Unable to consume and effectively utilize your member’s clinical data?

By: Lesley Brown, SVP Product Management at Halfpenny Technologies

Payers such as health plans and ACOs have a critical need for real time clinical data.  But unfortunately many have no way to actually ingest or view that clinical data. Payer data warehouses are typically focused on the storage and administration of medical claims and the integration of structured clinical data elements can become a multifaceted technical effort.  Utilizing clinical data effectively is not an easy accomplishment.  The actual consumption, normalization and storage of the data can become a complex and expensive endeavor even for the biggest or better resourced health plans.

Halfpenny Technologies continued investment in innovative solutions uniquely positions the company as a national provider of clinical data exchange solutions to the health care industry.

ClinScope Press Release

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What is the state of Clinical Data Exchange for Health Plans?

By: Lesley Brown, SVP Product Management at Halfpenny Technologies

As health care in the U.S. evolves, health plans and other risk bearing entities such as ACOs, have shown an ever increasing desire to acquire clinical data for their members.   This need is fast becoming more than a necessity, as value based care begins to drive reimbursements, revenue adjustment factors and quality performance, to name just a few.   While many health plans already have access to select quantities of clinical data (think Lab results, maybe even ADT data) their appetite is now evolving towards obtaining member Continuity of Care (CCD) data.  CCD is now heralded as the “superset” of clinical data, all the medical history, test results, medications for a member in one document.

Too bad then that the coordination and exchange of this clinical data from physician practice EHRs has become a significant pain point for many health plans and clinical data integration into payer systems has made minimal advancement in the past few years.  The challenges that health plans need to overcome range from technical ones, a lack of real clinical interoperability despite Meaningful Use (MU) Stage 2 and HL7 C-CDA requirements & specifications, to business ones, often a lack of clear business value and use case evaluation can stymie the best of endeavors.

Where and how to start?  Some of the common approaches payers can take for clinical data integration include building out point to point integrations (but who has time or resources for that!), accessing a state or local HIE (this is often limited by HIEs demands for standard data structures as well as a lack of data normalization) or partnering with one of a wide variety of vendors who claim they can facilitate non-claims based clinical data integration (many of whom fall short when attempts to validate data exchange are attempted).  Regardless of the integration arrangement health plans should be advised to start small and stay focused, successful data exchange projects have a value proposition and can demonstrate cost savings or increased revenue.  Examples include, risk adjustment factors that could benefit from the diagnosis list contained in a physician practice medical record or replacement of expensive chart reviews with defined data elements from an EHR.

Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

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Access to Actionable & Complete Lab & Clinical Results Data Enables Health Insurance Organizations to Improve Care Management

Health_plan_cardThrough truly interoperable lab and clinical data exchange, health insurance organizations (payors) can better manage individual care, support shared savings models, and deliver measurable and actionable outcomes.  Access to complete lab and clinical test results can help health plans drive down the cost of care and ultimately improve population.  Halfpenny Technologies offers comprehensive solutions to empower health plans with the right technology to tackle these initiatives and analytics tools for predictive modeling to address compliance and improve financial outcomes.

“Health plans struggle with the many challenges of health information exchanges and coordination of care,” Halfpenny Technologies President and CEO, Tim Kowalski, said.   “The clinical data integration solutions from Halfpenny Technologies, fuel health plans by giving them more complete access to the critical lab and clinical results data required for effective care management.  This data combined with powerful analytics and modeling tools empowers health insurance organizations to be more competitive and improve financial outcomes.”

Health insurance organizations are further burdened with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, Halfpenny’s solutions provides access to clinical data and the necessary analytics tools to allow health plans to effectively manage patient risk and ensure better care coordination.  A health insurance organization’s ultimate success will be determined by its ability to:

  • Predict shifts in membership-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Address health insurance organization’s need for complete clinical data

All health plans are facing the need to integrate clinical data such as lab results that is currently in disparate data warehouses across the enterprise.  Halfpenny Technologies aggregates, normalizes and consolidates laboratory and clinical test data so it can be seamlessly overlaid with quality report data, disease management data, population health data and claims data to gain holistic insights at the member level.

