Clinical Lab Test Results Clarence Smiley OIT Federal Lead, RPMS Laboratory Information Systems 1

Training Objectives Understand the MU objective and the measure Compare and contrast Laboratory Package, Reference Lab Interface, Point of Care lab & PCC Data Entry of structured laboratory data Discuss the unintended consequences of entering laboratory results into PCC data entry in the Electronic Health Record environment Clinical Lab Test Results

Objective and Measure Incorporate clinical lab-test results into certified EHR technology as structured data. More than 40% of all clinical lab test results ordered by the provider or by an authorized provider of the hospital for patients admitted to its inpatient or emergency department during the EHR reporting period, the results of which are either in a positive/negative or numerical format, are incorporated in certified EHR technology as structured data. Clinical Lab Test Results

MU Measure Type of Measure: Rate The number of lab test results whose results are expressed in a positive or negative affirmation or as a number, which are incorporated as structured data. >40% The number of lab tests ordered by the provider during the EHR reporting period whose results are expressed in a positive or negative affirmation or as a number. Clinical Lab Test Results

RPMS Reporting Logic Denominator Inclusions: COUNT: each V LAB entry ordered by an eligible provider during the EHR reporting period WHERE: the lab test is NOT a Pap Smear, determined by using the BGP PAP SMEAR TEST lab taxonomy AND WHERE: the result of the test is not equal to “canc” (canceled) AND WHERE: (EPs only) the ordering provider on the V LAB entry is the provider for which the report is being run Clinical Lab Test Results

RPMS Reporting Logic Numerator Inclusions: COUNT: each test in the denominator WHERE: the status flag is resulted WHERE: Results does not equal “comment” OR WHERE: Results = “comment” AND WHERE: Comments does not equal null Clinical Lab Test Results

RPMS Reporting Logic Measure Exclusion: EPs who order no lab tests having results that are displayed in either a positive/negative or numeric format during the EHR reporting period are excluded from this measure. Clinical Lab Test Results

What HIM Needs to Know Process for staff to request corrections Difference between POC documentation, regular hospital labs and outside labs Cumulative Lab Reports Different ways to print lab results Process of providing patients with lab results (Doctors input) Clinical Lab Test Results

How To Meet Lab Measure Using RPMS Using the RPMS Laboratory Information System – EHR Order Tab to electronically order labs – PCC Data Entry – Configure and use the EHR POC Test button – Bidirectional Reference Laboratory Interface 9

RPMS Lab Package Functionalities Primary function is to assist the Laboratory in managing/automating the workload and reporting process Designed to provide laboratory data to health care providers In Development: EHR Lab Accessioning GUI for small sites without a lab (Currently being beta tested by Blackfeet, GIMC, Mille lacs band, Parker, Sault faint Marie) 10

RPMS Lab Package Covers every functional area of the Clinical Laboratory; – Blood Bank – Chemistry – Hematology/Coagulation – Microbiology – Toxicology – Urinalysis – Pathology – Cytology – Quality Control 11

PCC Data Entry and Reference Laboratory Unidirectional issues EHR is not used to order labs RPMS LIS does not store laboratory results Lab results entered into PCC Data Entry are only available via Health Summary & database searches (ex. Q-Man) Patients have to be manually added to the reference laboratory work station, which has caused patient identification issues (RPMS and RPMS LIS not used) (patient ID errors can occur) 12

Diagram Compliments of Vina Montour, PIMC CIO 13 ELECTRONIC HEALTH RECORD

EHR Point Of Care (POC) test button Enables sites to enter POC results into RPMS LIS Results stored in RPMS LIS Results viewed in EHR There really isn’t a difference between the RPMS LIS, the Reference Laboratory Interface, and the EHR POC test button because all 3 modalities are part of the RPMS LIS The big difference is entering results solely into the PCC database, in effect, “bypassing” the RPMS LIS 14

What does the Reference Laboratory Interface accomplish? Automates the electronic ordering of labs and the automatic receipt of laboratory test results from a reference lab (ex. Quest Diagnostics) using EHR. Laboratory test results are stored in the RPMS Laboratory Information System and in PCC. 15

