Electronic Exchange of Clinical Laboratory Information: Issues and Opportunities. DATA SOURCES AND APPROACH


To gather comprehensive information on electronic exchange of laboratory data we conducted a scan of the available literature using PubMed to search for peer reviewed publications. We also conducted Internet searches to identify government reports and articles from trade publications of relevance to the issues of electronic clinical laboratory data exchange. Given the relative dearth of published or even publicly available materials on this topic, we also conducted a series of phone discussions with major stakeholders representing providers with EHRs currently interfaced with clinical laboratories, their national and regional lab partners, and EHR vendors.

A list of potential initial discussants who participated in these phone meetings as well as the topics covered in the meetings was developed through discussions with ASPE as well as the Health Resources and Services Administration (HRSA). Each call was led by a senior member of our team. The notes taken during the call were summarized for central concepts and themes. Multiple NORC staff collaborated on reporting and interpreting findings.
In an effort to trace the process of lab data exchange in health centers from the point of ordering to the laboratory and back to the provider in the form of results reporting, we began by holding discussions with health center providers and networks and used a classic snowballing technique by asking those networks to identify laboratory representatives with whom they had a business relationship. Similarly, EHR vendors were referred to us by the health centers that were their customers. This approach allowed us to “follow the data” and identify the issues encountered at various stages of exchanging lab information.

While we are not revealing the names of individual discussants or their organizations, we note that we spoke with two large health center networks based in different parts of the United States, one regional health information exchange organization, one integrated delivery network, two large national clinical laboratories, one regional laboratory and one EHR vendor.

In the remainder of the paper we discuss several aspects of electronic exchange of lab information. We begin with an overview of the exchange process and describe the various stakeholders involved in these exchanges as well as the role of standards and regulatory issues. We then discuss issues currently encountered by stakeholders and new opportunities for addressing these issues through cross‐sector collaboration. We end the report with a discussion of conclusions for policy and program officials as well as areas where additional research and analysis are needed.

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