Tools to support collaborative care and shared savings models

Halfpenny solutions supports both the accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) models to help health plans to drive down the cost of care.  Our solutions toolkits focus on improving quality and controlling cost of care by aligning the interests of health plans, providers and members.  Additionally, Halfpenny Technologies health plan tools:

  • Promote evidence-based medicine
  • Provide comparative effectiveness
  • Enable the seamless exchange of data for better integrated care
  • Offer analytics to support pay-for-performance initiatives

Measure return on investment with Halfpenny Technologies’ analytics tools

Real-time data exchange between health plans and providers is paramount to enable collaborative delivery model operation and measurement.  With Halfpenny Technologies solutions, health plans can analyze outcomes and address compliance through automated reporting for patient centric care analysis & recommendations based on nationally accepted recognized clinical guidelines.

Halfpenny Technologies solutions help Health plans face the challenges in measuring the return on investment of programs that provide “difficult-to-quantify” savings, such as wellness, case, care and disease management.  The clinical decision support, population health and revenue enhancement reports enable health plans to work more closely with providers to coordinate care, develop performance metrics, and implement long-term data tracking systems and processes.

For more information on these solutions, please visit us at http://www.halfpennytech.com/health-plan.html

by Patricia Brown

Director of Marketing

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.

Access to actionable lab data is essential for the success of care management for Health Plans & ACOs

Lab_data_health_plansHealth insurance and Accountable Care Organizations (ACOs) are faced with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, health plans and ACOs need to develop go-to-market strategies and analytics solutions that define the organization’s future position and answer critical questions surrounding growth, profitability and sustainability. The ultimate success of these organizations will be determined by its ability to:

  • Predict shifts in their customer-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Access to actionable lab data plays a significant role in the success.

Health plans utilize care management programs that typically implement a variety of interventions tailored to needs of specific groups of affected individuals.  A model that identifies those individuals who have high risk of complications has the greatest potential to impact outcomes and lower healthcare cost. Complete and real time lab results can help health plans model individuals who have high risk of complications, greatest potential to impact outcomes, and lower healthcare cost.

It is necessary for health plans to access to lab results to help them better determine the effectiveness of care management programs.   Some of the challenges and opportunities regarding lab data include:

  • Health Plans and ACOs typically experience difficulty receiving clinical data from labs.
  • Clinical data can have a significant impact on a health plan’s Medicare Five Star Rating, NCQA and HEDIS quality scores.
  • Health plans and ACOs seek laboratory data to reduce instances of drug contraindications, generate clinical alerts, and populate personal health records.
  • Lab results can demonstrate the efficacy of care management programs.
  • Ability to provide clinical data can be an important factor for a lab to achieve in-network status with a health plan or ACO.
  • Health Plans and ACOs share in a unique position to help a lab understand leakage (testing performed by out-of-network lab).

Health plans and ACOs need a true interoperability solution for lab and clinical data which can better enable their organizations to manage and lead in the coordination of individual care, support shared savings models, and deliver measurable and actionable outcomes that help health plans drive down the cost of care and ultimately improve population health.

Brian Muck is the SVP of Sales & Marketing for Halfpenny Technologies

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EHR Adoption for All – Now and Not Later!

The American healthcare system is fragmented, costly, hence underperforming. Despite significant islands of excellence, overall demographic measures position the U.S. far from the top of the developed countries, while health expenditure is the highest, and rising at an accelerating rate. There is a broad consensus that these trends are unsustainable and a change is mandated.  And while the type of change is still open for debate, the current law is threatened with repeal, and incentive payments may be cut or scaled down, it is generally agreed that health information technology (HIT) must play a significant role.

Despite playing a leading role in the development of health information systems and healthcare informatics research, such advances were slow to trickle down to the rank-and-file physicians in the US, and the adoption of electronic health records (EHR) lags significantly compared to other nations. Among the many reasons for this gap are lack of orchestrated effort and cost.  In the last several years we have witnessed a major change.  Government initiatives endorse and mandate the use of HIT across the continuum of care. The flurry of activities is accompanied by numerous new regulations that are difficult to comprehend and to comply with, especially by the providers that are supposed to implement them. They also result in higher development and implementation cost of new HIT systems and sustain a large and costly echo-system, thus maintaining a significant barrier to wider adoption.

Coupled with the technology initiative, there is also a move towards more comprehensive, integrated, community-based care delivery systems. ACO (Accountable Care Organization) is the new buzz word that describes a population-based, yet patient-centric, approach that promises to deliver cost-effective, comprehensive care. This has been long overdue. For many decades, healthcare delivery has been moving away from the community-based Primary Care Physician (PCP) model towards the partialist/specialist model coupled with healthcare consumerism.  Unique to the government’s ACO approach, is the combination of HIT and reporting measures to ensure quality of care and measure population health improvements. This initiative is attractive to practices and healthcare organizations since it promises to split any realized savings with the ACO.

Reviewing the draft regulations for ACOs, it appears that relatively small groups of physicians can form such an ACO. After all, this is a community-based approach, and a minimum of 5000 Medicare beneficiaries is required. However, a high bar is set by requiring appropriate administrative and clinical systems to be in place. Since only about 10% of physicians have even the most basic form of sanctioned EHRs, the cost of the required technology is likely to exclude many community physicians from participating in this community-based initiative.

The most basic building block of the HIT initiative is a compliant EHR whose data is standardized, potentially sharable, and can be queried in any meaningful way. The government EHR adoption incentive programs mostly address eligible providers. There are many physicians who are not eligible for participation. Thus, with or without incentives, the cost of EHR technology is still a significant barrier, most likely to postpone wide spread adoption, at levels such as in the Netherlands or Great Britain, for many more years. In turn, reduced levels of adoption will reduce and delay the effectiveness of many initiatives such as quality measures and ACOs.  As CMS and ONC ratchet-up the technology and compliance requirements, it is even more important to ensure faster and wider adoption of EHR technology by all physicians.

For effective delivery of coordinated healthcare in the community, there are many more participants than the physicians. Care coordinators, dietitians, social workers and many others are involved. Most are not eligible providers, but require supporting technological solutions that are not covered by current initiatives. It is quite likely that initiatives such as the adoption incentives and shared savings for ACOs will not cover the cost of the initial investment in technology required for effective population-based community healthcare. Perhaps it is the time to reassess our current approach, and focus more on wider adoption of EHRs and other first-line support systems for all providers (physicians and non-physicians) rather than follow, at this time, increasingly sophisticated schemes.

Gai Elhanan, MD is Chief Medical Information Officer at Halfpenny Technologies, Inc., a leading provider of clinical data exchange solutions.

Hospitals/Labs Outsourcing EHR Integration is an Emotional Hurdle, Not Financial

Healthcare is the largest industry in our economy, yet it is the last to migrate into the “digital or electronic” age. Healthcare has been last to the party largely because of the incredible amount of fragmentation within the industry. Additionally, the best of breed attitude regarding testing, diagnosis and treatment has resulted in the development of unique systems, equipment and protocols that were never designed to feed into a single or “connected” database.

Many factors are helping to fuel this change, but certainly the biggest factor is the federal government incentives for physicians to implement EHRs in their practices. Over 500 unique EHR vendors are participating in the biggest land grab that the industry has ever seen! While integrating one laboratory information system to one EHR may not present significant challenges, integrating 40 to 50 different laboratory and registration systems to over 500 different EHRs could tax any IT department. To add to the chaos, the hospitals and labs cannot predict or control the demand they will have from a quantity standpoint or from which EHRs.

Most businesses will evaluate their core competencies and decide which functions should be outsourced as opposed to keeping in house. For example, a law firm will probably outsource their printing, but keep their firms legal work in house. Healthcare facilities have been slow to subcontract anything due to the implications and potential effect it might have on patient care. As every piece of medical equipment now provides a digital record, how will facilities react? Should healthcare facilities farm out some of their information technology demands or should they staff up to meet the current peak demands they are experiencing?

Here are some reasons to outsource EHR connectivity:

  • Reduced cost from direct labor as well as general and administrative expenses
  • Move staff to more critical/unique tasks, providing flexibility
  • Allows for erratic demand; do not have to staff for peaks
  • Reduce start/completion time for projects

Outsourcing EHR connectivity is a lower cost alternative than keeping the function in house. Hundreds of facilities across the country have conducted an ROI analysis and determined that subcontracting is the more cost effective path to take. While the argument can be made that if current staff is under-utilized, performing this function in house would not add any incremental cost, few if any healthcare facilities find themselves in this position. Additionally, efficiencies exist when utilizing a team that has a successful track record to complete EHR connectivity projects because that is what they do “all day, every day!”

With all the demands that IT departments have to integrate equipment or systems within the four walls of the facility, by outsourcing EHR connectivity, options exist to be more responsive to those demands. Typically most facilities will put EHR connectivity at the bottom of the priority list, which can have a significant negative impact to growing/maintaining an outreach program.

As external physician groups sift through the 500 EMR vendors to find the right one, they generally do so without consulting their lab providers as to which one they chose or the timing for implementation. Most lab providers find out only when the EHR has been installed and they receive a call from the practice saying, “connect us.” Staffing for the peak is not cost effective and alternatively making the client wait until time is available usually results in a lost business opportunity.

It is very difficult, if not impossible, for an in-house staff to compete with a third-party provider regarding project completion. Constantly being pulled away for “higher priority” projects that will always be more interesting to the internal team can mean that the completion of EHR projects could drag on for several months, when in fact could be completed in a few weeks.

Why then is subcontracting such a huge hurdle for many organizations? Although there are very good reasons to subcontract, many administrations appear to want to internalize EHR connectivity for non-financial reasons that in some cases maybe emotional or “fear based” in nature. Because healthcare facilities are not traditional outsourced, they usually dismiss the notion without giving it a fair evaluation. IT departments, in particular do not want to give up the opportunity to increase their influence and or increase staff, and initially resist outsourcing.

Many in house staffs will embrace the idea of expanding their influence outside the walls of their facility and the challenges that new EHR connectivity projects can offer. What happens next is that they become embroiled in the “perfect storm” of ambulatory physician practices, the myriad of EHR vendors with their various capabilities, and their own clinical or business development staff. IT staffs quickly become disinterested in the repetitive nature of the process to electronically connect their clients, as well as meeting the objectives of all the different stakeholders. IT departments are usually not geared to be able to successfully meet all the challenges that these groups can present. Deadlines are missed, existing or potential clients are lost, and confidence in the internal staff to get things done suffers.

While outsourcing may not be the perfect answer for all, it clearly should be given greater consideration to meet the incredible demands that healthcare facilities will face over the next five years. At a minimum, it could be utilized as a backup strategy to augment internal staff and allow the facility to concentrate on its core competency of delivering the best in patient care. As their trust with the third-party provider grows, and emotion is taken out of the equation, it just might become a critical part of your “connected” strategy.

 

Where There is Change, There is Opportunity

As I was coming into Vegas, it occurred to me that never before in my 20 plus years of lab it experience have I seen so much change occurring in such a short period of time. We have ACOs coming at us, ICD9 to 10, there is the 4010 to 5010 conversion happening soon, the HITECH Act, stimulus funds, bending the healthcare curve, meaningful use for both ambulatory and acute, wild fires in Arizona and have I mentioned ACOs? We’re also seeing new and strange bedfellows coming around. Insurance companies are getting into the HIE and connectivity business, Quest has an ‘open connectivity strategy’ with Medplus and an EHR 360.

But on the other hand, I don’t think I’ve ever been so optimistic, too! All and all, the hospital and reference markets are doing very well.

If you look at the laboratory market in its entirety, 22% is the national, Lab Corp and Quest. They are organized. They seem to be everywhere telling their and your clients they can connect to an EHR in two weeks for practically free. But here is a surprising statistic; 54% of the lab market is hospitals, the rest is reference specialty labs and 5% POL. But the nationals at 22% are not nearly as big as what I would have guessed and, here is the kicker, they are not growing organically, it’s thru acquisition! Hospital labs are growing organically, so something is going right! Here is another statistic I picked up from an insurance company presentation. People in their 20s and 30s use on average two lab tests a year! People in their 50s, 60s and 70s use over eight! The sea is going to rise as all of us young baby boomers get a tad older.

But there is competition and change, and where there is change, there is opportunity. Let’s take the EHR market for a moment. It’s expected to grow from a 20-80% adoption rate in just a few years. Seventy percent of all EHR data is lab! Seventy to eighty of diagnosis are in part based on laboratory data! So what good is an EHR without the very valuable services the laboratory service market provides? Docs want the data in there, the EHRs want the data, insurance companies want the data and so does the government and, of course you know, it is in part tied to the subsidies.

