians rely on to make decisions needs to be in computable form and it has to come from labs and pharmacies," says HL7 board member Bill Braithwaite, M.D., Ph.D. "If that level of interoperability isn't achieved, then the decision support tools won't be taken advantage of."
The birth of ELINCS
ELINCS grew out of quality improvement and pay-for-performance efforts started several years ago by the California HealthCare Foundation, Oakland. CHCF project leaders wanted to include pharmacy and lab information in their measurements using EHRs but were stymied by the lack of interoperability.
"We wanted to get to outcome data, not just process data," explains Sophia Chang, M.D., director of the foundation's Better Chronic Disease Care program. "In other words, we wanted to see not just that someone had a hemoglobin A1c test, but what the results of that test were. The missing link was a standard for the exchange of lab results info."
CHCF developed a standard called Calinx, which became the foundation for ELINCS. At the request of David Brailer, M.D., former national coordinator for health information technology, CHCF spent most of 2005 working with laboratories, providers and payers to develop a national implementation guide based on HL7 messaging standards, but much more specific. For instance, ELINCS requires that all systems use the LOINC (Logical Observation Identifiers, Names and Codes) coding system for frequently reported tests. (Although the ELINCS project is moving to HL7's control, LOINC development will remain at the Regenstrief Institute, Indianapolis.)
In 2006, CHCF launched five pilot projects in California that involved major commercial labs Quest Diagnostics Inc. (Lyndurst, N.J.) and LabCorp (Burlington, N.C.), as well as EHR products such as GE Centricity and AllScripts Touchworks. "We wanted to see whether ELINCS is appropriate for use in live clinical information exchange," Chang says. Once it deemed the pilots successful, CHCF sought an adoptive parent for ELINCS. "It made the most sense to hand this off to an appropriate standards development organization," Chang explains. "We were always focused on the proof of concept."
CHCF had good timing, because while it was looking for a new home for ELINCS, HL7 was deciding it should start adopting externally developed implementation guides.
"The organization wants to make itself more relevant to groups implementing technology, not just to developers," says Bill Braithwaite, an independent health information policy consultant in Washington, D.C.
So ELINCS may be just the first of many HL7 adoptions of detailed implementation guides.
What significance does HL7's adoption of ELINCS have for EHR and lab info system vendors and their customers?
The work on ELINCS is taking place in pilot projects, and vendors and providers are discovering its constraints, Braithwaite says.
Many see it as a good start that just needs some tweaking.
"It's important to vendors that they have one standard they can work with, instead of three or four," he says. "The vendors were eager for something like this, and as it evolves they can have a say in how changes are made to it."
Several lab and EHR vendors demonstrated ELINCS at the Integrating the Healthcare Enterprise's January Connectathon in Chicago and at the Interoperability Showcase at the Healthcare Information Management and Systems Society (HIMSS) conference in New Orleans in February.
For providers, easier access to lab data may speed the widespread adoption of EHRs.
"This could have a huge role in promoting health IT adoption and, more importantly, improving clinical care," Chang says, "but the spec needs to be maintained and altered to keep up with all the changes taking place in the field."
David Raths is a contributing writer based in Philadelphia.