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As federal regulators propose major steps to advance on health information interoperability, some sectors of healthcare say they’ve made inroads in facilitating shared health records and data between providers and patients. Clinical laboratories in particular have taken steps to integrate laboratory information systems (LIS) and electronic health record (EHR) software programs while leveraging automation and robotics technologies to more efficiently process test results. However, some experts say the lab industry as a whole could do more to employ its systems to support efforts in preventing disease.
Interoperability signals an ability to share data automatically and seamlessly among multiple devices and organizations. Despite widespread EHR adoption, data sharing has floundered among many institutions, the National Academy of Medicine (NAM) reported last fall. In its 2018 report to Congress, the Office of the National Coordinator for Health Information Technology (ONC) outlined six major roadblocks to interoperability, including “a lack of standards development, data quality, and patient and healthcare provider data matching.” Burdensome and outdated federal documentation and reporting requirements and a lack of incentives to develop business models for optimizing health IT are other factors impeding the electronic information exchange among health systems.
Differences in proprietary interface technology among hospitals and other healthcare providers has contributed to data silos that prevent interconnectivity among systems from taking place, according to NAM. For clinical labs, linking LIS software with a hospital’s EHR software that comes from a different vendor poses an ongoing challenge. While LISes and EHRs can be taught to “speak” to each other through common Health Level Seven (HL7) language to get test orders and results to flow back and forth, shortcomings persist, Mark Cervinski, PhD, associate professor of pathology and laboratory medicine at Dartmouth Geisel School of Medicine, told CLN Stat.
One example of this disconnect involves cancellation messages generated by LISes that don’t travel back to EHRs. “For instance, if a hemoglobin A1c test is autocancelled by a frequency rule in the LIS, it can be a challenge to get the cancellation message to flow back to the EHR,” Cervinski said. Issues also arise when a hospital’s LIS system is different than the one a reference lab uses. “Some of the reports coming back from reference labs are quite complex and text-based. With a text-based format, it can be challenging to appropriately flag an abnormal test result,” he explained.
The industry needs a truly interoperable system that seamlessly shares data among doctors and their patients and leads to informed healthcare decisions, according to Rick Pollack, president and CEO of the American Hospital Association (AHA). “We see interoperability in action all around us. Mobile phones can call each other regardless of make, model, or operating system. The hospital field has made good headway, but it’s time to complete the job,” Pollack said in a statement.
Dual proposals released by ONC and the Centers for Medicare and Medicaid Services at the HIMSS19 conference seek to close these interoperability gaps. Both rules call for the adoption of standardized application programming interfaces to make it easier for patients to access and gain control over their health information. The proposed rules come on the heels of a six-point solution issued by AHA, the Federation of American Hospitals, and other national hospital groups. Any infrastructure that connects information-sharing networks “must be secure, cost-effective, accessible and updated over time. It will require consistent use of standards, semantics and a common set of ‘rules of the road’ for exchange,” the hospital groups suggested in their report. They also outlined the kinds of interoperable information systems that would support the best patient-centered care. Within episodes of care, this would include data from medical devices, billing, EHRs, quality reporting, and laboratories.
Among major hospital and health systems, 93% have made records available to patients online, and 88% are sharing records with out-of-network ambulatory care providers. In the field, new technologies and tools such as HL7’s Fast Healthcare Interoperability Resources standards framework, shows promise in facilitating better interoperability by adopting a normative approach to sharing electronic information. According to one blog post, ONC reported that 32% of health IT developers were using HL7’s framework, and more than 50% were using it in combination with another standard.
Looking at interoperability trends within laboratories, connectivity of instruments has moved further away from LIS, gaining increasing reliance on automation, observed Ken Blick, PhD, professor of pathology and director of clinical chemistry at Oklahoma University Medicine. “In the old days, specimens were manually processed and transported in the lab by technologists, then front-loaded onto the instruments for testing. Today, we get those tests done with interfaced robotics and middleware software which automatically process specimens then deliver specimens to various instruments for testing.” This is also true of point-of-care devices, in which labs are using middleware for wireless connectivity instead of LISes. At the University of Oklahoma, “we’re interfacing hundreds of point-of-care devices with middleware,” Blick told CLN Stat.
Some hospital systems have migrated to integrated LIS-EHR systems that come from one vendor, observed Cervinski. Labs that have heavily customized their LIS systems might feel like they have something to lose, yet, “increased ease of integration between the lab and the EHR may solve some of the persistent problems with building and maintaining an interface between disparate system vendors,” he added.
Going forward, laboratory results need to be more interoperable to make information more intuitive and understandable to patients, so they can maintain and improve their health, Blick offered. This means keeping tabs on key patient data—for example, hemoglobin A1c, glucose, lipids, electrolytes, hematology, and coagulation data. “And so far, we haven’t done a good job of that. Labs are sitting on the answer for maintaining health and preventing disease—we just haven’t packaged a laboratory product that readily makes sense to patients and motivates them. Until labs make that data more interoperable between various methodologies, we’ll have a hard time keeping people healthy.”