August 2010

Editors:
Raymond D. Aller, MD
Hal Weiner

A case for reporting laboratory results to EMRs in dual formats

Laboratory information systems should report results to electronic medical records and other external systems in two parallel formats—as discrete, fielded items and as formatted reports represented in PDF.

A system needs to receive fielded, or differentiated, data to activate decision rules based on individual field values. For example, an EMR might need to fire an alerting rule for a platelet count of less than 50,000, which doesn’t work with a full-page Portable Document Format, or PDF, report. Fielded items are also necessary because formatted reports are not amenable to such manipulations as computation, firing of rules, or trending by modern EMRs. Furthermore, formatted reports are problematic for electronic reporting to public health agencies since the receiving system can’t locate the diagnosis or microorganism amongst the human-readable formatting.

Despite these drawbacks, formatted reports, which may include graphical or image elements, such as photomicrographs, are essential to ensure that physicians understand the information being conveyed. Therefore, all electronic medical record systems should be able to display results as a PDF, in addition to providing them in a fielded format. Laboratory-formatted reports are essential for more complex result types, such as those for surgical pathology, molecular pathology, and flow cytometry, as well as when displaying clinical findings in a table format.

Laboratory results should not be presented to the EMR as a simple block of text because blocks of text cannot be computed at the individual result level nor printed as a report.

Garbling of meaning by an EMR or other clinical system has proven to be a problem with even relatively simple lab reports. We recently learned of a receiving electronic medical record system misinterpreting text being sent from a surgical pathology lab information system. The lab report stated “no evidence of abnormality,” but the receiving EMR displayed it as “evidence of abnormality.” In another system, report lines longer than 60 characters were truncated without warning.

Because of such issues, it is unrealistic to expect EMR vendors to reconstruct complex reports from a myriad of fields in an HL7 transmission. This effort would take years and be cost prohibitive. Consequently, laboratorians should insist that their LIS suppliers send a dual data stream for any results interface. LIS vendors should provide the traditional HL7 fielded stream, which can be used for those analytes trended by the EMR or as an alert trigger, as well as PDF pages of all analytes as the LIS would have printed them. LIS companies and laboratories that have a policy of sending a PDF only for a complicated format may jeopardize patient safety.

In the future, it is possible that these dual needs may be satisfied by transmitting reports in HL7 Clinical Document Architecture, or CDA. But in the meantime, PDF provides a simple and reliable alternative.

So why don’t all LIS vendors automatically send a dual data stream for laboratory results interfaces? Consider posing this question to your LIS vendor.

Federal government releases final rules on meaningful use

The Department of Health and Human Services has released the final rules establishing Medicare and Medicaid incentive programs for the meaningful use of electronic health records under the American Recovery and Reinvestment Act of 2009.

One of the regulations, issued through HHS’ Centers for Medicare and Medicaid Services, defines the minimum requirements providers must meet through use of certified electronic health records to qualify for federal payments. The other rule, issued through HHS’ Office of the National Coordinator for Health Information Technology, addresses data standards, implementation specifications, and certification criteria for EHRs.

The general consensus, based on more than 2,000 public comments, was that the criteria that were originally proposed were too ambitious, said HHS Secretary Kathleen Sebelius at a media briefing announcing the final regulations. Consequently, some criteria in the 864-page document were relaxed, including the following:

• Stage one meaningful use criteria were revised to include 15 core objectives for eligible health care professionals and 14 for hospitals. The criteria also include a menu of 10 other objectives for eligible providers and hospitals, of which, five must be met. The proposed rule had established 25 core objectives for providers and 23 for hospitals. The remaining objectives will be deferred until the second stage of adoption, in 2013.
• The requirement that computerized physician order entry be used for orders for medication, laboratory tests, and diagnostic imaging was revised to omit laboratory and diagnostic imaging orders.
• The requirement that physicians generate and transmit electronically 75 percent of permissible prescriptions was changed to a minimum of 40 percent in the final rule.
• A proposed requirement to submit claims and eligibility transactions electronically has been deferred until stage two of implementation.
• The number of clinical quality measures that must be met to demonstrate meaningful use has been set at 44 for eligible providers, with a requirement that they comply with six of them, but they are not required to meet specialty-specific measures. The proposed rule listed 90 measures, of which eligible providers had to comply with three general measures and three specialty-specific measures of their choosing. Clinical quality measures for hospitals were reduced from 35 to 15 mandatory measures.

