Monday, October 26, 2009

Accelerating Implementation of Laboratory Standards

On October 20, the Information Exchange Workgroup of the HIT Policy Committee heard testimony from laboratory information exchange experts and stakeholders.

The agenda and testifiers included:

Business Issues related to the Electronic Exchange of Laboratory Data
Mike Nolte, GE Health Systems
Vasu Manjrekar, eClinicalWorks
Phil Marshall, WebMD
Tim Ryan, Quest Diagnostics
Susan Neill, Texas Department of State Health Services

Business Issues related to the Electronic Exchange of Laboratory Data
Laura Rosas, New York City Primary Care Information Project
Sarah Chouinard, Primary Care Systems, Inc. and Community Health Network
Raymond Scott, Axolotl Corporation
Areg Boyamyan and Jim Timmons, Foundation Library

Regulatory and Policy Issues
Joy Pritts, Georgetown University Health Policy Institute
Don Horton, LabCorp
Jonah Frohlich, California Health and Human Service Agency
Walter Sujansky, Sujansky & Associates

You'll find an unofficial transcript here. (Thanks Brian!)

The major themes of the day were

1) Labs are complicated - there is great variation in the standards used, vocabularies adopted, and the way labs are ordered (there is no universal ordering compendium, but this is a project that HITSP and the HIT Standards Committee are working on)

2) CLIA is considering allowing “simultaneous delivery” of results to a Health Information Exchange instead of just to the ordering clinician

3) State laws are highly heterogeneous, as is enforcement

4) We need adoption and implementation of robust messaging and vocabulary standards. We should focus on the 300-400 tests that make up the vast majority of ambulatory lab transactions, and create a national mapping for those.

5) Lab results/ordering according to a well-defined national standard should be part of EHR certification

6) Meaningful use payments to hospitals should be contingent on their delivering outpatient labs according to the same standards recommended for EHR vendor certification. (I agree with this - BIDMC has committed that all its lab delivery to external organizations will use HITSP and HIT Standards Committee recommended standards in time for 2011 Meaningful Use payments.)

7) EHRs need to be conformance tested against specific standards to reduce the cost of interfaces.

A great day of testimony. I know that change is difficult but universal adoption of the HITSP Lab Result Capabilities, which provide significant implementation guidance for HL7 2.51 messaging, LOINC, UCUM, and SNOMED-CT will reduce the cost of lab interfacing. This, combined with the HITSP Lab ordering Capabilities to be completed by January, will accelerate adoption and implementation.

I support universal conformance testing of products for certification and a requirement for all stakeholders to use these standards as part of meaningful use criteria to claim stimulus funds.

Since 2011 data exchanges for meaningful use require Laboratory result exchange, there is urgency to do this. Over the next few months, the HIT Standards Committee will be spending a great deal of time discussing the ways to reduce barriers and enhance adoption so that we achieve the interoperability we need.

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