Ready for #HIMSS16?

The 2016 HIMSS Conference is almost a month away! Scroll through our infographic and find some useful information on the conference before you leave for Las Vegas.

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We are so excited for HIMSS and to showcase how we can solve your interoperability challenges.

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By Emily Pollock, Marketing Specialist at Halfpenny Technologies

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Supporting Shared Savings Models, Care Coordination & the Actionable Exchange of Lab Data with LOINC®

lab_test_tubesOften, when I make a presentation to healthcare executives and lab people, I’m struck by the level of unfamiliarity regarding the Logical Observation Identifier Names and Codes (LOINC®). It is not that all are unfamiliar with it; lab directors and some managers and medical technologists are familiar but, overall, most are not. This is a telling fact about the state of our preparedness for data sharing, coordinated care, and advanced analytics. As a further example, a group of senators recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) requesting a re-evaluation and “reboot” of the Meaningful Use (MU) program citing, among other things, concerns regarding the program’s ability to achieve meaningful interoperability. LOINC® is part of the solution.

LOINC®: The Cornerstone for Interoperability

The cornerstone of interoperability is the use of standardized data structure and coding schemes. Since clinical laboratory data comprise the bulk of an individual’s medical record and are essential for healthcare decision making, one would expect it to be prominently featured in all interoperability discussions. In the realm of clinical laboratory data exchange, specifically for lab results, two standards come to mind immediately:

  1. The Laboratory Reporting Initiative (LRI) as a structure standard, andLOINC-maooing_CTA
  2. LOINC® as a coding standard.

While both are mentioned in MU regulations and the accompanying Office of National Coordinator (ONC) standards documents, they are not widely recognized as critical for interoperability progress – but they are!

The History of LOINC®

The Logical Observation Identifier Names and Codes (LOINC®) system was created in 1994 at the Regenstrief Institute, associated with Indiana University. Initially focused on laboratory observations (all laboratory categories and Veterinary Medicine), it has also expanded to include other clinical observations made on patients.

  • LOINC® has been endorsed by the American Clinical Laboratory Association (ACLA) and the College of American Pathologists (CAP).
  • It has been adopted for test reporting by large commercial labs such as Quest, LabCorp, Mayo Medical Laboratories, and MDS Labs; large HMOs including Kaiser Permanente and Aetna; governmental organizations including the CDC, DOD, VA, and NLM.
  • Internationally, LOINC® has been adopted as a national standard in many countries, including the United States, and has been translated into many languages.

Interoperability has two cornerstones:

  1. standardized structure
  2. standardized content.

LOINC® was created to solve the problem of laboratory data interoperability by promoting standardized content. To date, most labs use proprietary order and results codes. In the past, when results were manually transported or faxed, standardization was not an issue. However, in our emerging electronic healthcare setting without content standardization there is no interoperability. LOINC® mapping can help.LOINC_mapping

Facts about LOINC®:

  1. LOINC® is the “new” standard for lab results and lab orders
  2. It is critical for Meaningful Use
  3. It can me key to the success of independent and hospital labs
  4. LOINC® is large and complex – Test dictionary builds and LOINC® mapping are specialty skills that require lab and LIS expertise as well as LOINC® expertise.

The prudent approach by hospital and independent labs is to be proactive and prepare while there is still time. That is why my colleague, Halfpenny Technologies Clinical Data Specialist Jane A. Burke BSMT (ASCP) and I have co-written a white paper positioning LOINC® with respect to care coordination, meaningful interoperability, the exchange of actionable data, and supporting shared savings models. We hope that this white paper entitled, Supporting Shared Savings Models, Care Coordination and the Actionable Exchange of Lab Data with LOINC®, provides the foundation for LOINC® knowledge and offers you the important questions you need to ask regarding LOINC® mapping and test dictionary creation for your organization.

Find a LOINC® Mapping Expert

For those that conclude that they do not have the skill set and/or the infrastructure to support LOINC®, alternatives do exist and should be examined. Most LIS vendors do not offer such services to support their software systems and most labs are left to fend for themselves. However, some third-party vendors offer services for the initial dictionary build, LOINC® mapping, ongoing maintenance, as well as, middleware solutions that can bridge the gap in current capabilities of existing LISs.

