Electronic Exchange of Clinical Laboratory Information: Issues and Opportunities. USING STANDARDS TO FACILITATE LAB EXCHANGE


Though not well understood by all stakeholders, messaging and content standards can be critically important to laboratory exchange and other forms of HIE because they facilitate interoperability by encoding health information using a common ‘language’ that can be read by multiple systems. Given the variety of different clinical information systems and the fragmentation of healthcare information, developing and supporting standards for both data content and messages is essential. Standards enforce a common language for exchanging information across disparate health systems and ensure that electronic messages are properly constructed upon receipt.

In the context of our overall model for lab exchange (Exhibit 1), each arrow represents a transaction that involves the electronic transfer of data and information between two entities. That transfer occurs in the form of a “message” that includes a series of data fields as well as the content feeding into those fields. The use of standardized message and content definitions to support these information transactions can substantially increase the interoperability and usefulness of laboratory exchange or other forms of HIE and may substantially reduce the cost of HIE to providers, payers, purchasers and the public over time.

The federal government has played a key role in standards development. HHS established the National Health Information Coordinator position in the Office of the National Coordinator (ONC) in part to facilitate the development of standards‐based electronic health records. Within the ONC, the Office of Interoperability and Standards (OIS) coordinates with other HHS offices to foster the use of standards and certified technology, and advance the development, adoption, and use of health IT standards nationally. The American National Standards Institute’s (ANSI’s) HITSP is a cooperative partnership between public and private sector stakeholders tasked with developing a broadly accepted set of standards that contributes to interoperability and health information exchange, and identifying gaps in standards development. HITSP has been tasked with harmonizing standards, developing nationwide health information network prototypes and recommending necessary changes to standardize diverse security and privacy policies. The goal of this effort is to achieve a widely accepted and useful set of standards that will enable and support widespread interoperability among healthcare software applications.

There are many standards that support the exchange of lab tests and results. The sections below are focused on some key standards and some of the major issues that we have identified as part of this environmental scan. We focus on both standards that are used primarily as messaging standards such as HL7 and others that are content standards such as the Logical Observation Identifiers, Names, and Codes (LOINC). We also address those standards that have been identified by HITSP as recommended for use in laboratory data exchange. Importantly, we discuss each of the key standards in light of the experiences of our discussants in using them and their perceptions regarding their overall usefulness. Our discussion of standards juxtaposes the intent and structure of HITSP standards to the real world experience of using these standards. We note that there are some standards that have been adopted and
widely used, while the use of others is limited. We also discuss that in certain areas, standards have not been embraced by key stakeholders.

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