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Health IT Standard eDOS Enables EHR Interoperability, Savings

A health IT standard for lab tests could improve EHR interoperability and reduce costs.

By Kyle Murphy, PhD

- Officials from the Office of the National Coordinator for Health Information Technology (ONC) and American Clinical Laboratory Association (ACLA) claim that a lesser-known health IT standard for ordering laboratory tests and services both enables EHR interoperability and the ability to generate cost savings.

Health IT standard for lab tests

The Laboratory Test Compendium Framework developed by Health Level Seven International (HL7) includes an electronic Directory of Service (eDOS). The standards developing organization has iterated on the framework over the past few years with the support of the ONC Standards & Interoperability Framework.

In 2015, HL7 released a guide for implementing the framework and the eDOS service. Now, ONC and ACLA are touting the framework’s potential to make lab test ordering more efficient and less costly.

First, eDOS eliminates the need for manual curation and loading of lab test catalogs.

“ACLA member laboratories polled their clients and found it can take a range of 30 minutes (simple) to 8 hours (complex) to load a lab test (and associated result code) into their EHR system for users to be able to subsequently select,” ONC Director of the Office of Standards and Technology  Steven Posnack, MS, MHS, and ACLA Vice President of Government Relations Thomas Sparkman write on HealthITBuzz.

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“Because using the eDOS approach could dramatically reduce the manual effort to receive and integrate a laboratory partner’s catalog of available tests and services into a provider’s EHR, clinical practices can achieve significant savings over time,” they add.

Second, it saves time when actually ordering tests.

“For instance, the American Clinical Laboratory Association (ACLA) estimates a typical practice ordering an average of 1,000 frequently ordered lab tests from two laboratory organizations could save $94,500 just by using eDOS,” Posnack & Sparkman claim. “Further, in comparison to current methods, eDOS would enable EHRs to directly import a lab’s test compendium information in minutes.”

As laid out in the blog post, each lab maintains a director of tests and services comprising the name of the test or service, requirements for the specimen to be processed, the type of contain for blood samples, and additional information from the patient for administering the test or service.

A lack of EHR interoperability has made the process of performing and recoding a lab test or service labor-intensive:

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For example, for a breast cancer test such as BRCA, the lab needs to know if the BRCA gene mutation has been detected in other members of the patient’s family, in addition to the patient’s race, both of which may impact the laboratory test or results. This information has historically been delivered to the lab on paper and, in more recent cases, via the web. But inevitably this information must be transcribed into the local EHR or ordering system. This process is inefficient and may introduce transcription errors that practices need to troubleshoot and rectify, all of which add up in terms of lost time, more costs, and potential repeat tests.

The process becomes more complicated as the number of labs a clinical setting uses increases:

In addition, most health care organizations and practices have relationships with multiple labs. This means they must repeat this labor-intensive process for every lab, every update to existing tests, and every new test that is added. It now can take a highly skilled and knowledgeable worker many hours to review multiple laboratory catalogs and determine commonalities, if any. As in so many areas, it is far faster and cheaper to load and verify the information electronically directly from the original source than to re-key, review, de-bug, and re-review each time the information is used.

Through the use of the Laboratory Test Compendium Framework, labs and EHR vendors (and health IT developers more generally) can avoid the hassle of relying on one-off interfaces between their respective systems.

“By moving to a consistent, standardized interface for the delivery of mission critical health information – at least mission critical for patients – labs and health IT developers can move toward a single, standardized approach that would work for all of their clients, or at least drastically reduce the number of customized interfaces to be supported,” Posnack & Sparkman argue.

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For healthcare providers, the benefits of using eDOS would be automation of lab tests and services as well as support for customization for ordering and grouping. Down the line, providers could make use of the functionality for clinical quality improvement and clinical decision support.

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