Providence Health and Services, in Portland, Ore., didn’t have a crystal ball, but the health care system was already well on its way to “meaningful use” before the federal government even coined the term.
For the past several years, PHS/Oregon, which consists of eight hospitals and more than 75 clinics, has been adapting its lab information systems to integrate with electronic medical records.
“Having the EMR as the center of the practice and communicating with [our] physician groups is a very important strategy for our organization in years past and in years to come,” says Ruth Johanson, information technology program director for PHS/Oregon. Johanson spoke about the health care system’s EMR efforts at a Dark Report audioconference, titled “New opportunities for your lab’s LIS-EMR interface,” earlier this year.
PHS/Oregon first created LIS-EMR interfaces for the health system’s internal physicians, who were using GE Healthcare’s Centricity EMR. The organization then adapted the link to serve its external physician clients who also used Centricity, Johanson explains. The LIS-EMR interchange allowed for transmission of lab results, transcribed reports, and diagnostic images.
As a growing number of external physician clients began using other EMRs, Johanson adds, the health system started creating point-to-point HL7 LIS-to-EMR interfaces for those clients that didn’t use the Centricity product. The health system also began using a Web-based application from Atlas Medical that allows physicians at offices that don’t use EMRs to view lab results online. “It allowed them to get their results in real-time and in a very controlled manner” versus relying on faxes, she says. “And it still remains very popular with physicians who don’t have EMRs.”
PHS/Oregon also purchased an LIS-to-EMR link application from Ignis Systems to augment the link with its Centricity EMRs. The application can verify lab orders for medical necessity compliance and generate advanced beneficiary notice forms.
Middleware companies can be a valuable resource in wading through the intricacies of EMRs, Johanson says. “They really are a great place to start.”
PHS/Oregon provides lab results to 51 non-PHS clinics, which collectively use 11 different EMR systems, through point-to-point HL7 interfaces, Johanson continues. An additional 284 clients receive their results via the Atlas application.
The health system’s LIS doesn’t offer a link for computerized physician order entry, but that’s coming. “We are looking to move into a bidirectional order and results interface for lab and diagnostic imaging requests to replace that one-way push of results reporting,” she says.
But before a hospital takes such steps, Johanson points out, it should conduct a readiness assessment to determine the strengths and weaknesses of its LIS and how well that system will integrate with a particular EMR system. For example, Johanson says, a lab’s list of tests should be consistent and simple and match up with the directory of services in the EMR. “If you can keep those [variances] to a minimum and have common order sets and standardization, it will help in your ability to implement the EMR connectivity within the lab much more quickly,” she explains.
But LIS-EMR compatibility isn’t the only challenge. It can be difficult to obtain involvement and commitment from EMR vendors, Johanson says. These companies may be rolling out other functionality or implementing other products that take priority, or they may not be willing to discuss their EMR’s lab interface capabilities unless they have a client that is interested in the lab’s services.
Contracting requirements can also be problematic. Johanson says PHS requires there be a contract with the EMR vendor to which the health system is linking, but developing and finalizing such legal documents can take several months.
For these and other reasons, Johanson says, it’s important to have a mature operations model in place that reflects an adequate amount of research about EMR capabilities and establishes clear roles and responsibilities for the vendor, physician client, and lab in developing the LIS-EMR interchange.
“Have escalation paths in place,” Johanson advises, “especially if you’re not getting a response from a vendor. Who is the one that goes to that vendor and brings your request in front of them again? You, as the hospital, don’t have the relationship with the vendor.” It’s the clinics and physician offices that have that relationship.
Communicating with the entire hospital organization is critical as well, Johanson says. “Many people need to be onboard [and understand] what you’re doing and how you’re doing it so they can continue to be supportive. That internal visibility really, really helps.”
You need strong leaders who recognize the importance of external EMRs and who will advocate for electronic connectivity, she continues. “I can’t emphasize how lucky we were as an organization to have a really business savvy lab administrator” who saw the value of this.
Brady Worldwide has introduced the latest version of its LabelMark label-design software.
LabelMark 5.1 offers enhanced lab-specific label-design wizards, data-entry tools, and printing capabilities to expedite the process of identifying and tracking patient specimens and samples.
Users of the software can manipulate their data and design their labels in Microsoft Excel and then print them on a Brady desktop printer or portable label printer. The software also allows users to design page and label dimensions that match the label-printing material in their printer.
LabelMark’s lab design wizards allow users to visually select label parts to design labels for centrifuge tubes, vials, test tubes, slides, tissue cassettes, and other items.
New data-entry capabilities include graphical and fixed-line mode label editing.
The annual HIMSS conference, held earlier this year in Atlanta, adhered to tradition by offering a cornucopia of products and services for laboratories. Like the feasts of past years, the 2010 HIMSS exhibition served up more than 900 companies. Following is a sample of what “Newsbytes” contributing editor Raymond Aller, MD, found to be interesting, unique, or useful.
