Lab Centralizes Interface With Physician Systems

With the increasing adoption of electronic medical-record (EMR) systems, Winchester, Va.-based Piedmont Medical Laboratory (PML) knew it needed to find a secure and reliable way to interface with the various practice management and EMR systems used by its physician practices.

While many larger national labs are offering connectivity services, such as electronic test ordering and results reporting, to their physician practices, PML did not have the internal resources required to develop and manage the integration process – a significant competitive disadvantage that was resulting in revenue shortfall and potential loss of clients.

“With more physician practices making the move from paper-based records to electronic systems, physicians expect to be able to easily access all patient information, including clinical and pathology test results, in a central location,” says Joe Skrisson, CEO of PML, an independent clinical lab owned by eight hospitals and two pathology groups. “As a hospital-based regional lab going toe-to-toe with the national labs, we quickly realized that to remain competitive, we not only had to find a way to establish interfaces from our laboratory information system to the leading physician EMR and practice-management systems, but also achieve connectivity with hospital-information systems (HIS).”

Because clinical data is typically the largest component of the EMR, its timeliness and accuracy are critical to the physician decision-making process, helping to ensure positive patient outcomes. While establishing connectivity between the physician EMR and laboratory-information system (LIS) is crucial, Skrisson says, this is a daunting task due to the numerous EMR systems available and their inherent lack of interoperability.

The difficulty is further compounded, he adds, by the idiosyncrasies of each EMR vendor’s implementation of the HL7 standard. Because there is no one-size-fits-all solution, labs often need to develop interfaces with physician EMRs on a case-by-case basis.

“One of our biggest challenges was that we didn’t have the budget or infrastructure to support the development of the multiple interfaces necessary to move lab data back and forth to our various physician clients,” says Skrisson. “Although we had been using lab order-entry-and-results software, it didn’t provide us with the functionality we needed. Ultimately, we wanted to be able to deliver electronic laboratory results to physicians in real time.”

In particular, PML wanted to create a shared lab-testing environment, which would require development of a multiway interface between Piedmont’s LIS, the HIS at one of PML’s owner hospitals and PML’s Web-based outreach software, which the lab offers to physicians to enable them to electronically order tests and receive results. The goal was to be able to split all lab orders originating from the physician group into tests that could be performed at the hospital, and tests that needed to be performed by PML – based upon rules such as payer, test type or time of test.

The orders would then be routed to the appropriate destination and, upon completion of testing, results would be transmitted to both the outreach software and to Piedmont’s LIS so the patient could be billed. PML also hoped to be able to provide physicians with a health information-exchange (HIE) hub that would allow them to view consolidated results from their particular EMR.

Utilizing Flexible Integration

To keep up with the growing demand for connectivity, Skrisson realized he needed to find a vendor that would provide not only the HIE technology but also the project-management skills required to address the lab’s complex integration requirements. PML invited multiple integration vendors to submit proposals outlining their approach to the lab’s connectivity challenges. PML then asked selected vendors to complete a test project.

“We hoped to find a company that would really take the time to assess the challenges within our operation and think about innovative ways to address them,” says Joe Litten, technical director at PML.

After a thorough evaluation, PML chose Philadelphia-based Halfpenny Technologies because of the company’s flexible integration platform and its project-management skills. Halfpenny’s HIE solution allows labs to integrate with a wide variety of legacy information-management systems, without the need to develop costly and labor-intensive code-based interfaces or hire additional IT staff.

“As a hospital-based regional lab going toe-to-toe with the national labs, we quickly realized that to remain competitive, we not only had to find a way to establish interfaces from our laboratory information system to the leading physician EMR and practice-management systems, but also achieve connectivity with hospital-information systems.”

The implementation process commenced with an onsite visit by Halfpenny to collect the necessary information regarding PML’s operations and existing IT infrastructure, including software, hardware and network configuration. Halfpenny then defined and documented the project deliverables and identified the requirements and features of each of the associated components.

Next, a project team was assigned to PML, with a project manager who was responsible for interacting with PML’s physician clients, as well as with the relevant hospital, lab, EMR and HIS/LIS vendors. The team also consisted of technical analysts, development specialists and medical technologists who worked with the lab’s internal staff.

