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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)
slide3
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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