Integration of Paper-based Send Out Laboratory Reports in an Electronic Medical Record

1. Integration of Paper-based Send Out Laboratory Reports in an Electronic Medical Record Walter H. Henricks, M.D.; Kavous Roumina, Ph.D.; Richard M. Hill, M.B.A.; Sandra L. Krall; Shirley A. Stahl Center for Pathology Informatics Pathology and Laboratory Medicine Cleveland Clinic, Cleveland, OH

2. Background • Laboratory test results received on paper from reference laboratories (“send out” tests) represent an important potential gap in lab data management in the EMR era. • Establishing electronic laboratory information system (LIS) interfaces to all referral labs for esoteric tests is not feasible. • Many reports are complex and include charts, tables, or graphs and therefore cannot easily be transcribed into the LIS.

3. Environment and Vision for Handling Sendout Lab Reports • Previous: • Paper copies of outside reports sent to chart • Subset of outside reports transcribed into LIS • Results not readily available to clinicians in EMR • Envisioned: • Images of outside reports scanned into EMR • True copy of report is available (vs. transcribed) • Results readily available to any interested clinician anywhere

4. Objectives • Implement document imaging to integrate paper-based send out laboratory reports into an EMR system • to improve result availability • to reduce errors (e.g. transcription)

5. Technology • Document imaging system (OnBase, Hyland Software, Westlake, OH) • Scanning device (Fujitsu 5750C, Tokyo, Japan). • EMR system with computerized physician order entry (CPOE) (Epic Systems, Verona, WI) • LIS (Misys Healthcare Systems, Raleigh, NC)

6. Design • Entry of an order for a send out test in the EMR triggers an order to the LIS and sends patient demographics and partial order data to the imaging system. • When a paper test report is received from a reference laboratory, a generic result is entered for the pending order in the LIS, and this result crosses to the EMR.

7. Design (cont.) • The paper report is scanned and indexed based on data elements which are automatically populated from data provided by EMR (e.g. patient identification number). • Acceptance of a report “image” by the imaging system triggers a message to EMR, resulting in linkage to the original order. • A hyperlink to the imaged report is displayed in the EMR’s result screen for that particular test order.

8. Paper clip icon identifies orders with scanned reports

9. Hyperlink to scanned result image Generic result entered in LIS and interfaced to EMR

11. Alternate view of all scanned documents for a patient

12. Results (two month evaluation period) • 6241 reports • 8212 pages (1.32 pages per report) • Two scanning devices • Reports available in the EMR on the day of receipt. • 1-2 hour/day scanning and indexing time

13. Results (cont.) • Overwhelmingly positive physician response (no need to track down paper copies of send out lab reports) • Elimination of errors in transcription of outside reports into LIS • Implementation requirements: 3 people involved, approximately 192 hours

14. Conclusion • Integrating scanned images of paper-based send out reports improves result availability, reduces transcription errors, and addresses a deficit in laboratory result reporting in an EMR environment.