Also under the final rule, clinicians will be required to report data on three core quality measures—blood pressure, tobacco use, and adult weight screening and followup—starting next year. They must also select three other measures from established lists for reporting purposes.

The amount of incentive money available under the rule remains the same, allowing physicians and hospitals to carve up $27 billion in bonus Medicare payments for adopting EHRs. Physicians can receive up to $44,000 from Medicare, and slightly more if they practice in underserved areas, or up to $63,750 from Medicaid.

The final rule is available at www.ofr.gov.

Association for Pathology Informatics unveils journal

The Association for Pathology Informatics has launched the online Journal of Pathology Informatics. The open-access, peer-reviewed journal will feature such content as original research articles, technical notes, book reviews, commentaries, editorials, and letters.

The release of the electronic publication brings to fruition a dream of William Dito, MD, a pioneer in pathology informatics. In the late 1960s, Bill contributed to such publications as the American Journal of Clinical Pathology and Archives of Pathology articles about using informatics to improve various tasks within the laboratory. He also shared his knowledge in presentations at national pathology meetings and through teleconferences.

By the early 1980s, it became clear to Bill that pathologists needed a journal focused on informatics. Therefore, he took on the role of editor for Informatics in Pathology in 1984. But despite early enthusiasm, many pathologists skilled in informatics were too busy or otherwise preoccupied to submit articles to the journal. Consequently, even with Bill’s valiant efforts, publication ceased at the end of 1987.

Today, many more physicians and other medical professionals are practicing informatics. Academic organizations are according professional recognition for informatics research. And an electronic journal can provide information more rapidly and to a wider audience than can a print magazine.

Bill died in 2004, but if he were still with us, he would surely join me in applauding the Association for Pathology Informatics for introducing its official journal.

The Journal of Pathology Informatics is edited by Anil Parwani, MD, PhD, and Liron Pantanowitz, MD, both of the University of Pittsburgh Medical Center. To access articles or submit manuscripts, go to www.jpathinformatics.org.

Medrium to use laboratory results distribution system of RelayHealth

RelayHealth has signed an agreement to provide the health care information technology company Medrium access to its laboratory results distribution systems for exchanging information via Medrium’s electronic medical record.

The partnership will link the Web-based communication services of McKesson’s RelayHealth division with Medrium’s EMR. This will allow physicians using the EMR to automatically receive results from LabCorp, with which RelayHealth has a relationship nationwide.

Medrium, Circle No. 190

RelayHealth, Circle No. 191

CDC grant to support electronic exchange of laboratory data

The Centers for Disease Control and Prevention has awarded the Association of Public Health Laboratories a $2 million grant to provide technical assistance for advancing the electronic exchange of laboratory data.

The two-year grant supports technical assistance for linking disparate laboratory reporting systems at state health departments, public health laboratories, and hospitals.

The award is funded through the federal government’s Health Information Technology for Economic and Clinical Health, or HITECH, Act.

Contracts

St. Petersburg, Fla.-based All Children’s Hospital has expanded its relationship with Mediware Information Systems by purchasing Mediware’s BloodSafe Tx handheld software application. The product, which verifies patient identification and validates blood and transfusion specifications at the patient’s bedside, is fully integrated with Mediware’s HCLL Transfusion blood bank software.

Mediware Information Systems,

Circle No. 192

Pathology Inc., Torrance, Calif., has purchased Xifin’s revenue cycle management system. Pathology Inc. specializes in women’s health diagnostic testing services.

Xifin, Circle No. 193