The current explosion of healthcare information technology (HIT) will continue to heavily impact healthcare in the foreseeable future. In the US, recent regulations and financial incentives, such as “meaningful use” definitions, accountable care organizations (ACOs) and the emergence of health information exchanges (HIEs) are all part of the push toward patient-centric, coordinated care.
Fundamental to coordinated care is the efficient sharing of information by all stakeholders within the health system, and beyond the walls of clinics and hospitals to the community, the region and the nation. In this increasingly interconnected world, connectivity is a strategic imperative for clinical labs and key to their transition from the health system’s numbers factory to a valued partner in delivering and measuring patient care.
“Meaningful use” of electronic health records (EHRs) is defined by federal regulation and refers to a set of criteria based on which clinicians and hospitals can qualify for incentive payments authorized by the Health Information Technology for Economic and Clinical Health Act (HITECH). The regulation defines a “menu set” of ten objectives, out of which a provider must select five to implement by 2011-2012 to qualify. And one of these menu set objectives, “Incorporate clinical laboratory results into EHRs as structured data,” along with its corresponding measurement, “More than 40% of clinical laboratory test results where results are in positive/negative or numerical format are incorporated into EHRs as structured data,” in effect requires lab data to be applied to judging clinical outcome. Labs will need to provide data to their own and affiliate EHRs in standardized Health Level Seven (HL7) and Logical Identifier Names and Codes (LOINC®) interoperable format. All of this will enable a two-way flow of information between the lab and the EHR and will challenge the lab to go beyond reporting results to providing diagnostic information within the broader context of patient status.
Similarly, labs will increasingly need to provide information on a real-time basis to support ACOs. ACOs are healthcare providers organized around the specific goal of providing quality and cost-efficient care to Medicare beneficiaries with the incentive of receiving a portion of measurable cost savings when specific performance standards are met. The demand for efficient, coordinated delivery across the continuum of care and the focus on performance measurements once again point to the importance of connectivity.
Health information exchanges (HIEs)
Incentives and expectations are materializing for regional cooperatives in the form of HIEs that will demonstrably improve patient care by improving access to patient health information created by multiple providers through broadly shared databases. The Keystone Health Information Exchange (KeyHIE) is one of 16 such beacon community initiatives. At KeyHIE, interoperability is not only improving efficiency and reducing redundancy through coordinated care, and enabling more efficient access to specialized resources, it is opening the door to improving processes.
For example, an initiative is under way to improve physician order entry of lab tests and thus reduce incorrect test orders, a major source of errors. A standardized and simplified user interface will walk the physician through the maze of technical specifications (e.g., qualitative vs. quantitative, ultra-sensitive vs. standard) and help physicians put the test order in the clinical context.
Nationwide Health Information Network (NHIN)
NHIN Direct technology for the delivery of lab results (also known as the Direct Project) is likely to take off this year. Today, labs typically only create interfaces to practices and hospitals that provide them with enough business to justify the interface costs. With the Direct Project, delivering lab results is as simple as sending them via email, with the added benefit of security. The Office of the National Coordinator of Health Information Technology (ONC) is investing to develop capacity for the Direct Project, and EHR vendors are being pressed to deliver EHR products that will receive lab data via the Direct Project and import them into the EHR automatically. This will allow for easy delivery of discrete results to small physician practices and critical access hospitals that have little IT infrastructure. ONC noted recently that it is certain that Labcorp and Quest have been busily developing solutions for this new delivery method, but it is concerned that the smaller labs would not catch wind of this trend until after the big labs cornered the market.
These are just some examples of how connectivity is driving and supporting the quest for improved healthcare efficiency and quality. They point to the strategic importance of lab connectivity—within and outside the lab. IICC was created to modernize instrument interface and interoperability standards to integrate into the mainstream of this HIT flow. Providers and producers of laboratory diagnostic information have teamed to bring about an accelerated movement out of the laboratory numbers factory environment into meaningful and timely delivery of valuable lab information.
Jay B. Jones, PhD, DABCC, Board Member and Chair of the Provider Review Committee, IICC, and Director, Chemistry & Regional Labs, Geisinger Health System