Managing Orders And Results For Multiple Labs at a Large Physician Group

Managing Orders And Results For Multiple Labs at a Large Physician Group

Introduction Amar Bulsara Family Physician Group Director of IT and Software Development Pat Wolfram Liaison Healthcare Director EMR-to-Lab Integration

Session Learning Objectives: How we improved physician workflows How improving the lab order improved operations Maintaining the order status automatically. Cross Reference Files -- Ugh! How that s simpler now Our return on investment

About Family Physicians Group Family Physicians Group was founded with the goal of providing a full selection of the medical services you need in one convenient location. As a patient-centered medical home, we guarantee personalized care that gets results. Our Facilities: 54 Physicians 24 Locations throughout Central Florida 350 Centricity Users Our EMR staff 4 Full time Centricity Support Staff (Clinical Content) IT Support Team (4 HelpDesk and 1 Systems Engineer)

Where Our Tests Are Performed Labs: LabCorp Quest Diagnostics Radiology / Imaging Departments In-house (X-Rays, Echo s, Ultrasounds) SimonMed Boston Diagnostics Other local centers

Challenges Workflow: Choosing the correct lab Manually keeping the order status up to date, or not. Call backs from the lab when the order was incomplete or unclear Missing account/demographics/insurance Missing clinical information Support challenges Keeping our lab result cross reference files up to date Maintaining the ordering categories and codes for each lab Maintaining draw rules (required insurance, AOE questions,..) Compliance and Regulations New Meaningful Use requirements CLIA

Physician Ordering Workflow Before One ordering compendium for LabCorp, one for Quest Physician evaluates insurance Chooses correct lab based on insurance Today Single ordering category System chooses the right lab Same requisition printer for both labs Same label printer Benefits Easier to use, so it s easier for physicians to adopt Now a MU requirement

Auto Routing How It Works Point-of-care ABN Validation (Uses lab s ABN rules) Other rules ABN Validation 3 FPG s EMR-LINK Account Rules-based routing (insurance and location) Clinic specific mapping of EHR-to-Lab data Order Entry Questions Requisition printing ABN printing Label printing Clinic s mapping tables EHR data Lab 1 Data Lab 2 Data Provider Names Order codes Lab order codes UPIN/NPI Lab order codes Insurance Lab Insurance Lab Insurance Location of Care Lab account # Lab account # 5 Lab compendiums (edos) LabCorp Quest Requisition Completion HL7 Order 6 Req Lab HL7 compliant ORM Complete order information to lab s requirements EMR-Link Flex Connector 2 4 Orders Results 7 Label Manifest Reports Future Orders Billing interface back to PM 1 Your EMR Order Codes Meds Radiology Clinics EHR LinkLogic Secure HTTPS downloads EMR-Link Connector 9 Lab Result Manager Auto-Completion Provider desktop notification 8 Electronic (HL7) Result LIS Services

Maintaining the Ordering Compendium Before Our staff kept the lab order codes/descriptions up to date Changes from labs, we d update the category Today Single ordering category Orders cross reference tables on the web service Labs provide compendium updates Benefits Easier to maintain

The Labs Update EMR-Link When They Change Codes The practice has access to all those updates Point-of-care ABN Validation (Uses lab s ABN rules) Other rules ABN Validation 3 Clinic s EMR-LINK Account Rules-based routing (insurance and location) Clinic specific mapping of EHR-to-Lab data Clinic s mapping tables EHR data LabCorp Quest Provider Names EMR codes LabCorp test codes Order Entry Questions Requisition printing ABN printing Label printing UPIN/NPI Quest test codes Insurance Lab Insurance Lab Insurance Location of Care Lab account # Lab account # 5 Lab compendiums (edos) LabCorp Quest Requisition Completion HL7 Order 6 Req Lab HL7 compliant ORM Complete order information to lab s requirements EMR-Link Connector 2 4 Orders Results 7 Label Manifest Reports Future Orders Billing interface back to PM 1 Your EMR Order Codes Meds Radiology Clinics EHR LinkLogic Secure HTTPS downloads EMR-Link Connector 9 Lab Result Manager Auto-Completion Provider desktop notification 8 Electronic (HL7) Result LIS Services

Lab Results Workflow Before Physician reviews and signs lab results Manually updated the order status (or did not update) Today, Signing results automatically updates order status (autocomplete) Benefits Maintain CLIA compliance (lab order status) Savings of xxx hours a month (assuming xxx lab orders)

Lab Results Setup/Maintenance Before Manually updated the results cross reference file Often DID NOT keep the xref file up to date Today, On-line xref editor does Benefits Clinical accuracy --- results flow to the flowsheet where they can be reported/trended/and trip protocols Less time consuming to maintain xref files

Other Benefits of the full Bi-Directional Interface Reduces LinkLogic Errors due to ID mismatches. AOE questions are updated by the labs, not us. Less call-backs from the lab. The orders contain what the labs need User ID ensures ordering physician is notified, not responsible provider. Saves an average of 360 hours a month

How It All Works Point-of-care ABN Validation (Uses lab s ABN rules) Other rules ABN Validation 3 FPGs EMR-LINK Account Rules-based routing (insurance and location) Clinic specific mapping of EHR-to-Lab data Order Entry Questions Requisition printing ABN printing Label printing Clinic s mapping tables EHR data Lab 1 Data Lab 2 Data Provider Names Order codes Lab order codes UPIN/NPI Lab order codes Insurance Lab Insurance Lab Insurance Location of Care Lab account # Lab account # 5 Lab compendiums (edos) LabCorp Quest Requisition Completion HL7 Order 6 Req Lab HL7 compliant ORM Complete order information to lab s requirements EMR-Link Connector 2 4 Orders Results 7 Label Manifest Reports Future Orders Billing interface back to PM 1 Your EMR Order Codes Meds Radiology Clinics EHR LinkLogic Secure HTTPS downloads EMR-Link Connector 9 Lab Result Manager Auto-Completion Provider desktop notification 8 Electronic (HL7) Result LIS Services

Patient Engagement Enhanced Results.. Simple and easy to read Customizable Patient View PCP decides Show only Normals Show only Abnormals Present in Graphical view Add patient specific comments to add more value

What We Learned (or might do differently) We can t live without it Simple and intuitive Setup, Configuration and Implementation is a breeze