Integration of Paper-based Send Out
Laboratory Reports in an Electronic
Medical Record
Walter H. Henricks, M.D.; Kavous Roumina, Ph.D.; Richard
M. Hill, M.B.A.; Sandra L. Krall; Shirley A. Stahl
Center for Pathology Informatics
Pathology and Laboratory Medicine
Cleveland Clinic, Cleveland, OH
Background
• Laboratory test results received on paper from
reference laboratories (“send out” tests)
represent an important potential gap in lab data
management in the EMR era.
• Establishing electronic laboratory information
system (LIS) interfaces to all referral labs for
esoteric tests is not feasible.
• Many reports are complex and include charts,
tables, or graphs and therefore cannot easily be
transcribed into the LIS.
Environment and Vision for Handling
Sendout Lab Reports
• Previous:
– Paper copies of outside reports sent to chart
– Subset of outside reports transcribed into LIS
– Results not readily available to clinicians in EMR
• Envisioned:
– Images of outside reports scanned into EMR
– True copy of report is available (vs. transcribed)
– Results readily available to any interested clinician
anywhere
Objectives
• Implement document imaging to integrate paperbased send out laboratory reports into an EMR
system
– to improve result availability
– to reduce errors (e.g. transcription)
Technology
• Document imaging system (OnBase, Hyland
Software, Westlake, OH)
• Scanning device (Fujitsu 5750C, Tokyo, Japan).
• EMR system with computerized physician order
entry (CPOE) (Epic Systems, Verona, WI)
• LIS (Misys Healthcare Systems, Raleigh, NC)
Design
1. Entry of an order for a send out test in the EMR
triggers an order to the LIS and sends patient
demographics and partial order data to the
imaging system.
2. When a paper test report is received from a
reference laboratory, a generic result is entered
for the pending order in the LIS, and this result
crosses to the EMR.
Design (cont.)
3. The paper report is scanned and indexed
based on data elements which are
automatically populated from data provided by
EMR (e.g. patient identification number).
4. Acceptance of a report “image” by the imaging
system triggers a message to EMR, resulting in
linkage to the original order.
5. A hyperlink to the imaged report is displayed in
the EMR’s result screen for that particular test
order.
Paper clip icon identifies
orders with scanned
reports
Hyperlink to scanned
result image
Generic result entered in
LIS and interfaced to EMR
Alternate view of all scanned documents for a patient
Results (two month evaluation period)
•
•
•
•
6241 reports
8212 pages (1.32 pages per report)
Two scanning devices
Reports available in the EMR on the day of
receipt.
• 1-2 hour/day scanning and indexing time
Results (cont.)
• Overwhelmingly positive physician response (no
need to track down paper copies of send out lab
reports)
• Elimination of errors in transcription of outside
reports into LIS
• Implementation requirements: 3 people
involved, approximately 192 hours
Conclusion
• Integrating scanned images of paper-based
send out reports improves result availability,
reduces transcription errors, and addresses a
deficit in laboratory result reporting in an EMR
environment.