NORC at the University of Chicago is pleased to present this discussion draft of a white paper entitled “Electronic Exchange of Clinical Laboratory Information: Issues and Opportunities” for the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS). As is well known within the health care policy community, the 1999 Institute of Medicine report To Err Is Human: Building a Safer Health System called for better use of information systems as one means to help improve the quality, safety, efficiency and effectiveness of health care delivery in the United States.1 Subsequently, the President, Congress, and others have set goals challenging the health care sector to move towards wide‐spread and more systematic use of electronic data sharing (commonly referred to as health information exchange or HIE) to support health care delivery and public health goals.
Perhaps no aspect of HIE is more important to helping providers improve care for patients than the ability to seamlessly and electronically order tests from clinical laboratories and retrieve the test results using provider‐based applications such as clinical provider order entry (CPOE) or electronic health records (EHRs). Laboratory information exchange occurring in this manner can facilitate clinical decision support features such as clinical reminders, access to prior clinical laboratory results and closer monitoring of key population health indicators. Giving clinicians and public health officials these capabilities can improve the quality, timeliness and cost‐effectiveness of health care delivery.
The purpose of this white paper is to enhance understanding of the current processes, issues and opportunities involved in the electronic exchange of patient level laboratory information in ambulatory settings. We focus more specifically on the major challenges that federally supported health centers and other safety net provider’s face in establishing and maintaining stable interfaces with their laboratory service providers and in assuring that lab information is available in an accurate, efficient and useful manner. Health centers and safety net providers are central to ensuring access to quality care, improving outcomes and quality of life for persons with chronic illnesses, and eliminating health disparities. Inherent to understanding the challenges faced by health centers is a broader understanding of the issues involved in moving to the use of consistent data exchange standards and implementation approaches for lab information exchange in ambulatory care settings generally.
Our paper walks through several key topics that we have researched through scans of literature published in peer reviewed journals, government reports and industry or online publications as well as through a series of telephone conversations with individuals representing key stakeholders in lab information exchange. Topics addressed here include:
- An overview of the current approaches used for electronic exchange of clinical lab data between provider EHR systems (for safety net providers in particular) and clinical laboratories.
- A review of the key stakeholders involved in lab exchange including ambulatory providers, clinical laboratories, systems and application vendors, regional HIE organizations, provider networks and public health;
- A review of the use of standards to facilitate a more systematic and consistent approach to lab exchange with a particular focus on standards promoted by the Health Information Technology Standards Panel (HITSP);
- A discussion of issues and challenges facing widespread participation in electronic lab exchange in ambulatory settings; and
- A discussion of conclusions particularly as they relate to ongoing federal efforts to facilitate lab exchange and need for additional research and analysis to address what is still unknown.
Prior to discussing each of these topics, we provide a brief background section to elaborate the importance of lab exchange to health care and public policy stakeholders.