College of American Pathologists
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July 2009

Raymond D. Aller, MD
Hal Weiner

Grappling with EMR adoption? Accept, adapt, and prosper Grappling with EMR adoption? Accept, adapt, and prosper

The accelerating pace at which physicians are adopting electronic medical records is a double-edged sword, with the potential to improve or impair the relationship between laboratories and their physician office clients. But outreach and reference laboratories can use EMR-lab system integration to their ad-vantage by providing client physicians added functionality and simultaneously branding their laboratory services.

“EMRs were meant to provide better patient care and to make the physician’s life easier—they are not necessarily meant to create clean lab orders,” says Rob Atlas, president and CEO of Atlas Development Corp. Atlas recently spoke with CAP TODAY about his 2009 Executive War College presentation, “Branding Your Lab in the Age of the EMR.”

Electronic medical records aren’t intended to meet the needs of laboratories and can even wreak havoc with labs’ branding and ability to operate efficiently, Atlas explains. Wide adoption of EMRs threatens reference and outreach labs’ control of preanalytic and postanalytic workflow and has the potential to reduce the number of clean orders. Yet laboratories have the ability to electronically control such workflow and deploy value-added services that enhance customer relationships and keep the lab’s name—and brand—from being buried in the EMR. In fact, says Atlas, outreach laboratories have, for more than a decade, used information technology to differentiate their services from those of competitors and eliminate the inefficiencies associated with paper orders, with a demon-strable return on investment.

Much of the efficiency associated with systems that connect labs with physician offices, often referred to as laboratory-provider links software, is driven by the fact that physician office staff enter lab orders into these systems, thereby simplifying the lab’s order processing, customer service, and billing work-load.

Laboratories that are making full use of lab-provider links software should be equipped to handle the federal government’s push for universal adoption of electronic medical records, Atlas says. Labs, in general, are key producers of medical information and early adopters of information technology and are already acting as consultants to community physicians, he adds. They should capitalize on these strengths, Atlas continues, and provide additional services to ensure they aren’t perceived as merely “data factories that take orders and hand back results.”

To that end, he says, new and more complicated genomic tests present a great opportunity for labs to offer decision-support services because of the steep learning curve associated with use of such assays. “Help physicians decide what to order and how to interpret results,” Atlas urges. Doing so makes sense because the majority of actionable information contained within the EMR comes from the lab. “Don’t let the EMR or other system get in the way of your lab’s relationship with doctors,” he emphasizes.

The right laboratory-provider link system can wrap around the EMR to ensure the lab gets clean orders and maintains its brand profile. Specific system features that aid branding in the preanalytic workflow process, even if the orders come from an EMR, include the capability to electronically segregate orders that need further processing and cleanup by the physician office, so only complete orders are forwarded to the laboratory, and the ability to automatically print laboratory-branded requisition slips, directions to the lab’s patient service centers, specimen labels, advanced beneficiary notices, and alternate lab requisitions based on payer or lab network rules. Also helpful are the ability to electronically queue problems for a lab’s customer service personnel and physician offices and to automatically check eligibility and preauthorization procedures. Features such as these speed payment to the lab and enhance customer service, Atlas says.

With regard to postanalytic workflow, Atlas suggests that systems auto-print result reports, even when HL7 results are being delivered to the EMR. And because the EMR may not support images or unsolicited results, systems that connect labs and physician offices should enable the physician to view results remotely and provide decision support for follow-up testing and treatment protocols. Systems should allow the physician office to initiate “fax to” or “copy to” requests to consulting physicians and electronically request phone calls, instant messaging, or other modes of electronic communication, Atlas adds.

“Some labs get an order, send results to the EMR, and think they’re done,” he says. “But you need to do these additional things in case problems arise and to brand yourself. The challenge is to orchestrate information transfer. The opportunity is to maintain a competitive advantage over competing labs. That means giving physician offices value-added services.”

