There are technical, process and cultural changes that have to take place for the integration of clinical laboratory information systems and clinical electronic medical record (EMR) systems, notes Michael Streetman, Ph.D., a partner in the application delivery area at Dallas-based ACS Healthcare Services.
"The first challenge is the purely technological one — getting disparate applications to be able to communicate with one another, and that involves correctly formatting a lab order and correctly receiving the lab test results back in a format that would automatically update the clinical information system," says Streetman, who has been helping to lead an intensive lab integration and EMR development project at the University of Pennsylvania Health System in Philadelphia.
"Of course, the universal goal is to try to make a patient's information available to any provider who needs it wherever that patient happens to land," says Rick Marshall, manager of lab information systems at Ohio State University Medical Center in Columbus, Ohio. "It's of great benefit to the patient, but it also is a benefit to the provider, as it makes it easier to treat the patient."
At OSU Medical Center, though, lab/EMR integration was essentially completed by early last year. And, as a result, Marshall reports, "The information flows much more quickly, and it's a lot more accurate when it arrives, because you don't have to transcribe it to pass it from one system to another." What's more, everything is Web-based, so that physicians go online, place orders, and then receive lab test results online. And, he adds, "Because we made it easier for them to order, we actually increased the volume of the existing business." OSU's core lab system vendor is Raleigh, N.C.-based Misys Healthcare Systems; Atlas Medical Software, Calabasas, Calif., helped the organization go online.
For the physicians
On the physician group side, Lynda Carroll, lab supervisor at the 40-physician Family Care Partners practice in Jacksonville, Fla., reports that the need to make clinicians and staff more efficient was a clear driver for integration. The process took place in stages — the group went live with its EMR last March, and the integrated lab system went live in June. There had been a lab system in place for a few years prior to the new system's implementation, but when the EMR went live, the only way to get lab results into it was via manual entry.
"We were always hunting for orders and coding until the integration initiative was complete, she reports. (The group uses Carmel, Ind.-based Orchard Software Corporation for its lab solution, and Horsham, Pa.-based NextGen Healthcare for its core EMR.) Carroll and her colleagues say the actual implementation was not difficult. "The start-up costs were higher than expected," notes Frank Allen, the group's business manager, "but it's paid for itself several times over already." Indeed, the group was able to eliminate four positions through attrition because of the implementation.
One area that hospitals, medical groups and health systems really need to look at is the pathology lab, says Steven Olsen, pathology director at High Point Regional Health System in High Point, N.C. At the 373-bed hospital organization, Olsen and his colleagues have taken the visual and data information in pathology reports — microscopic images, diagram-based reports — and have created what they are calling a "virtual print," a visual equivalent of a text-based or image document that one might print out, but which is saved to the hospital's EMR.
The result is something that looks like a PDF, but which allows referring physicians and specialists to not only read and interpret pathology reports electronically, but also to show them to patients if they wish.
Ultimately, Web enablement will be critical to forward progress on both the clinical lab and pathology fronts, says Betty Judge, director of product marketing at Psyche Systems. In the meantime, she says, a major task for the industry will be the development of technical standards for laboratory instrumentation.
The path ahead will be a long one, says Corlice Mims, a Hartford, Conn.-based consultant for ACS Healthcare Services specializing in lab IS. On the one hand, she says, larger patient care organizations with more resources will tend to move far more quickly, while smaller and rural facilities will lag behind. But the IT solutions exist now, she adds, to get the job done.
Mark Hagland is a contributing writer based in Chicago.