I’m always sad when I come across an EMR implementation that doesn’t have an interface between their EMR and their lab. I can appreciate someone having just implemented an EMR not having a lab interface. However, it should be one of the first things on your list to implement. It’s such a great compliment to your EMR software.
First thing I must suggest is that you get a bi-directional lab interface if at all possible. One way lab interfaces can work, but do take more management to make it work right.
Why Get a Lab Interface with Your EMR?
Lab interfaces are so seamless. The order is made in the EMR and it’s automatically is sent to the lab. Talk about removing a lot of the possibilities for error. In our case, we have an in house lab and so this saves a ton of time for the lab rat tech as well. No more data entry into the Lab’s LIS system. As a side note, we also use the lab order in our EMR to print out the labels for the specimen. This is an unbelievable time saver and much more accurate. Small things like this are just another hard to calculate benefit to an EMR.
The largest benefit to a lab interface is receiving the results back electronically. Compare this to receiving a paper copy of the lab results. Often this paper copy is sent to a fax machine and then the hunt begins to get that result to the right paper chart/person. The time savings here are apparent. With a lab interface, you no longer have to file the lab results in the paper chart (or scan them into your EMR). The results are automatically available in the EMR and routed to the ordering provider. They can be signed electronically and no one has to then go back and refile the chart.
What’s even more important is that with the lab interface all of those lab results are now stored in discrete values. Storing the lab results this way means that you can graph lab results over time, do studies on lab results across your patient population, and eventually may be needed to satisfy the government and insurance reporting requirements.
Cost of a Lab Interface
Many people are often surprised to find out that there’s sometimes a cost associated with implementing a lab interface. In fact, there could be multiple costs involved.
The costs depend a lot upon your EMR vendor and the lab with which you’d like to interface. Some EMR vendors will offer a lab interface for free (or part of the standard cost of the EMR) while others will charge. The same is true for labs. However, more labs are willing to offer their interface for free. Often that just requires the right negotiating skills. If you’re a large customer of that lab, then if you talk to the right people you can usually get the interface for free. Labs are easier to negotiate with since a lab interface benefits the lab as well. $5,000 seems like the standard charge (from what I’ve seen) for most interfaces. Yes, that’s possibly $5,000 to your EMR vendor and another $5,000 to your lab.
The industry’s tendency to charge for interfaces really bothers me. Interoperability is a major component of the federal push for EMR adoption, and as you point out in this post, it’s a big source of the projected long-term cost savings. Yet with the status quo right now, just adopting an EMR doesn’t mean you’re interoperable – there are additional costs in time and money, if it’s even possible.
I can’t count how many times a customer of my mobile charge capture company has been shocked and appalled to learn that while we never charge for interfaces, their billing software / PMS / EMR demands $5000, $10000, or north of $15000 to begin the project. The interface cost alone dwarfs the cost of our software.
Cost is one consideration, but medical practices that are considering an interface should also do their research about a vendor’s interface management experience. Otherwise, you can end up sinking a lot of money into an interface that takes months to complete while developers are pointing fingers at each other and you’re left holding the bag. Questions to ask lab companies, EMR/PM vendors prior to beginning an interface: Do all vendors comply with industry standard coding languages (preferably Health Level 7)? How many successful integrations are under each vendor’s belt? (if they have not completed any, you may want to be wary). Is there a dedicated team of interface developers, or will your project get pushed onto the back burner in a busy Product department? What is the average timeline for completion? Once you’re satisfied with answers to those questions, it’s a good idea to check references. Until we have a truly interoperable system in place, the onus is on medical practices to be educated and savvy about the interface process.
Adam and Jennifer,
Thanks for rounding out the discussion of interfaces. We had to have our interface built from the ground up. We basically did all the testing for the lab interface ourselves since we didn’t trust the EMR company to make sure EVERYTHING went through correctly. Lab results were something we didn’t want to gamble on. It was a lot of work, but was some of the best work we did and well worth the effort.
John,
Great post. It motivated me to publish a similar post to my company’s blog, one that is a more tailored to the AE-EHR and its tasking and RIS integration capabilities. I also touched on the costs and benefits to an immunization data exchange with an immunization registry. You can find both here: http://blog.galenhealthcare.com/
As a follow-up to implementing a lab interface, I published an article on the ingredients to a successful interface project. In our experience, by following the keys to success outlined in the blog article, we were able to crash project time lines, accommodate for advance business logic via our advanced knowledge of the AE-EHR API, and also reduce implementation costs. You can find the blog article here: http://blog.galenhealthcare.com/
We have just upgraded to a new CCHIT certified EMR. In our old EMR we had a lab interface so we do not relish the idea of going forward without one. However, after waiting almost a year too have the lab interface done. We are now expected to sign a contract with the third party vendor building the interface between the EMR vendor and the lab which would require us to pay $1000.00 per year in support fees to maintain the bridge. The initial work is covered by the lab. We do have an interface built with another lab with no extra charges. Has anyone else encountered this problem. This fee is on top of the high support fees we are already paying to the EMR vendor whose response is that “this is nothing to do with us, we do not support third party interfaces.”
Has anyone else encountered this problem and also how are physician offices expected to pay extra support fees on top of those already charged by EMR vendors.
Hi Carol,
Sadly this is all too common. That’s why it’s so important during the EMR selection process to talk about all the costs related to that EMR. Of course, that’s probably not much consolation to you now.
This is a pretty common thing for an EMR vendor even to charge you for the lab interface. Although, I must admit that I’ve generally see them charge for it up front with some nominal fee for updates. In fact, I know many that are easily paying $5k to get a lab interface. Sometimes they even get to pay the lab company $5k and the EMR vendor $5k to build it.
Some people actually change labs over this. Some lab companies use this as a way to get new customers by offering a free lab interface. I’m not sure if that’s an option for you.
After reading all these articles related to EMR – Lab Interface, I come to a conclusion that, indeed, the cost of the HL7 interfaces must play a critical role in the EMR selection process. Connecting each lab to the each EMR out there is not only costly but affects interoperability. These lab results will remain in that EMR/LIS loop and will not be shared with other healthcare providers unless you create another EMR-EMR interface which will cost you an additional $5k and so on. I do not have to be an expert in statistics to know that connecting an EMR to all LIS out there or connecting an LIS to all EMRs out there is virtually impossible.
The solution may sound simple; creating a cloud which serves as an intermediary between LISs and EMRs. All LISs (Labs) will send electronically (via internet) all results using HL7, and doctors will pull these results into their EMR. Of course, doctors will not be able to pull these results in unless they have the right to do so. If this works, cost and interoperability issues are minimized.
This is not only possible but we have been doing this for more than a year. The cost of the interface for the Labs and the doctors is $0 and they get what they need; orders and results, respectively.