We worked for an entire year testing, making requests, testing, more requests and more testing before we were able to launch an interface between our lab and EMR, but it’s been one of the best things we’ve done. The reason it took so long is the topic of another post, but it was for good reason.

One of the best advantages to a lab interface with your EMR is that you don’t have to worry about what to do with all those paper labs that you’ve signed. Inevitably all those signed paper labs will have to be scanned and attached to a patient in your EMR.

Really, that’s why a lab interface is so much better. The interface inserts the lab info right into your EMR so you don’t have to worry about:
1. Losing your lab results (before or after you sign it)
2. No need to scan your signed lab results into your EMR
3. You can run really cool reports on the data from those labs in your EMR (ie. blood sugar change over time)
4. Most EMR will notify you that there are lab results to read, so there’s no more waiting for the paper to somehow make it to you

In our EMR, a lab result gets easily signed off with the click of a check mark. Actually our labs our grouped into batches according to labs that were ordered at the same time. This makes it so all our lab results appear on one nice lab report as opposed to one lab report per lab. All doctors have to do is highlight all the labs and click “Mark as Read” and that whole batch of lab results are signed electronically in the EMR.

Of course, many of you will probably ask how we handle abnormal results. Well, I guess you’ll just have to wait to learn about that.

Face Authentication Software
The Healthcare IT Guy posted an interesting review of some auto-recognition and auto-login system for healthcare workstations called FastAccess by Sensible Vision. A standard web cam, easily installed software that can recognize my face to log me in. I need to get me a demo so I can try it out.

US Healthcare System
This is a nice article saying that although the media describes the US Healthcare system as broken down, many “better” healthcare systems aren’t immune to problems.

Mirth Project
I really like the idea of an open source project that supports HL7 messaging. I just can’t get my head around what exactly this means and how they are making the wretched HL7 messaging any easier.

ASTM - Continuity of Care Record(CCR) Standard
HL7 - HL7 Standard

I know I’m missing a lot, but I’m sure my trusty readers will let me know of any others worth mentioning. I also must admit that I wish I would have gone to either the HIMSS or TEPR conference this year. I should have planned better. The HIMSS 2006 would have been really cool because I could have gone to the blogger meetup. Maybe next year.

The assumption that was made by my clinic(thankfull not me since I hadn’t been hired) was that the interface would be bi-directional. What does that mean? That means that when a Pharmacy is ordered by a Doctor the script would automatically be available in the Pharmacy program(one direction). Then, when the script was filled it would post the charge back to your EMR(second direction). The assumption was made that this would just happen without considering a few questions. First, what happens when someone doesn’t want to fill their script at our pharmacy? Then, the Pharmacy database is filled with a ton of scripts that they never needed to fill. Also, what happens when a drug is filled in your EMR that isn’t available in your Pharmacy program? How does your HL7 interface match a prescribed drug with the drug in the pharmacy database which has enough inventory? How does the interface pass the charge back when someone brings in a pharmacy from another doctor?

For those of you familiar with HL7 interfaces you know that many of these things can be solved. In fact, I hope that somebody will post some ideas on the best ways to accomplish this. However, these are important things to consider and discuss when purchasing an interface. In many cases the “mythical” concept of it all just working may leave you with a uni directional interface.

Not that a uni-directional interface is bad. The fact is that my clinic currently have two uni-directional interfaces. One direction patient information and insurance eligibility is passed. The other direction charges get passed back. This has worked out quite well even though we expected a bi-directional interface.

The moral of the story is to Ask Questions and then Ask MORE Questions! You aren’t an expert on HL7 and you have the right to know what your vendor means by an HL7 interface.

I imagine there are other options than HL7, but so far I haven’t seen any. So, I’ll assume for now that there aren’t any until someone corrects me.

Here’s some good info I got from this website:

Continuity of Care Record Is Developed by

ASTM International Health Care Informatics Committee

W. CONSHOHOCKEN, Pa., 5 January 2006—A revolutionary new ASTM International standard will change the way in which healthcare professionals preserve and transfer healthcare information about their patients. The standard, E 2369, Specification for Continuity of Care Record (CCR), was developed by Subcommittee E31.28 on Electronic Health Records, which is under the jurisdiction of Committee E31 on Healthcare Informatics.

The Continuity of Care Record is a core dataset to be sent to the next healthcare provider whenever a patient is referred, transferred, or otherwise uses different clinics, hospitals, or other providers. The CCR will bring an end to physicians and other healthcare professionals having to act “blindly,” without easy access to relevant patient information. It will provide the necessary information to support continuity of care, thus reducing medical errors, achieving higher efficiency, and creating better quality of care.

During the past two years, U.S. President George W. Bush has called for greater interoperability of electronic medical records and personal health records. E 2369 represents a major step forward in assisting vendors and healthcare organizations in their search for simple, yet powerful tools that will help meet the president’s objectives.

Eleven sponsoring organizations have supported the efforts of Subcommittee E31.28 throughout this process: the Massachusetts Medical Society, the Healthcare Information and Management Systems Society, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Medical Association, the Patient Safety Institute, the American Health Care Association, the National Association for the Support of Long-Term Care, the Mobile Healthcare Alliance, the Medical Group Management Association and the American College of Osteopathic Family Physicians.

“The wide range of sponsors for the CCR initiative demonstrates its uniqueness as well as its strength,” note CCR task group co-chair Claudia Tessier. “Clinicians, both individually and through their membership organizations, have been the main drivers of the CCR. Through them we have identified the most relevant patient information to be shared among providers. Thus, they and their patients will be its main beneficiaries.”

One of the sponsoring organizations, the American Academy of Family Physicians has launched Project Continuity of Care, an initiative designed to raise awareness of E 2369, to develop and deploy field-capable CCR-compatible software applications and tools, and to accelerate integration of the CCR into existing electronic health record software.

“We now have the CCR standard, an affordable technology for capturing a patient’s most relevant health information and making it personal, private and portable,” said Douglas E. Henley, M.D., executive vice president of the AAFP, in announcing Project Continuity of Care.

“Our aim is to provide physicians and other caregivers with access to this summary medical information when and where it is needed, and to give patients the assurance they deserve that they won’t suffer in an emergency because of lack of information about their personal illnesses or treatment plans.”

The ASTM standards development process and membership on Committee E31 is open to all interested parties.

For further technical information, contact Claudia Tessier, Mobile Healthcare Alliance (MoHCA), Washington, D.C. (phone: 202/352-3019; ctessi@attglobal.net). For committee membership or meeting details, contact Daniel Smith, ASTM International (phone: 610/832-9727; dsmith@astm.org).

Committee E31 is one of 138 ASTM technical standards-writing committees. Established in 1898, ASTM International is one of the largest standards development and delivery systems in the world. ASTM standards are accepted and used in R&D, product testing, quality systems, and commercial transactions around the globe.