CAP STS, dbMotion tackle systems interoperability CAP STS, dbMotion tackle systems interoperability

The College of American Pathologists’ SNOMED Terminology Solutions division and dbMotion have joined forces to build a semantic health information exchange ontology based on SNOMED Clinical Terms, or SNOMED CT, for clinical vocabularies.

“Pairing dbMotion’s software expertise in bridging disparate systems across health care organizations with CAP STS’s deep clinical and technical expertise in ontologies and vocabularies creates a solution to one of the most vexing problems in health care today—lack of systems interoperability,” says Kevin Donnelly, vice president and general manager for CAP STS.

DbMotion brings to the partnership its dbMotion Solution interoperability platform, which connects patient care settings so health care organizations and ex-changes can integrate and leverage patient-specific data and other information.

“This joint development enhances the ability of the dbMotion platform’s applications and services to make use of the true meaning of interoperable shared information that in turn empowers health care teams and enhances clinical workflows,” says Ziv Ofek, founder and chief technology officer for dbMotion.

NetLims offers new release of AP module NetLims offers new release of AP module

NetLims has introduced the latest version of AutoAP, an integrated anatomic pathology module for its AutoLims laboratory information system.

Among the new features in AutoAP are the capability to default sample source and work items according to procedure and print the relevant labels in one- and two-dimensional format; a fast-mode processing feature to automatically handle all steps at the grossing stage; redesigned work screens that include more data; real-time alerts if results are invalid or require additional review; the ability for pathologists to edit results or sign reports from one screen; and a variety of CLIA and non-CLIA management reports, which can be generated from AutoWeb, AutoLims’ integrated Web outreach module, or by requesting an automated report copy that will be periodically faxed or printed, or both.

CSS upgrades software with EMR functionality CSS upgrades software with EMR functionality

CSS has released an enhanced version of its WebResultsView laboratory outreach software, through which the clients of independent reference labs can receive test results using only a Web browser. Users can also export an HL7 file for import into their electronic medical record system.

WebResults View and CSS’ Web-OrdersView are part of a suite of software that allows reference lab clients to quickly place orders, print bar codes, and obtain advanced beneficiary notices via a browser and Internet access. Users receive and download results into their electronic medical record system in the same manner.

Global Patient Identifiers teams with MednetWorld Global Patient Identifiers teams with MednetWorld and Global Patient Identifiers Inc. have partnered to deploy GPII’s Voluntary Universal Healthcare Identifier system.

The service allows participating hospitals, clinics, and other providers to issue cards to patients to identify those patients across any GPII-connected sys-tem while protecting patient data.

Under the agreement, Mednet will offer VUHID-numbered cards to its clients as part of its Mednet NHIN Gateway product suite. Mednet will also donate equipment and software to the nonprofit GPII to help launch the service.

“We feel this service will enhance patient privacy while speeding clinical information sharing in emergencies and disasters,” says John Fraser, CEO and board chairman of

Mednet’s customers include health information exchanges, payers, public health entities, and U.S. researchers working on ways to securely share clinical and research data among numerous parties.

SCC synoptic reporting tool receives CCO certification SCC synoptic reporting tool receives CCO certification

SCC Soft Computer’s SoftPath synoptic reporting tool has received certification from Cancer Care Ontario.

The certification authorizes SCC to assist hospitals in Ontario, Canada, with meeting CCO’s 2008–2009 College of American Pathologists/Collaborative Staging aligned data standards for pathology reporting.

NIH offers licensing for Venn diagram software NIH offers licensing for Venn diagram software

The National Institutes of Health is making available for licensing its interactive Venn diagram software for microarray analysis, genomics, and bioinformatics.

The software is being released for licensing to speed commercialization of results from federally funded research and development projects.

The Java-based software can show multiple conditions in a single graphic along with a text output of specific genes. It can also display numerous comparisons.

Additional information is available at

Contract Contract

As part of its efforts to roll out its advanced molecular diagnostic testing business nationwide, San Diego-based Sequenom Center for Molecular Medicine has selected McKesson’s Revenue Builder technology and billing services product to handle its laboratory billing and collections.

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 Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at