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How to Map Epic EHR Lab Orders to Reference Laboratories

By Charlie Francen of CTG Solutions

- As Epic Community Connect continues to expand, more physician offices loosely affiliated with multi-hospital systems are expected to begin participating in the shared electronic record system. These physician offices may send patients or specimens to reference laboratories such as Quest or LabCorp rather than the hospital laboratory, and will need Epic build and interfaces to connect to them. The use of reference laboratories may be the result of the physician office’s preference, but many times it is based on contracts with the patient’s insurance.

Mapping lab orders to reference laboratories in Epic EHRs is a multi-step process

Ensuring that lab orders and results for reference laboratories are correctly mapped in Epic EHRs is an important task, yet it is also quite time-consuming. Here are the five steps involved:

Pre-build: Reference laboratories perform tens of thousands of laboratory analyses annually.  When working with one, request the utilization/compendium for any orders sent during the last year from all offices in the region, not just the offices going live on Epic. Taking this step will ensure you receive the majority of orders the physician offices may need. The files received will have the reference lab test name and code, the reference lab result name and code, and order questions. My recommendation is to map lab tests that are ordered once per month or more in the region.

The compendium information that is usually not sent by the reference laboratory are the reflex orders and result codes based on high/low or positive/negative results from the original order. If these codes are not requested, mapped and tested, patient results will be delayed in the future.

Build: Most laboratory orders and result components will already be built for the hospital laboratory in Epic. The more esoteric laboratory orders and components, however, may need to be created for reference laboratories before mapping.

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Many of the order questions will need to be created due to the esoteric-type orders. I recommend entering the name of the reference laboratory in the questions. The order question IDs will need to be entered into the procedure along with other Epic questions.

The Resulting Agency record will also need to be built in Epic. LabCorp and Quest usually come as part of the model, but the address, phone number and laboratory director will need to be added.

The Epic model system also comes equipped with a LabCorp and Quest basic requisition. Copy the model requisitions. You will need a requisition for reference laboratory collection and for clinic collection for each of your reference laboratories. Examples of changes that will need to be made to your requisitions include Customer Name, Question IDs, and removing the labels if using plain paper.

Other files that may need to be built if your facility is directing lab orders based on patient insurance are Ancillary Service Package for each reference laboratory and question rule. The question rules are based on payer, so the questions are required only for orders going to the reference lab. The rule is added to each question.

Mapping: The order questions are mapped in the Resulting Agency record, not in Identity. The procedures, result components and department are mapped in Identity. Map each Epic procedure to the reference lab order ID. You can only have one reference lab ID per Epic EAP (procedure record). Map each result component to the corresponding reference lab component ID(s). You can have more than one reference lab ID per LRR (component record).

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Testing in the test environment: Once the mapping is complete and the interface is built, it is time for testing. Quest and LabCorp have a set of testing scripts they require for regulating agency compliance. But these scripts do not include all the testing. It is crucial to test all the orders, results and questions you have mapped in Epic with the reference laboratory testing team.

During testing, Quest and LabCorp also have set results they must enter. For results that trigger reflex testing by the reference laboratory, test the orders twice. Request “low or negative results” with one set of testing and “high or positive results” with the second set of testing to ensure the reflex orders are triggered and resulted.

After you review the test results, designate a laboratory practitioner to proof all results for correct units, reference ranges and general appearance.

Roundtrip testing in the production environment: After the full database is tested for your reference laboratory and all issues are resolved, it is time to test in the production environment. This testing needs to be scheduled and communicated with your interface team and your reference laboratory contact. The interface team will turn the interface on in production for just enough time for the procedure to reach the reference laboratory and for the reference laboratory to enter a result. Only one procedure with a single result is needed to ensure your mapping for the department (clinic) is correct in production.

The entire testing process will take much longer than the set of testing required by the reference laboratories; even so, it provides an early discovery of issues, which ultimately results in greater patient care and provider satisfaction.

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Charlie Francen, Delivery Director at CTG Health Solutions and a medical laboratory scientist, has 35 years’ experience in the healthcare industry including 12 years working with the Epic Ambulatory and laboratory services. Her implementation experience includes workflow analysis, design, building, testing, training, material development and support for EpicCare Ambulatory, ADT, CPOE and HOD.

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