EHRs Are In Every Lab’s DNA

The following article first appeared on Medical Laboratory Observer (MLO) on September 25th, 2018. It was written by Advanced Data System's Vice President, Marc Klar.

Like virtually every other entity in healthcare today, laboratories need to stay engaged and connected with the two groups of people most important to them: their referring physicians or sources (such as hospitals or companies that require employee testing), and the laboratory’s patients.

For connecting and engaging with referring physicians or a hospital, both of which no doubt have an electronic health record (EHR) system, nothing works better than having a bi-directional interface between the EHR and the LIS (laboratory information system). Even better is when the laboratory’s “presence” can actually be embedded into the referrer’s EHR, solidifying the laboratory with the referrer.

It works like this: once the test(s) needed for the patient is determined, the referrer creates the order in their EHR, selects the laboratory from within the EHR, and transmits the order to the LIS from the EHR without ever leaving the EHR. The functionality is exactly the same as transmitting electronic prescriptions to the patient’s pharmacy.

The laboratory is now notified about the patient and the test(s) that is/are needed.

Being bi-directional, once the results are ready the laboratory transmits them from the LIS back to the referrer’s EHR. Even more ideally and specifically, those results should land directly in the patient’s laboratory results section in his or her profile in the referrer’s EHR, and not in a general inbox requiring someone on the referrer’s side to move those results into the patient’s record.

The EHR should be able to track submitted orders for which results are still pending. There are only two reasons why results are pending: (1) the laboratory hasn’t determined the results yet, or (2) patients who were supposed to have gone to the laboratory for their tests haven’t done so.

The second possibility is especially troublesome since these may be time-critical/health-critical tests. If the patient hasn’t gone to the laboratory yet and the laboratory relays that to the referrer, the referrer is now able to remind the patient, guarantor, care provider, or authorized family member about the urgency in having the patient’s test(s) completed.

When results are transmitted from the LIS to the EHR, the EHR should “ping” the referrer as those results come in. It’s even better if the EHR can issue extra alerts or red flags whenever results are out of normal range.

Just as referrers should be able to track their submitted orders from their EHRs, the laboratory should also be able to track results that were transmitted back to each referrer, including when they were transmitted.

Time for Results

This type of circular digital connectivity supports a three-way win. First, the laboratory is right there to be easily selected from within the referring source’s EHR in order to transmit the orders.

Next, the laboratory’s results are transmitted back to the referrer’s EHR completing the second third of the circle.

The third part of the “win” circle involves the patient because while the patient may not realize it, it’s to his or her advantage that the background choreography between the referrer and laboratory is electronic, clean, and traceable on both sides.

Other specialized engagement tools might be available starting with ways to ensure patients actually show up if they’re supposed to go to the laboratory for their tests, avoiding the scenario mentioned above about not having potentially health-critical tests performed.

Your laboratory is a business, so before describing those tools, let’s talk about another reason you want patients arriving for their tests: revenue.

The patient needs tests for which a laboratory is required. Yours is the one that has been selected; hopefully through the referrer’s EHR. Now you need the patient to arrive so the test(s) can be performed, and the patient can be billed. You can’t bill for a no-show.

One tool is when the LIS has a portal through which the referrer’s office can schedule, or at least request the appointment for the patient, while the patient is still with the referrer. In this scenario, not only are the orders transmitted from the EHR to the LIS, but the appointment is also scheduled or requested on the spot. The patient doesn’t have to think about scheduling the appointment later which could lead to procrastination or worse, simply ignoring it.

So … if the appointment can be scheduled or requested while the patient is still with the referrer, and if the orders can be transmitted to the LIS, and if online forms specific to the test(s) can be completed in advance by the patient, then there’s really nothing left for the patient to do other than go for the test. Basically everything’s done.

Still the patient needs to physically arrive, so here is another engagement item: LIS-generated appointment reminders to send via mail. Even better, interactive reminder texts sent to patients’ cell phones. Patients would be able to confirm or cancel by simply replying to these texts. Those who cancel can be called to reschedule, and the laboratory can try to reschedule other patients to fill in the gaps. Patients who don’t confirm or cancel can be called.

Perhaps the most common reason for patients not arriving for their appointments is that they simply forgot. Well-timed reminder texts are ideal for overcoming this situation and for filling in gaps for those who cancel.

A tremendous side benefit to portals and texting is how they both work to keep patients engaged and connected with your laboratory, which in turn has a direct effect on your revenue.

Two Observations

First, there should be a secure patient portal on the EHR side. This allows patients to access a variety of different capabilities, including the ability to see their laboratory results if the practice chooses to make them available on the portal.

Second, the EHR should certainly have its own billing and reporting system for use by the practice.

If it’s a full service vendor that also has a laboratory-specific billing and reporting system, that system should be able to handle in and out of network laboratory electronic data interchange which includes claims, payer-based authorization alerts, patient statements, full laboratory financial and management reporting, PAMA reporting, and even reports and management for the laboratory’s sales team activity and commissions. Of course, clean integrations with virtually any LIS should be easily accommodated.

To recap, tools can be employed (1) by the laboratory on the LIS side, (2) through its referrers’ EHRs for keeping the laboratory “top of mind” with those referrers, and (3) for keeping laboratory patients yours if future testing is ever needed. These tools all work together to help promote patient—and laboratory—well-being.