As individual deliverables were completed, integration testing was performed. Upon completion of the development tasks for the deliverable components, a final testing round was performed and the solution was available for deployment.

“With so many parties involved, the integration process was complex,” says Skrisson. “If a delay or a roadblock came up, Halfpenny would reach out to the appropriate parties in an effort to resolve the issues in a timely manner, although this was often challenging due to the competing priorities of the many vendors we were working with.”

Interface as Command Center

To develop the multiple interfaces required to establish connectivity between the internal legacy systems and external systems in the physician practice and hospital that PML was working with, PML leveraged the integration vendor’s interface engine. Functioning as an HIE command center, the interface engine is able to securely capture, transform, map and route clinical data to a large number of EMR and LIS systems.

The Web-based architecture supports a variety of data formats and standards, including HL7, XML, X12, DICOM, delimited files and structured print output. This versatility was key for PML, since the systems with which the lab would be interfacing do not adhere to a single standard.

Due to the number of interfaces being created and the multiple data transactions that would be processed via the interface engine, ensuring data security was critical. The integration vendor’s ITF-SecureConnect solution was deployed to create connectivity within the shared testing environment.

The solution provides the file encryption and security of a hardware VPN but can be installed quickly and does not require networking expertise – simplifying implementation and streamlining work flow for the lab’s IT resources. In addition, since a direct connection to a practice’s network is never established, the potential for security breaches is eliminated.

PML has collaborated with the integration vendor to establish interfaces to multiple EMR and HIS systems used by its physician clients, including Allscripts, NextGen, eClinical Works and DigiCharts.

“This integration among disparate systems has enabled us to more effectively manage the flow of lab test orders, results, billing data and health-plan reporting,” Skrisson explains, “which has resulted in improved operational efficiencies and an enhanced bottom line. In addition, because the integration vendor hosts the interface engine for PML, the lab has been able to minimize the costs, implementation time frames and work flow typically associated with interface development.

“Since PML is a regional, community-based laboratory, we lacked the deep pockets of our national lab competitors,” says Skrisson. “Therefore, we needed to define a strategy that would afford the development of multiple clinical-data interfaces without the associated cost and expertise of creating them in house.”

Through the HIE interface engine, PML’s physician clients are now able to order lab tests via a secure Web-based interface. Orders are transmitted from the physician’s EMR or the lab’s outreach software to PML’s LIS, which retrieves the orders, routes them and waits for the results. The data then is transmitted through the interface engine to the EMR or outreach software and is also electronically submitted to PML’s billing company for processing. For physicians connected to the HIE, all results are consolidated and available in a common view from their EMR.

“The key to success in creating clinical-lab connectivity lies in making the interface process as seamless as possible,” says Litten. “With the interfaces in place, we can now quickly set up our customers for electronic order entry and results reporting, enabling them to meet security requirements, while also providing timely and accurate results to their patients.”

PML plans to develop a data repository of patient results for use in future data-mining activities – for example, providing health plans with utilization statistics.

“We would also like to use the repository to develop a disease-management strategy that could be provided to physicians,” says Skrisson. “It’s essential to be able to anticipate and respond proactively to clinical data-exchange requirements. Physicians expect clinical and pathology results to be delivered electronically to their patients’ EMRs, and we are now able to do that.”

From the Catalog

According to www.halfpenny.com : By facilitating access to and retrieval of clinical data, health information exchange (HIE) has the potential to improve healthcare quality, reducing medical errors and lowering costs by setting the stage for increased interoperability and information sharing among providers, payers, patients and other stakeholders. HIE enables the transfer of data via secure electronic networks, resulting in more efficient delivery of results to healthcare providers and promoting communication among hospitals, laboratories and physician offices. Clinicians are able to quickly and reliably access patient information from other clinical data repositories at the point of care, allowing them to provide improved patient care and minimize the chance of duplicative tests and therapies. Created to address the business goals and HIE challenges of hospitals, laboratories and pathology groups, Halfpenny Technologies’ solutions offer the flexibility, reliability and security required to meet the diverse clinical data exchange needs within today’s healthcare environment.

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October 2010