Integrating your LIS to your Physicians EMRs. . What Hospital Outreach Programs Need to Know

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1 Integrating your LIS to your Physicians EMRs. What Hospital Outreach Programs Need to Know Pat Wolfram VP Marketing and Customer Services Ignis Systems What We ll Talk About What is an EMR? Physician Adoption of EMRs EMR to Lab Integration Opportunities The Government Gets Involved EMR Certification through CCHIT Ways You Can Prepare For, or Even Influence, EMR Choices.

2 EMR: The Out Patient Clinical System Out Patient Clinic Hospital or IDN PMS 98% Adoption EMR 20% Adoption Administrative Registration Scheduling Billing Clinical Patient charts Meds, problems, allergies Results (labs, ECG, Rad, ) HIS CDR Administrative Registration Scheduling Billing ADT Clinical Enterprise-wide repository Generally labs and documents About EMR Adoption CAGR 21% $2,002 $1,744 $1,527 EMR Penetration # Docs % of total E 2008E 2009E 2010E 2011E Solo ,075 10,391 11,898 13,623 15,607 17,898 20, ,000 26,840 32,754 40,000 48,911 59,899 73, ,020 11,095 13,642 16,763 20,592 25,295 31, ,816 9,691 12,021 14,921 18,512 22,929 28, ,203 12,855 16,129 20,063 24,600 29,567 34,982 Total Penetration 58,114 70,872 86, , , , ,447 Total # Doctors % 12.9% 15.7% 19.2% 23.3% 28.3% 34.3% Source: CDC, Health Affairs, AC Group, MGMA, SFG Research. Compiled: Susquehanna Financial Group investor report on Allscripts, published 3/22/07

3 About EMRs: What They Do Electronic Medical Record What was was paper, isn t. Anytime access To To patient s charts. Clinical workflow mgmt Clinical assessment Disease management Integration to/from: Labs Radiology ECG/Cath Other EMRs Outcomes Reporting How Clinics Adopt EMRs Usually begin with low impact, high value modules; then move up Investment (time, tools, etc, ) Lab results are required in 90% of EMR go-lives View and Sign Office Communication Phone notes Virtual to do list Office efficiencies Lab orders are adopted when general orders are adopted Medication Management Full Encounter Documentation Script legibility Interaction checks Formulary compliance Minimal workflow impact Populates chart with clinical data; lab results and transcription Chart review from home EMR Implementation Timeline Orders Face sheet documentation E&M Compliance Billing efficiencies Disease management CPOE requirement Complete EMR workflow

4 Lab Orders In The EMR Integrates with with overall EMR workflow Clinics adopt lab lab orders when they they adopt orders in in general (ECG, Radiology, Referrals, ) ) Orders has has two two phases Decision (physician) Processing (nurse) Physician orders in the EMR Clean Orders Compliant with MN Signed ABNs Full insurance information Text report Structured Image ref Link to LIS LIS Results: Desktop Notification Notification on on physician s desktop Along-side radiology reports, referrals, ECG ECG results, Secure , , Charts Charts on on hold, hold,.. Highlights for for Out Out of of range range results results Physician orders in the EMR Clean Orders Compliant with MN Date Name Document Signed ABNs Full insurance information! 3/27/2007 Callaway, Carl LIS Lab Rpt: Lipids Text report Structured Image ref Link to LIS

5 Results: Discrete Data Import Structured Data/Results Trending Reportable Can Can be be exported to to a Hospital CDR Physician orders in the EMR Clean Orders Compliant with MN Signed ABNs Full insurance information Text report Structured Image ref Link to LIS LIS Results: Documents Import Text Text Reports Most human readable RTF RTF formatting Just Just like like the the fax/printer Physician orders in the EMR Clean Orders Compliant with MN Signed ABNs Full insurance information Text report Structured Image ref Link to LIS LIS

6 Results: Links Import Link Link to to your LIS LIS LIS LIS reports LIS LIS viewer Just Just another EMR document. Physician orders in the EMR Clean Orders Compliant with MN Signed ABNs Full insurance information Text report Structured Image ref Link to LIS LIS Physician Trends / Requirements The EMR Is Their Clinical Desktop All Orders Originate From My EMR Zero Clicks Make it part of my EMR workflow All Results Return To My EMR Match to the right patient Inform the right ordering provider Update my order information. Single EMR Library For Lab Ordering (more advanced users) Physicians Would Rather Not Need To Know The Lab Service Provider The Nurse/Phlebotomist Needs To Know.

7 Lab Requirements Great Service To The Physician See prior slide Support My Operations Complete Order with My Lab Order Codes Validated for Medical Necessity Includes Billing Information (insurance, accounts,..) Includes AOE answers Electronic (time savings, no key-punch errors) The Key is a Mature Lab Order 1 Point-of-care ABN Validation (Uses lab s ABN rules) 2 A Mature Lab Order The right Provider ID The right test order code The right insurance code The right billing account. 3 Lab compendiums Order Entry Questions Requisition printing ABN printing Label printing Lab ABN Validation Clinic s mapping tables EMR data Lab 1 Data Lab 2 Data Provider Names UPIN/NPI codes Lab Order codes Lab order order codes Insurance Lab Insurance Lab Insurance Order completion HL7Order 4 HL7 compliant ORM Complete order information to lab s requirements Location of Care Lab account # Lab account # 6 Routing Rules (choose the lab) Integration Module Match to patient chart Auto-Completion Physician desktop notification Lab Order Codes Meds Radiology LinkLogic 5 Lab Result Manager Electronic (HL7) Result LIS Services Clinic s EMR