Reference Laboratory Interface Released in 2006 as RPMS Lab patch interface engines to electronically connect your facility to the reference laboratory – Ensemble: used primarily to send billing information to support Quest and Lab Corp Laboratories – Generic Interface Engine: to interface RPMS Lab package with the reference labs 2 types of interfaces; bidirectional and Unidirectional OIT only recommends implementing the bidirectional version of the interface (because of MU and CPOE) 16

Implementation of Reference Lab Interface Cimarron Medical Informatics (CMI) performs all of RPMS implementation efforts – Currently in the middle of a ARRA contract to implement 75 sites throughout IHS Implementation of the interface is time-intensive & requires the coordination of several parties: – Facility (clinic, hospital) Implementation Team – OIT network Team – ref lab project Team – CMI Team Implementation Timeline: – Takes approximately 6-12 weeks from the time CMI actually initiates the implementation to the time a site can order and result one lab order 17

Implementation of Reference Lab Interface Prior to implementation, contact your reference lab representative. The ref lab representative will then: 1.Submit a project request plan to their respective national office 2.Reference laboratory will begin process of appointing a project team (project manager, implementation specialist, IT Staff, Billing) 3.Provide your site with test utilization reports 4.Provide your site with a test compendium listing laboratory order and result codes used by the reference lab 5.Steps 3 and 4 will be used by CMI to build and map laboratory reference tests in your RPMS LIS 6.Each reference laboratory company has its own unique set of order and result codes, insurance codes, mapping codes, etc…making implementation a complex process 18

Design of Interface Design of the Interface (bi-directional) Provider ORDERS Tests in EHR (CPOE counted here) Lab ACCESSIONS test(s) in RPMS LIS 1.Electronic Order is created & sent to ref lab 2.Shipping Manifest Printed GIS Interface LAN-LAN VPN Orders received by Reference Lab Information System Testing performed Results released Results received in RPMS LIS Results verified using lab package Results available for provider review in EHR & results sent to PCC

Ref Lab Bidirectional vs Unidirectional Bidirectional allows a site to use EHR/RPMS LIS to order and view lab results using the EHR Lab Tab – Results populate RPMS LIS – Providers can take advantage of EHR graphing capabilities – Results also populate PCC Database – “CPOE” lab entry allows MU calculation Unidirectional does not allow a site to use EHR to order and view lab results via the EHR Lab Tab – Results do not populate RPMS LIS – Results populate PCC database 20

Ref Lab Bidirectional vs Unidirectional Unidirectional interface does not allow a site to use EHR/RPMS LIS to order labs – This “flavor” of the interface does not use the RPMS LIS – Lab results are not available in EHR Lab Tab – Results are available on Reports Tab of EHR (ex. Health Summary) – Results are available for statistical/clinical reports 21

Labs ordered using Ref Lab workstation for ordering labs Outside of RPMS (impossible to compute numbers for CPOE) Reference Lab Information System receives laboratory order and performs testing Generic Interface System (GIS) PCC Database (V LAB) RPMS Server Unidirectional interface design RPMS Laboratory Information System Telecommunications interface 22

EHR RPMS LIS GIS Reference Laboratory File (LA7 Message Queue) File 63 (Lab Data File) OE/RR PCC Database (V Lab) RPMS Results viewed in EHR Lab Tab Structured Data CPOE 23

Ref Lab Implementation status 75 sites slated for implementation by CMI 32 sites completed 26 sites in process 17 sites with barriers (ex. waiting on Quest billing component, Tricore development – interface not developed, Northern Plains Lab – Interface (Aberdeen Area), Quest – standard and non standard interface, need to make changes to the non standard interface) 24 sites to be contacted (list sent to CMI) 24

Interfaced laboratories Quest Diagnostics Sonora Quest Diagnostics Laboratory Corporation of America Regional Medical Laboratories (RML) Northern Plains Labs Marshfield Clinics (WI) Marquette General Interpath Labs Munson Healthcare Labs (Lower peninsula of MI) 25

Planned interfaces Affiliated Labs of Maine Tricore Reference Labs (ABQ) PAML (Portland area) 26

Questions? 27