Exhibiting their latest laboratory information systems at the Healthcare Information and Management Systems meeting were Epic and Keane. After several years spent developing and marketing electronic medical records, computerized physician order entry functionality, and other products, Epic has returned to the LIS marketplace with Epic Lab. The company, a leader in the public health LIS arena in the 1980s with its Epic Cohort product line, has installed Epic Lab, which is designed for clinical and public health labs, in several sites.
Keane went live with the first site of its new LIS, Keane Optimum, last year and expects to install several more sites this year. The new LIS is based on the .Net and the Internet Explorer browser.
The Marshfield Clinic displayed its clinical information system, Cattails, at the HIMSS meeting. The medical facility has used the clinical system, which it built over the past three decades, for its internal operations at the clinic and its related practices. Recognizing the value of the system, the clinic decided to market the product and its component parts, including a full-featured LIS, to the general U.S. hospital and laboratory market.
Not every lab information systems company sells LISs—some help labs eek more value out of the systems they already own. These vendors typically specialize in a particular brand of laboratory or hospital information system but work on others as well. Among the companies offering such services and that were exhibiting at HIMSS was S&P Consultants, which specializes in fixing or enhancing Cerner applications. Softek Solutions and Liberty Solutions offer products to monitor and manage Cerner Millennium systems as well. The Shams Group and Healthline Information Systems provide enhancements to the general functionality of Meditech systems. Shams also works on systems from CPSI, Siemens, and QuadraMed. And Interface People focuses on creating interfaces between Meditech systems and other clinical and administrative systems.
The number of biometric technologies to positively identify patients and medical staff continues to grow, as evidenced by an abundance of such products at the HIMSS show. The exhibition not only featured products for fingerprint identification, such as those marketed by Lumidigm and Care Fusion, but also those focusing on other body parts. Among the latter were the latest generation of Eye Control’s SafeMatch iris identification system, as well as Fujitsu’s PalmSecure palm vein identification solution and Hitachi’s VeinID product for recognizing vein patterns in the finger.
Several vendors also displayed software to manage biometric information across the enterprise. MediBase featured its Basemetric integration software product, which uses Hitachi finger vein technology to identify returning patients. Indigo Identityware’s secure fingerprint identity manager application, also called Identityware, provides integrated real-time single sign-on access. Not only does the system sign on users, but it recognizes what applications they access most frequently. And M2Sys’ BioPlugin Hybrid server integrates biometric technology for fingerprint, palm vein, finger vein, and iris into a variety of applications for identifying patients or medical staff.
For decades, health care informaticists have recognized that, in general, laboratories need to do a better job of testing and validating system functionality not only when installing a new system, but every time they do an upgrade. Among those vendors touting automated testing tools to help with such tasks in the laboratory was Ratio, a division of Software Testing Solutions, which featured modules for testing and validating Sunquest blood bank and lab information systems and other products. Vedant displayed its TestStream product for testing and validating LISs from such companies as McKesson, Cerner, and Sunquest, as well as a variety of blood banking systems.
For laboratories that have retired an LIS or clinical system but keep it running simply to retrieve the exact im-age of an old report or other data that were not migrated over to the new LIS, Legacy Data Access offers a solution. The company presented its service to remove data from old lab systems and make the information avail-able long term on the company’s Web-based repository.
A fascinating application featured at HIMSS was Electronic Breadcrumbs, from EBC Wayfinding, a locator system that helps hospital patients and visitors find their way. Patients or visitors go to a kiosk in the hospital lobby and select a destination from a list. The kiosk then prints out detailed directions to that location. If users are unsure they are going the right way or decide to make a side stop, they can go to any kiosk, scan their bar code, and print specific directions from their present location to their destination. The direction slip can also provide detailed instructions in reverse for exiting the hospital.
AssistMed has released the Duet data-transformation platform.
The product allows health care professionals to dictate or handwrite medical information and receive it back in a secure format as digital input for health care information systems.
AssistMed Duet “allows physicians to record their speech using inexpensive recording devices,” such as a digital recorder or phone, says Leonardo Berezovsky, MD, AssistMed’s chairman and CEO. A digital pen that uses Anoto technology can be used to capture handwritten data from familiar paper forms.
Duet is a software-as-a-service solution available as a transaction or subscription model.
The system securely transmits data to the company’s hosted plat-form and processes the information without interfering with a physician’s workflow routine.
Orchard Software recently launched its blog, eLABorate.
“Our goal with eLABorate is to provide the laboratory community with an assortment of topics discussing clinical labs, anatomic pathology labs, informatics, reporting, integration, and the latest with molecular testing,” says Curt Johnson, Orchard’s vice president of sales and marketing.
The blog is located at www.orchardsoft.com/blog.
Dr. Aller is director of automated disease surveillance and team lead for disaster preparedness Focus B, Los Angeles County Department of Public Health. He can be reached at firstname.lastname@example.org. Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at email@example.com.