Developing Bidirectional Lab Interface within the EMR

1. Developing Bidirectional Lab Interface within the EMR Lydia Gonzalez, MD, MPH, FAAP Clinical Informatics, Director / EMR Project Manager Mr. Ivan Pan Clinical Informatics, Senior Analyst

2. The Players • MHHC • FHQHC operational for 30 years with 70+ providers, and multiple locations • GE Centricity • EMR product chosen, which interfaces with our PM system • Quest • Lab service for our enterprise • Ignis • Provides Bi-directional interface service (EMR-LINK)

3. GOAL Upon implementation of our EMR, to provide the ability to order labs and receive labs results in a timely fashion. Historically, we ordered on paper requisitions and received labs on paper printouts/lab copies. Providers could also retrieve labs by accessing an internet program, Quest 360 Care. Lab reconciliation was problematic.

4. Background Information • MHHC was involved in a collaborative with 3 other community health centers, known as METCHIT. • CBWCHC, Settlement, Soundview

5. Steps To Interface • Review of historic lab ordering for site(s) • Mapping of distinct labs for each site was sent along with universe of ordering for center • Analysis of frequency of lab ordering for universe, site and specialty was conducted • Development of custom list within EMR for each specialty >>note: In-house labs were not included

6. Ordering Setup • Mapping MHHC lab orders to Quest orders • based on most frequent utilization in the past two year • Simplified orders mapping/referencing:

7. Ordering In Action • Directly order lab test from EMR’s own orders module

8. Reporting Setup • Mapping Quest lab results to MHHC data points (observational terms) • Simplified results mapping/referencing: • Difficulties: • Similar/Same result description with different result code • Lack of report content as a whole • Similar observational terms in EMR

9. Report Is Back • Directly goes into the patient’s chart • Pending ordering provider’s review and signature • All result (data points) are mapped to Observational terms in the EMR

10. At go live – preloading lab data • For each site, a years worth of data is brought over into the EMR. • A list of ordering providers are reviewed, to match with existing providers (issue of misspelling, or providers no longer employed which are then assigned to Director of Service) • Documents are/were brought over as signed

11. Lab Reporting into the EMR • Suppress incomplete lab results • Panic values will be called in • Complete labs are transmitted daily to the ordering provider for signature • Our policy that all documents/labs are signed within 48 hours • Provider is responsible for follow up • Coverage schedule for covering desktop

12. Advantages • On time ordering • Future ordering for returning patients • Timely retrieval of labs • Timely response for abnormal labs • Data driven lab reconciliation is now possible electronically (without separate process) • One of the great HOORAH to EMR implementation.

13. Challenges • Occasional need for partial lab result • Follow up of patient who does not show for lab • Site, center-wide lab reconciliation • Integration with in-house lab • Active PI project