Experiences with LIS-EMR Interfacing
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- Rolf Parks
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1 Experiences with LIS-EMR Interfacing Session on: Future of Pathology Informatics and the LIS Pathology Informatics 2012 October 9, 2012 Walter H. Henricks, M.D. Cleveland Clinic
2 LIS-EMR Interfacing isn t so much about interfacing as it is about interfacing HUH???
3 Definitions of Interface Noun: a device or program for connecting two items of hardware or software so that they can be operated jointly or communicate with each other Verb: interact with (another system, person, organization, etc.)
4 Cleveland Clinic Health System 9 hospitals (with laboratories) 17 satellite clinics/ascs ~160K admissions/yr ~187K surgical cases/yr >20M billable tests/yr >86,000 blood components transfused/yr (main campus)
5 Cleveland Clinic Experience with LIS- EMR Interfacing LIS-EMR interfaces since 1995 Order entry CPLIS Results reporting CPLIS and APLIS Current EMR replacement of legacy EMR: Ambulatory 2002 Inpatient 2006 APLIS-EMR orders interface 2009
6 LIS-EMR Interface Environment Tumor registry Other registry Pharmacy CPLIS APLIS IF Engine Billing EMR Outreach Client LIS Outreach Client EMR State Health Department
7 Operational Considerations in LIS-EMR Interfaces Maintenance of EHR settings related to laboratory tests Change control and communication (e.g. test definition updates) Troubleshooting and client support Training of EHR users in test result viewing and (eventually) test ordering Handling of corrected results Monitoring or quality of service Client site contact and engagement
8 Two year experience with commercial EHR in setting of 54,000 lab test results per month New categories of result management errors: Interface and results routing errors Provider record issues MD dictionary definitions EHR system settings user configuration, unsolicited orders System maintenance-related errors Common thread results not routed or available to provider who was expecting them Some involved settings in the LIS J Am Med Inform Assoc. 2010;17:104-7
![Int J Med Inform 2010;79:e58-70. It became clear that the [CPOE] project s management grossly underestimated the CPOE-L implementation project.](/docs-images/27/10495140/images/9-0.png "The technical infrastructure of some laboratories proved to be enormously complex, and the large number of specialized laboratory services added to this complexity.")
9 Int J Med Inform 2010;79:e It became clear that the [CPOE] project s management grossly underestimated the CPOE-L implementation project. The technical infrastructure of some laboratories proved to be enormously complex, and the large number of specialized laboratory services added to this complexity. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way.
10 Toward a Broader View of Interfacing Successful and accurate exchange of test results and orders between LIS and EMR Application of laboratory domain expertise to management of laboratory information in the EMR
11 Fostering Laboratory s Credibility for EMR Issues Anticipate challenges in EMR-laboratory information management Provide laboratory resources to troubleshoot and resolve EMR-laboratory issues as they arise Raise awareness of EMR-laboratory issues with clinicians and IT support staff
12 LIS-EMR Interfacing Success Factor #1: Build relationships at various levels of the institution CIO/CMIO Chief of Staff Influential clinicians Quality/Safety Officer Compliance Office EMR support staff
13 LIS-EMR Interfacing Success Factor #2 Draw upon laboratory staff who support LIS to work on laboratory information management in the EMR Activities that translate well from LIS to EMR: Test definition Interface implementation System testing and validation Change control practices
14 LIS-EMR Interfacing Success Factor #3 Demonstrate benefits of having laboratory subject matter experts involved in EMR issues Work directly with EMR support staff Document/track laboratory involvement in resolving or preventing EMR problems Identify risk management issues
15 Examples of Laboratory Involvement in EMR Configure CPOE screens Manage laboratory test definitions in EMR Ensure required elements are in EMR for lab orders and results Contribute to clinical scenarios used during EMR system selection Participate actively in cross-departmental committees or projects Schedule meetings between laboratory and EMR IT support
16 1990: Am J Clin Pathol 1990;94(Suppl 1):S2-S6 Strategically, political power accrues to those subunits of an organization that are best able to solve its strategic problems.
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