8 Rules Based Routing Clinic s mapping tables Order Completion ABN ABN Validation ABN Validation Validation EMR Lab1 Lab2 Lab3 Provider s UPIN / NPI / EMRLogin Order codes Tests Tests Tests Electronic (HL7) Order Lab Insurance Insurance Insurance Insurance Location Acct # Acct # Acct # Routing Rules (chooses the lab) Web Service Access Lab Your EMR Order Codes Meds Radiology Services LinkLogic Lab Result Manager Electronic (HL7) Results Clinic s EMR Industry Trends Reference Labs Are Gearing Up Investing in EMR integration They Have a Head Start More EMR Vendors Are Entering The Market. 32 Vendors Have Been Certified as EMR Vendors Over The Past 12 Months. The Government Plays An Active Role Certifying EMR Vendors Driving EMR Standards Funding Pilot EMR Programs (to seed the standards)

9 AHIC: The hub that drives opportunities for increasing nation wide health information interoperability The Certification Commission for Health Information Technology (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) American Health Information Community (AHIC) Health Information Technology Standards Panel (HITSP) National Health Information Network (NHIN) Architecture Projects CCHIT focuses on developing a mechanism for certification of health care IT products HITSP brings together all relevant stakeholders to identify appropriate IT standards HISPC addresses variations in business policy and state law that affect privacy and security NHIN is focused on interoperability pilots Stark and EMR Certification In In August August 2006, 2006, the the Department of of Health Health and and Human Human Services (HHS) (HHS) published rules rules that that provide provide an an exception under under the the physician self-referral prohibition law law (Stark), (Stark), as as well well as as safe safe harbor harbor under under the the anti-kickback act act (AKA), (AKA), for for the the donation of of interoperable EHR EHR technology to to physicians and and other other health health care care practitioners or or entities. EHR EHR software is is deemed to to be be interoperable if if a certifying body body recognized by by the the Secretary has has certified the the software no no more more than than months months prior prior to to the the date date it it is is provided to to the the physician/recipient. CCHIT CCHIT is is an an officially recognized certifying body body CCHIT CCHIT = Certification Committee for for Healthcare Information Technology

10 CCHIT Requirements: Today For Interoperability, It s a Low Bar 32 EMR vendors have been certified CCHIT Interoperability Requirements (that impact labs) 2009 Send Send a Lab Lab Test Test Order Order electronically electronically and and more. more Receive Receive Microbiology Microbiology lab lab results results Capture Capture co-signatures co-signatures for for orders orders Associated Associated Images Images with with result result Receive Receive General General Text Text Reports Reports Display Display normal normal versus versus abnormal abnormal results results Display Display flow flow sheets sheets Provider Provider notification notification Order Order lab lab diagnostic diagnostic tests tests Associate Associate a diagnosis diagnosis with with a test test Test Test specific specific AOE AOE prompts prompts Transmit Transmit the the order order on on paper. paper. Group, Group, or or panel panel ordering ordering Missing Electronic Electronic Orders Orders Auto-update Auto-update of of orders orders Rules Rules based based Routing Routing

11 Another Way To Choose An EMR CCHIT KLAS Basic Basic Order Order Functionality Functionality Basic Basic Result Result Functionality Functionality vendors vendors comply comply today today EMR-Lab Mature Integration Merge Merge EMR EMR and and lab lab rules rules Closed Closed order-result order-result loop loop Billing Billing and and clinical clinical maturity maturity Consumer Consumer report report of of HCIT HCIT Service Service Focus: Focus: Did Did they they do do what what they they said said they d they d do? do? Extra Mile Rules Rules based based routing routing Image-based Image-based reporting reporting Things You Can Do Confirm Government (CCHIT) Certification. Look Beyond Government Certification Team With Your Physician Groups In The EMR Selection Process. Choose One That s A Win For You Both. Leverage Your Departmental Integration Strengths.

12 Orders hospital services Departmental Cooperation Clinic Hospital Rich Orders ECG PACS Lab Results review LinkLogic Lab results ECG reports/images Radiology results/images Full text report Structured results URL link to image Link to reporting system Engine Clinic Clinic Benefits Integrated Integrated Orders Orders (not (not an an afterthought) afterthought) Fully Fully functional functional results results interface. interface. Hosted/Subsidized Hosted/Subsidized EMR EMR Full Full Hospital Hospital Services Services tied tied to to their their EMR EMR results/reports/images: Labs, Labs, Imaging, Imaging, Discharge Discharge Summary Summary Hospitals You You have have an an engine engine share share it. it. You You have have a competitive competitive bundle bundle of of services services (labs, (labs, radiology, radiology, cardiology, cardiology,.).) When When one one department department builds builds an an interface interface type, type, tie tie into into it. it. Show Show the the doctors doctors a roadmap; roadmap; labs labs now, now, radiology radiology next next In Closing.. Embrace EMR Lab Integration First Mover Advantage. Be a Partner on the EMR Selection Committee The First Lab in Becomes the Defacto Standard If You re First You ll Deploy Faster 2 nd lab will write translation tables. 2 nd lab won t have the loyalty

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