Session 8: Achieving Meaningful Use: Lab Results

4/13/11: 10:30 --11:30AM

Session Objectives

  • Discuss how Direct can be used to meet meaningful use and State HIE Program requirements to deliver structured lab results


  • Will Ross, Project Manager, Redwood MedNet, Inc.
  • Kim Long, Program Manager, MedPlus, a Quest Diagnostics Company


  • We have not discussed the Work Force program as extensively. We are currently training a great number of people for these types of positions. They understand business, but not necessarily healthcare. Look to the workforce program and the educated people that will be coming out is June.
  • Meaningful use (MU) requirements related to incorporating lab results as structured data and submitting lab results to public health agencies are optional/part of the menu-set; they become core in Stage 2.
  • By comparison, the State HIE PIN identified receipt of structured lab results as one of the key responsibilities that states and SDEs MUST address in 2011.

  • Why Direct for Lab Results? Important to remember that Direct is just one tool in the State HIE toolbox. There are numerous advantages to using it:
    • Direct is MU-compliant. MU was one of the strong considerations around the design of Direct.
    • Direct is standardized and simple, which improves the chances of uptake among providers.
    • Direct is scalable. It can be used beyond 2011 in meeting future stages of MU and an organization’s business goals.

  • Lab results exchange Type 1: Lab sends lab result to ordering physician.
    • Workflow steps:
      • Provider issues test order to external lab
      • External lab’s LIMS receives test order
      • Based on test result delivery instructions, the LIMS sends test results to the ordering provide
      • Ordering provider’s LIMS confirms receipt to conform with laboratory regulations
      • Ordering provider’s LIMS sends test result to EHR system for incorporation into the patient record.

  • Lab results exchange Type 2: Lab sends results to Public Health
    • Workflow steps:
      • The testing lab’s LIMS sends a test result to Public Health.
      • Public Health confirms receipt to conform with laboratory regulations.

Presentation 1, Will Ross, Redwood MedNet, CA

  • Redwood Mednet is a local HIE in northern California, which began production in 2008 and is currently serving 50 providers
    • All of Redwood Mednet’s providers are independent and not aligned (e.g., small district critical access hospitals)

  • Technology solutions:
    • Classic HIE interfaces between healthcare facilities
    • CONNECT Gateway to other HIEs or federal partners
    • Direct Messaging HISP available to any other HISP
    • Bi-directional link to Microsoft HealthVault

  • Redwood found that Direct would be helpful for exchanging patient summaries between unaffiliated healthcare facilities without EHRs.
    • Many area facilities without EHRs have created a common way of exchanging paper patient care summary documents - They fax 7 documents.
      • Redwood saw this as a great opportunity for Direct.
      • The transport relationships already exist - trust and process.

  • Redwood also acknowledges that the Direct delivery option would work well for labs because it would cut out the necessity for labs to build point-to-point interfaces into the EHRs at each provider practice.

Presentation 2, Kim Long, MedPlus

  • MedPlus is a subsidiary of Quest Diagnostics and the developers of Care360 Network, including 3 core products: CareLabs, CareEHR and CareData Exchange
  • Curently working on a Direct Pilot in Connecticut using Care360
  • MedPlus’s process for leveraging Direct for lab results exchange:
    • Quest Laboratory Information System (LIS) feeds directly into Care360 or the Lab Hub
    • Lab Hub feeds into EMRs that already have interfaces built
    • Now, Lab Hub also feeds into the HISP

  • Two steps to set up a connection to Quest for lab delivery via Direct
    • 1: Direct Client Application Setup
    • 2: Establish trust for Direct client and/or associated Healthcare Domain
      • Share certificates

  • Sends enhanced or regular PDF-ed lab results to provider email address or sends HL7 message to an EHR
    • PDF doesn’t require validation (under College of American Pathologists and CLIA regulations)

  • John: It’s important to distiguish between the two components of lab interoperability: transport and content
  • There are initiatives focused on pieces of lab results interoperability challenges:
    • S&I Framework Lab Results (LRI) Initiative
      • Developing use cases and functional requirements
      • Selecting the appropriate subset of tests to be included in the standard as well as corresponding vocabulary
      • Identifying assumptions behind existing standards and elements to be harmonized

    • State HIE Lab Interoperability Community of Practice (CoP)
      • Standardized contract language
      • Levers for Medicaid
      • Defining CLIA and other related regulations

FAQ Session

  • Are any of your pilots encouraging the use of C37 standards?
    • MedPlus is not.
    • Redwood Net is technology neutral. Functionally, none of the standards are off of the table. The key question is whether the format is usable for receivers and senders
    • Jitin: The C37 standards are under consideration by the S&I Framework, states should stay tuned for more information later in the year

  • Sandeep Kapoor (KY): Why does it make sense to use Direct for labs for MU? Most EHRs already have the capability of getting labs from Quest or LabCorp via HL7.
    • Will Ross: Most providers are sending/receiving lab results from more than one lab. If the EHR vendor charges more than $1700 per interface to lab, the providers can’t afford it. Direct reduces the number of interfaces required and could prevent a log jam at the providers’ office.
    • Ross Martin: Has also heard of a provider’s experience that, after paying $10,000 for a lab interface to be built in the EHR, it is 6 months late.
    • Arien Malec: When you’re a practice that has to have relationships with many labs (e.g., local, national), you either need to have an HIO in the area or pay for interfaces. Providers need more options. Direct is another tool for transport - S&I framework initiative will help to figure out the content issues.

  • David Kibbe (AAFP): Wants to address the issue of vendor lock-in. In the ambulatory care environment today, EHRs do not want to “play ball” (allow data to flow freely between organizations). Doesn’t think that will continue much longer.
  • Lab results exchange via Direct is low-risk for Quest - maybe higher risk for other vendors. A lot of vendors have already written code and changing their strategy in the current environment is risky for them. National standards would give vendors the sense of security to improve their labs strategy.
  • For Kim Long (MedPlus): When you are sending results via Direct, how do you identify the provider’s address and do you plan to use state-wide provider directories, if available?
    • If via email, we create that address for him and provide log-in and password information. This is part of their HISP. If he is using it as a third party EMR, we request their address. This is under the assumption that they are giving them the correct address.
    • Is that part of the requisition? No, it’s a one-time set-up for the address. From then on they’d use that address.
    • We would associate this with that provider through the order. When it is resolved, that Direct address is associated with him in the system.