California’s Medical Laboratory Assessment and Planning Project. Presentation to S&I Framework LRI Group. Robert Dieterle Technical Architect Cal eConnect, Inc. June 14, 2011 Washington DC. BACKGROUND. A California-based nonprofit Created by the State of California
California’s Medical Laboratory Assessment and Planning Project
Presentation to S&I Framework LRI Group
Cal eConnect, Inc.
June 14, 2011
To collaboratively establish policies, services, and innovations that make possible the appropriate, secure, and efficient exchange of electronic health information for the purpose of improving health and health care safety, quality, access, and efficiency for all Californians.
Scope of the California Project
“Conduct a comprehensive assessment of the laboratory and provider landscape related to electronic laboratory ordering and results delivery between ambulatory providers and California’s laboratories.
Scope of the Project -- Electronic Lab Result Reporting and Meaningful Use Criteria
“Incorporate clinical lab test results into EHR as structured data”
“Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies (directly from EP/EH or through performing lab)’’
Cal eConnect /
CA Dept. of Public Health
A. Meaningful Use – Stage 1/2/3 – to EHR
B-1. Meaningful Use – Stage 1/2/3 – to PH
B-2. Meaningful Use – Stage 2/3 – to PH
CID = Center for Infectious Disease
CSRB = Cancer Surveillance Reporting Branch
CLPPB = Childhood Lead Poisoning Prevention Branch
GDB = Genetic Disease Branch
HL7 v2.3, v2.3.1, etc.
HL7 v2.5.1 -ORU^R01 Message
HL7 v2.5.1 -ADT, OML, etc. Messages
While there are ~20,000 CLIA certified labs in California, we estimate the target lab population to be ~9,000.
Physician Office Labs are the majority of California labs (50-60% of labs), but their estimated test volume is only ~10%.
Hospital Labs only represent ~5% of California labs, but they appear to account for the largest % of test volume.
Independent Labs only represent ~4% of California labs, but likely account for ~33% of test volume.
Rural labs make up 20% of the lab population; yet their volume is unknown.
Several labs are unaware of existing standards, definitions, available resources, and California’s overall direction.
Many small labs do not have the existing infrastructure to exchange data electronically.
Labs will adopt a new standard or implementation guide only if their trading partners are ready for the standard.
Some labs appear to be reliant on their LIS vendors for guidance with adoption of an HL7 standard or implementation guide.
Since a variety of LIS and EHR systems are being used in California, many labs must build their own interface(s).
The majority of labs who are transmitting data electronically today appear to be able to transmit in HL7 2.3.1.
The larger the lab (volume), the higher the likelihood that it is ready to transmit in HL7 2.5.1.
Many labs need to support multiple HL7 versions based on the interfaces with their trading partners.
Labs are not motivated to adopt a HL7 messaging standard due to the high cost, without an incentive or mandate.
Volume of Medi-Cal tests is not a determining factor of readiness to adopt a HL7-compliant messaging standard.
Based on lab type, size, and other factors, each lab faces its own unique challenges and barriers to adoption.
Encouraging Implementation Guide adoption among Medi-Cal FFS labs would require significant changes to the Medicaid Program Administration (MCPA).
Encouraging Implementation Guide adoption via the Managed Care contracts would have a high cost and low impact.
Standardization would help but is difficult to enforce and monitor.
Some states have adopted and communicated a statewide standard/specification (and implementation guide).
In addition to standards and specific implementation guides, states have implemented translation services to support labs who cannot meet the standard.
Other states have implemented financial and technical assistance programs to facilitate adoption.
Barriers to electronic lab reporting and standard messaging - Summary
Implementation options/strategies for electronic lab reporting and standard messaging – Summary
Regulatory Inventory – Summary
Cal eConnect is committed to partnering with other states, the federal government, and the industry to facilitate the adoption of a common implementation guide that fills the required gaps that are currently impeding exchange.
For more information about this project or Cal eConnect, visit: