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.

What is the Right Connectivity Strategy for My Outreach Program

and how about them U of A Wildcats; I think they have a real chance this year in the NCAA!

Let’s review the environment. In many areas of the country, the penetration rate of physician of EHR/EMRs will drive from a lowly 20% to nearly 80%. This adoption rate is fundamental to the changes necessary to drive more effective and efficient healthcare. But let’s also be honest, too; it is also driven by funding from good old Uncle Sam. These physicians and physician groups will also want to comply with meaningful use criteria to qualify for stimulus funding to underwrite their costs of entering the new electronic medical record and health record era.

Meaningful use criteria, as many already know, in stage one, two and three begin and then accelerate sophisticated use of these systems. Early stages mandate the storage of discrete data like lab which comprises nearly 80 to 90% of the potential data within an EMR. Let also not be modest; laboratory diagnostic data represents probably the largest data source for diagnostic efforts of physicians. No bias here! Later stages mandate Order Entry so drug-to-dug, drug-to-disease interactions can be checked, and – drum roll, please – laboratory ordering which eliminates errors, reduces manual data entry, (there is a solid ROI behind clean orders and getting paid, but that’s another blog) and promoting quality and efficiency across the spectrum of care.

It only makes sense. Reality check number one; there are at least 375 different EMRs out there that we know about. We are learning about new ones on the pace of a couple per month. It is the Wild West, and it sort of feels like a there is a stampede coming over the hill doesn’t it?

If you are one of the 75% of hospitals laboratories in America with an outreach program or are a reference lab, you could be facing this stamped and that’s actually not the worse part. The worst part is they are all DOCTORS!!!!! (By the way, I hope our Chief Medical Information Officer does not read this blog, but I couldn’t help throwing that analogy in. You should see him when he is mad; he turns all sort of funny shades of red and purple! Anyway…) So, you are facing the stampede and wondering what’s the right strategy. Okay, let’s start with the options.

Option 1. My IT department controls an Interface Engine. Why can’t I just connect my orders and results to it, and let them connect to all the different EMR’s? Sounds simple, right?

Here are a couple questions to ask yourself.  Does your IT department have a lot of extra time on their hands? Have they already completed the ICD9 to ICD10 and 4010 to 5010 conversions? Are they prepared to handle the stampede? Can they deal with 375 different EMR systems? Are they good with doctors?

Option 2. I could use the physician access system/portal vendor I am currently doing business with! Sounds good, doesn’t it? If you are using one of them, they probably already have some connections out there. You have used them for quite some time. You like them or maybe not.

Okay, here are a couple questions to ask yourself. Are they prepared to handle the stampede? Can they scale to the demand you have and all of their other customer’s needs, too? Is EMR connectivity a sideline or are they really in this business with both feet? How is there service now? What might it be like when things get really crazy?

Option 3. Use the local HIE. This one usually comes from corporate. “We don’t want you wasting time building interfaces to EMR’s, because we have that covered with this here strategic relationship with the state’s HIE!”

Okay, you have got my pattern figured out. Here are some questions to ask yourself. Who is faster at building interfaces to my clients’ EMR, the HIE or my competitor? Can you afford to wait? Does the HIE initiative take care of the special requirements and workflow of lab order and result processing? How are the specimens going to be received? Will I be able to get paid with the information they are sending? How will MRN, Event, Episode or Account Numbers be associated with the order when transmitted to the LIS? Will the physician be presented with ask-at-order-entry-questions? Will an ABN get printed, signed and will the transaction contain an indicator of same? Is the HIE technology biased in any way that might prevent it from interfacing really well to all my customers EMRs?

(Note to reader: some HIE technology vendors are also EMR vendors and may not play nice with other EMRs or heavily influenced by your competitor. You get the picture. Their goals may not coincide with your goals to protect and grow your business.  At the worst case, you might want your own strategy in place or at least a backup!)

Option 4. Find a vendor who does this for a living: just this.

Big Finish – I hope you find the rather weak attempts at humor and analogy not too distracting. There is merit within each option and other’s I haven’t mentioned, but I pick on each pretty hard for a purpose. There is a are large demand for connectivity now and we expect it to grow.  Your strategy and options deserve careful consideration and potentially a multifaceted approach. If you already have a strategy, great, what’s your back up plan? If you don’t have a strategy, it’s probably time to start the process.  I welcome any and all comments, thoughts, concerns as long as they are positive and constructive, for the rest I’d like to introduce you to our CMIO; he’d love to hear from you!!!!!

(Note to reader: Our CMIO, Dr. Gai, is actually an incredibly smart, nice, and visionary individual. His face doesn’t turn red when he gets mad either. I’ve never actually seen him mad, and I enjoy his company. I just made all this up to see if he would read my blog!)