Management of Laboratory Data and Information Exchange in the Electronic Health Record

Abstract

In the era of the electronic health record, the success of laboratories and pathologists will depend on effective presentation and management of laboratory information, including test orders and results, and effective exchange of data between the laboratory information system and the electronic health record. In this third paper of a series that explores empowerment of pathology in the era of the electronic health record, we review key elements of managing laboratory information within the electronic health record and examine functional issues pertinent to pathologists and laboratories in the exchange of laboratory information between electronic health records and both anatomic and clinical pathology laboratory information systems. Issues with electronic order-entry and results-reporting interfaces are described, and considerations for setting up these interfaces are detailed in tables. The role of the laboratory medical director as mandated by the Clinical Laboratory Improvement Amendments of 1988 and the impacts of discordance between laboratory results and their display in the electronic health record are also discussed.(Arch Pathol Lab Med. 2015;139:319-327; doi: 10.5858/arpa.2013-0712-SO) L aboratory information systems (LISs) are designed to meet workflow needs within the laboratory as well as interface with electronic health record (EHR) and billing systems. Configuration and maintenance of appropriate communication between an LIS and an EHR are very much institution dependent and beyond the scope of this document; however, understanding the complexity of the problem is not.Although anatomic pathology (AP) and clinical pathology (CP) specimens, workflows, and results reporting share many common electronic communications issues, the complexity of the LIS-EHR data flow problem is increased as AP and CP each also have unique information management requirements. Most institutions will have an AP LIS (APLIS) to handle data and workflows related to testing of surgical and cytology specimens, as well as a separate CP LIS (CPLIS) to facilitate testing and reporting of blood and other specimen types. In an attempt to more effectively address these complexities, we will first examine shared issues and then explore issues unique to each type of system. ISSUES SHARED BETWEEN APLIS AND CPLIS Patient IdentificationPositive patient identification is essential at every step of the care life cycle, from the time a patient presents to a clinic through ordering, phlebotomy or biopsy, testing, result transmission, result review, billing, and taking action based on a result. Unique patient identifiers that always associate patient identity with the correct patient data are a crucial problem that has not yet been successfully addressed by legislation. This association is critical when an LIS transmits patient data across multiple institutional, office, health information exchange, and personal health records, as well as state and federal registries for mandatory reporting (eg, communicable infectious diseases for population su...

Laboratory Information Systems in Molecular Diagnostics

“…The problem may be compounded depending on how test order choices are displayed in an electronic health record (EHR) order entry screen. 3 Because of misunderstanding or to time pressures, the wrong testing choice can get ordered. Costs of selecting the wrong test can be high from multiple perspectives, and not only financial.…”

“…Even with this "simplest" reporting, there can be data management challenges that include reference ranges and unit designations that must be conveyed as well. 3 The next level of complexity involves conventional AP reports. Pathology reports are perfect examples of highly narrative reporting that lack discrete data elements (ie, "free-text" narrative).…”

Laboratory Information Systems

“…Sometimes reports may appear quite different in the EHR compared with the LIS, with potential for misinterpretation. 15,16 An LIS may be able to provide interfaced electronic reports that preserve formatting (eg, portable document format, PDF), and if the receiving system can accommodate such reports, this may be a mechanism for improving readability.…”

Advancing laboratory medicine in hospitals through health information exchange: a survey of specialist physicians in Canada

“…Although physicians may have access to LIS, these systems are primarily designed to meet the needs of laboratory personnel. Therefore, other laboratory information exchange (LIE) systems are required to improve the reliability of the laboratory testing process [13] and, hence, need to be integrated with other clinical information systems physicians use in hospitals such as electronic health records (EHRs) [14,15].…”