HHS faces hurdles on electronic exchange of medical lab results

Federal health authorities will face several problems implementing the electronic exchange of patient lab results as part of an electronic health record (EHR) system, members of a federal advisory workgroup said at a meeting today.

The workgroup is a task force of the Health IT Policy Committee that advises the Health and Human Services Department’s (HHS) Office of the National Coordinator for Health information technology. HHS plans to release regulations later this year on how to distribute $19 billion in economic stimulus funding to doctors and hospitals that buy and "meaningfully use" certified EHR systems.

Roughly 8,000 hospital labs and 6,000 independent clinical labs perform three quarters of the lab testing in the United States and some of those facilities have installed interfaces that enable standardized electronic delivery of the results, Jonah Frohlich, deputy secretary of health information technology at California's Health and Human Services Agency, testified before the Information Exchange Workgroup.

Without interfaces in place, many lab results that could be sent electronically are scanned and faxed to physicians, he said. “While approximately one-quarter of physicians nationally have an EHR, many still receive faxed lab results that are either manually entered or scanned into the patient record. This is a limitation of both the lab and EHR industry,” Frohlich said.

Although the large independent labs that use modern service-oriented architectures are capable of handling electronic records, many of the hospital labs do not effectively support standards for reporting lab tests, Frohlich said.

Hospital-based labs "have far fewer IT resources and less expertise to support electronic lab ordering and results reporting. Yet they provide a significant share of lab testing services,” Frohlich said.

One obstacle is the difficulty and expense in establishing an electronic interface between a lab and an EHR system. The process requires testing of a virtual private network or Web-based connection, planning and coding the interface, sending and verifying messages, and training.

“We found that the process typically takes three months or more to complete – hardly the 'plug-and-play' connectivity we have come to expect from our iPhones,” Frohlich said. The interfaces typically cost about $5,000 each, he added.

Frohlich made several recommendations to support more rapid and reliable implementation of lab interfaces, including requiring EHR systems to adopt and use national lab standards and display the results in a way that is compliant with clinical lab requirements.