Being able to positively answer the above questions or, at least, have a roadmap to achieve them within the first year of the start of MU stage 2 (2014), will prepare the lab for the realities of providing clinical services to physicians in the era of accountable care.

For more information, on LOINC® Mapping and Test Dictionary builds, please contact Halfpenny Technologies at 855-277-9100 or visit us online at http://www.halfpenny.com.

Gai Elhanan, M.D., M.A.

Chief Medical Information Officer

*LOINC is a registered United States trademark of Regenstrief Institute, Inc.

When Splitting Up is for the Best

Centralizing. One-stop-shopping. Consolidating. Sole sourcing. Streamlining. All of these actions have one common denominator; unifying a set of activities under one umbrella. Why not? It’s easier, more convenient, and should be cost effective, right? Maybe, but perhaps not when it comes to hospitals, labs, and physicians needing their lab orders to be routed to more than one testing laboratory for various legit reasons.

Ordering lab tests can be a complex process, even within a health network. Oftentimes a single lab order should be divided into two or more requisitions. The reasons can be many. The physician’s office can perform one or more of the tests in the office. The insurance company requires the separation. It’s most cost effective to send one of the tests to an outside lab. The order needs to go to a third-party subcontracted by the first lab. The provider prefers to bill insurance companies directly in order to obtain markup revenue, regardless if test is or is not conducted in their office. Hence, this is definitely an instance when splitting up is for the better.

Since test results from labs due influence nearly 70% of all healthcare decisions made today while representing only 2% of total healthcare costs, hospitals, labs, and physicians should have the choice and flexibility of splitting a requisition when needed. But let’s throw another monkey wrench, so to speak, into the mix while we’re at it. Does the hospital, lab, or physician office have an existing electronic health record (EHR) system in operation to automate and streamline the clinician’s workflow, reduce any errors and offset costs? What happens when there is an EHR system in place? What happens when there isn’t? How does an EHR system facilitate splitting an order? Better yet, how do you split a requisition without an EHR system?

Questions, questions, and more questions. Well, here are some answers.

The best action is to provide hospitals, labs and physician offices with a simple way to divide a single lab order into two or multiple, with or without an EHR system. A foolproof method to automatically split orders right from the start, during order entry and based rules on sample type, storage temperature, testing location, test type, order location, billing status, CPT code, order choice priority or type, insurance, physician preference and/or other measures.

Halfpenny Technologies (HTI), a leading provider of healthcare connectivity and integration solutions, offers hospitals, labs and physicians the means to split a single lab req into two or more requisitions with or without an existing physician EHR system. This capability is not only priceless, but essential as most physicians utilize multiple labs and route their test orders in accordance with the patient’s insurance, type of tests required, billing practices, or their own preferences.

Here’s how Halfpenny generates split requisitions. With an EHR system, Halfpenny receives the lab order from the EHR and automatically splits it according to rules controlled by authorized users and then prints specific labels, requisitions, and/or manifests as needed and routes the orders to the correct testing laboratory based on the hospital or physician’s workflow requirements. When the results are received, Halfpenny re-bundles and forwards them into the appropriate patient record within the EHR.

When there is not a physician EHR system, Halfpenny will implement one of its own proprietary solutions, ITF-Portal® or ITF-GoDoc® MobileOE, to facilitate the order entry directly and split the req utilizing the same rules described above. Either way, the split successfully occurs and the results can be combined and incorporated into an EHR system if available or viewed within one or both of the HTI solutions.

Splitting up a req to be routed to the correct testing laboratory is not only in the best interest of hospitals, labs, and physicians, but in the long run it’s also in the best interest of the patient who receives better care and better patient services. It saves valuable time, unnecessary costs and precious manpower. If you are still sole sourcing your lab orders to one facility, look a little further to the many benefits and advantages of splitting up a requisition. You might realize that breaking up is not so hard to do after all.