Developing bidirectional lab interface within the emr
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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. The Players. MHHC FHQHC operational for 30 years with 70+ providers, and multiple locations

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Developing bidirectional lab interface within the emr

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


The players
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)


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.


Background information
Background Information

  • MHHC was involved in a collaborative with 3 other community health centers, known as METCHIT.

    • CBWCHC, Settlement, Soundview


Steps to interface
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


Ordering setup
Ordering Setup

  • Mapping MHHC lab orders to Quest orders

    • based on most frequent utilization in the past two year

  • Simplified orders mapping/referencing:


Ordering in action
Ordering In Action

  • Directly order lab test from EMR’s own orders module


Reporting setup
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


Report is back
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


At go live preloading lab data
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


Lab reporting into the emr
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


Advantages
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.


Challenges
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


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