So in our own analysis, we have determined that a physician on average trades with 2.8 laboratory service providers each and many have more than this. Physicians will want this data electronically, including orders and, if they don’t get it, they may decide to go elsewhere. So here is the opportunity and the threat. Without a strategy and connectivity, your clients might go elsewhere to get it, but with a strategy you can secure, clients who might otherwise leave and you may be able to expand you market share (organic growth) from those labs that are not so well prepared. As an aside, there are there are around 375 to 400 different EHRs out there and we haven’t seen a consolidation yet, we actually are meeting new ones still.

Okay, here is the crass commercial. At Halfpenny, we connect to EHRs, to approximately 128 different EHRs today. We provide this connectivity day in day out and are good at it. We are ‘the’ strategy for some organizations and others we augment or are a backup to existing IT initiatives. We also push results to hand held devices, now orders too, and provide LOINC mapping. Okay, I am done. Anyway, my encouragement is to develop a strategy if you don’t have one and or you might consider a backup position too … and if interested, we’d love to talk with you.

 

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.

Back to the Past with a New Exploding Market

What is the most closed hospital information system (HIS) system available today? Who are open vendors? Sunquest, Cerner, McKesson. Do they have a proprietary integration engine? No, they partner with vendor neutral solutions. Will they coexist with competitors solutions, or allow the hospital to make best in class and best in service choices without penalty?

Historically, open systems architecture and service philosophy has been the topic of many tradeshow seminars, not to mention the promise of most vendors in the HIS market today. It wasn’t always that way. Why? Their constituency wanted the ability to choose specific solutions that best fit their departmental or enterprise needs without bias.

It is a rare hospital that buys all of its IT from a single supplier. Many will argue that a single supplier just does not exist that can competently supply all. Therefore, their clients want a fundamental ability to simply choose and an ability to interoperate without bias. Popular terminology then and now includes ‘best in class,’ ‘best in suite,’ ‘best in service’ or ‘open architecture.’ Can you imagine all the hundreds of vendors trying to work out how to integrate with each other? This is just one of the reason HL7 gained adoption.

Users wanted their systems to work together efficiently, with full functionality and without the penalty of high costs of proprietary integration. From this desire or requirement, open tools were developed to promote this concept of open systems, called integration engines. These engines currently sit in the middle between systems to transfer data allowing all systems equal access and could even conformed to specific formatting requirements. They work very well within this environment and nearly all hospitals have one. They are the clinical, administrative, and ADT information highway within a hospital, and they are open to all applications capable of connectivity.

These engine vendors, not surprisingly, were and are NOT owned by the major HIS vendors. Why? It would be a clear and loud conflict of interest. Would a major HIS vendor be incented to invest in connectivity to its competitors? Absolutely not! An engine vendor that is vendor neutral is very incented; in fact, that is how they make money. It is fundamental to their value. So, many forward-thinking HIS vendors partnered with engine vendors, like McKesson, who used ITC or DataGate for example.

So what is happening now? It is sort of ‘Back to the Past!’ There is a new exploding market, with nearly 400 different ambulatory EHR vendors and growing. Market adoption is going from 20 to 80% in the near term future, an astounding rush to connect with suppliers of clinical information. So the value and promise of an EHR is gained, not to mention stimulus money, but the vendor tactics are as old as the hills!

It seems every vendor with a bias, or ax to grind, wants to control/own the information highway. EHR vendors are developing HIEs that work well with their EHRs but not with others. Big surprise, insurance companies are buying HIE companies. Now this is scary and service providers for laboratory are also trying to own the highway to the physicians EHR. How open are they going to be if they allow another laboratory service provider to play on their highway they lose money? It is fundamental.

But who loses the most? The physician receives one choice free and clear, however, the other choices, if available at all, will come at a penalty, of time, money availability or choice. To trade with other service providers, they will be strapped with multiple point-to-point interfaces that, when evaluated individually, may be cost prohibitive or the expense of operating on multiple highways, which is actually a lot harder than it sounds.

Even though the service providers, out of the goodness of their hearts, are offering to put their proprietary infrastructure in place, it may not be worth it. It reminds me of a Trojans bearing gifts. Don’t be fooled. A service provider who is recommending an open solution is listening and taking a broader view of the market. Look for suppliers who are promoting open systems architecture and mean it.