Developing Bidirectional Lab
Interface within the EMR
Lydia Gonzalez, MD, MPH, FAAP
Clinical Informatics, Director / EMR Project Manager
Mr. Ivan Pan
Clinical Informatics, Senior Analyst
The Players

MHHC


GE Centricity


EMR product chosen, which interfaces with our PM
system
Quest


FHQHC operational for 30 years with 70+ providers,
and multiple locations
Lab service for our enterprise
Ignis

Provides Bi-directional interface service (EMR-LINK)
GOAL
Upon implementation of our EMR, to provide
the ability to order labs and receive labs results
in a timely fashion.
Historically, we ordered on paper requisitions
and received labs on paper printouts/lab copies.
Providers could also retrieve labs by accessing
an internet program, Quest 360 Care. Lab
reconciliation was problematic.
Background Information

MHHC was involved in a collaborative with
3 other community health centers, known
as METCHIT.

CBWCHC, Settlement, Soundview
Steps To Interface
Review of historic lab ordering for site(s)
 Mapping of distinct labs for each site was sent
along with universe of ordering for center
 Analysis of frequency of lab ordering for
universe, site and specialty was conducted
 Development of custom list within EMR for each
specialty
>>note: In-house labs were not included

Ordering Setup

Mapping MHHC lab orders to Quest orders


based on most frequent utilization in the past
two year
Simplified orders mapping/referencing:
Ordering In Action

Directly order lab test from EMR’s own
orders module
Reporting Setup

Mapping Quest lab results to MHHC data points
(observational terms)
Simplified results mapping/referencing:

Difficulties:




Similar/Same result description with different result code
Lack of report content as a whole
Similar observational terms in EMR
Report Is Back



Directly goes into
the patient’s chart
Pending ordering
provider’s review
and signature
All result (data
points) are mapped
to Observational
terms in the EMR
At go live – preloading lab data



For each site, a years worth of data is brought
over into the EMR.
A list of ordering providers are reviewed, to
match with existing providers (issue of
misspelling, or providers no longer employed
which are then assigned to Director of Service)
Documents are/were brought over as signed
Lab Reporting into the EMR






Suppress incomplete lab results
Panic values will be called in
Complete labs are transmitted daily to the
ordering provider for signature
Our policy that all documents/labs are
signed within 48 hours
Provider is responsible for follow up
Coverage schedule for covering desktop
Advantages






On time ordering
Future ordering for returning patients
Timely retrieval of labs
Timely response for abnormal labs
Data driven lab reconciliation is now possible
electronically (without separate process)
One of the great HOORAH to EMR
implementation.
Challenges





Occasional need for partial lab result
Follow up of patient who does not show
for lab
Site, center-wide lab reconciliation
Integration with in-house lab
Active PI project