6 Key Considerations for Optimizing Your Hospital Laboratory's EHR System

In 2009, the Obama administration signed into law the America Recovery and Reinvestment Act. Under this legislation, the HITECH Act makes healthcare providers who adopt meaningful use of electronic health records eligible for incentive payments starting in 2011. As more hospitals and community-based physicians make a move toward implementing EHR systems in their organizations, hospital leaders are now faced with the challenge of aligning the systems with in-house laboratories. Not only is a seamless integration between the hospital and its laboratory important in order to achieve efficient delivery of care, but incorporating laboratories into EHR implementation can be a way for a hospital to obtain incentive payments in the future. Here Kelly Feist, vice president of marketing at diagnostic information technology solutions company Sunquest Information Systems, offers six considerations for hospital leaders.

1. Stark Safe Harbors protect hospitals looking to incorporate EHRs with outside physicians.
Although Stark legislation prohibits healthcare organizations and physicians from referring patients to facilities in which they have a financial interest, the law includes a number of safe harbors. One of these safe harbors allows a hospital to extend its EHR services to community physicians, as long as the recipient, in this case the physicians, cover at least 15 percent of the costs tied to implementing and maintaining those systems. Extending EHR services allow better integration among hospitals, individual community physicians and laboratory facilities.

"The safe harbor helps encourage hospitals and physicians in the community to start sharing electronic information," she says. "Until the HITECH legislation of 2009, the adoption rate of EHRs was actually quite low, but now we're seeing adoptions occurring on a steeper curve. We're seeing larger 200-bed plus hospitals take advantage of the anti-kickback safe harbor ruling. With the adoption of electronic medical records by physicians in community, lab testing plays a role there. Lab test results are the most requested data by [all physicians]."

2. Focus on service for your hospital-based laboratory. It is critical hospitals continue to market the services that the in-house laboratory can offer to community physicians, with an emphasis on direct access to lab results through the hospital lab's EHR system. Ms. Feist says many freestanding laboratories run outreach businesses to rack in additional revenue because of the extra samples taken in from community physicians, ambulatory surgery centers and other healthcare facilities. Given the reality of laboratory outreach, hospital should market its own laboratories services to maintain a competitive edge.

"The core of the success for hospital-based laboratories is service, so if a hospital is delivering excellent service, those community-based physicians will want to send more lab tests to your hospital and bring you their business," Ms. Feist says. "Hospitals have to know there's a competitive market going on for laboratory services, and service is really the driver in how customers are won and lost even in that aspect. So the ability to able to electronically interoperate with community physicians becomes important."

3. Work with a vendor who understands final rules for meaningful use. Final rules for meaningful use of EHRs under the HITECH Act are just going through its first stages. Although 2011 final rules for meaningful use have already passed, those rules are going to continue to evolve, Ms. Feist says. For hospital-based laboratories, that means paying close attention to how results can be electronically transmitted and to whom.

"There are some statements that are very specific to lab testing and results, and with the Office of the National Coordinator already looking forward to what the 2013 rules should be, it's a good possibility those future rules will have more stringency on how information in transmitted," she says. "That's why hospitals have to make sure the vendor they are working with understands what the current rulings are."

In addition to this, hospitals should look to accrediting bodies — such as Drummond Group and CCHIT — that are deemed by the ONC to be authorized testing and certification bodies for certification of EHR systems.

4. Rapidly deploy interfaces to physician offices. Hospital leaders need to rapidly deploy interfaces to physician offices EHRs so that the laboratory and hospital can best connect with the physicians in their communities. The demand for interfaces to physician office EHRs is on the rise, resulting from the recently legislated incentives for adoption under the HITECH Act.

"Deploying interfaces rapidly will become more and more important for hospitals," Ms. Feist says. "For example, hospitals may want to shoot for having those systems live in a couple of weeks instead of a couple of months. Being able to turn around the test results quickly and accurately and have those results flow across the interface into physicians' EHRs becomes increasingly important. It's a competitive environment, so if a hospital-based lab can't reach interoperability or connectivity quickly, those physicians will find someone else who will."

5. Offer resources outside of EHR systems to help facilitate delivery of care. It is widely accepted that physicians who decide to implement EHRs in their practices will likely see decreased productivity because the initial stages of deployment requires some time spent troubleshooting and learning how to use the system. Hospital leaders should consider this challenge in medical practices and offer physicians other web-based solutions to continue toward the ultimate goal of interoperability and connectivity.

"We know the adoption curve for EHRs is just starting to pick up, so there will be a period of time where we have a significant number of physicians who don't have a fully operational EHR system," Ms. Feist says. "So it's incumbent upon hospital-based labs to make sure they can connect with those physicians in some kind of format, which is typically carried out in the form of a web-based physician portal. This way, physicians without EHRs can enter orders electronically until they have their EHRs fully implemented and online."

6. Set up a governance structure or committee to oversee EHR interoperability. Ms. Feist says hospitals would benefit greatly from setting up a governance structure or subcommittee whose responsibility is to oversee the implementation and interfacing of EHR systems between laboratories and physicians and achieve interoperability across the entire enterprise.

"The overall goal for these governing bodies has to be interoperability above all and not just between two people or between two departments but across the entire continuum of care," she says. "These leaders have to make sure everybody is on the same page and moving in the same direction to meet meaningful use criteria for 2011 in order to be eligible for incentive payments and also decrease cost and improve care."

Learn more about Sunquest.

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