Steven Posnack, Director, Office of Standards & Technology
Thomas Sparkman, Vice President, Government Relations, American Clinical Laboratory Association (ACLA)
Last year, Health Level Seven International (HL7) released an implementation guide that provides a standardized way to exchange the catalogs of (thousands) laboratory tests and services that a clinical laboratory can perform. We wanted to highlight the implementation guide’s potential to not only advance interoperability, but also to create cost savings and improve patient care.
Today, many clinical practice managers across the United States must manually curate lab test catalogs. By contrast, the implementation guide outlines how to provide electronic Directory of Services (eDOS) information to all providers that order lab work – using electronic health record systems (EHRs), laboratory information systems (LIS), and others – and the guide explains how to enable lab-to-EHR interoperability by using data formats that EHRs can incorporate into lab ordering systems.
By using the guide to automate eDOS, practices can reduce labor costs, improve test ordering accuracy through clinical decision support, and more rapidly support precision medicine as new tests and services are added by labs to their compendiums. 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. (ACLA is a trade association representing national, regional, hospital and esoteric laboratories.) Further, in comparison to current methods, eDOS would enable EHRs to directly import a lab’s test compendium information in minutes.
In short, eDOS delivers a faster and cheaper method to leverage a years-long effort by the ACLA to standardize catalogs for the most commonly ordered lab tests. If you’re interested in unlocking these benefits for your practice, see below for more details and background information – including a simple calculator to help organizations estimate potential savings based on their real costs and processes. And don’t hesitate to contact us at the Office of the National Coordinator for Health Information Technology (ONC) at ONC.firstname.lastname@example.org if you would like to get more information about eDOS.
Directory of Services
In the health information technology (health IT) ecosystem, every lab has a directory of tests and services provided to their clients that contains:
• the test or service name;
• requirements for the specimen to be processed in the lab test such as body site source;
• the type of tube/stopper/additive for blood specimens; and
• additional information from the patient to process the test or perform the service.
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.
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.
The Cost of the Status Quo
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. Based on this polling, ACLA recently released an estimate that demonstrates the potential savings health care providers and facilities can achieve if they were to move toward the standardized approach eDOS offers for the electronic receipt and maintenance of a laboratory’s test compendium.
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. To help practices more accurately assess their own situation, ACLA and ONC have collaborated to actively promote awareness and encourage adoption of the eDOS standard.
A first step is the availability of a simple calculator to help organizations estimate potential savings based on their real costs and processes.
Let’s use information one participant laboratory supplied that we used to calibrate the calculator as an example. In this case, the initial load of orderable tests and supporting data such as panel test grouping and ‘ask on order entry’ questions will only happen once, has 200 entries and an average of 10 percent of changes requiring manual updates with a 5-year time horizon.
The calculator estimates that with a transition to electronic delivery and initial load, their manual time-on-task would be reduced anywhere from 50-75 percent, with costs dropping from $19,000 pre-eDOS to as low as $9,500 with eDOS.
eDOS Can Make an Impact
What’s in it for labs and health IT developers? Today, the specifications for lab interfaces are often customized one-offs and non-standard. The eDOS implementation guide has been enhanced to align with lab order and lab result implementation guides’ specifications. Altogether, eDOS, the lab order, and lab result implementation guides form a trio of specifications that standardize laboratory data exchange from end-to-end. 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. Ultimately, this would benefit all parties involved by eliminating expensive customized interfaces.
What’s in it for health care providers? In addition to the substantial potential savings estimated by the calculator, eDOS supports the definition of panels of specifications created both by the lab and by the local practice, meaning eDOS can support providers’ customization for ordering and grouping. In the future, providers (and their health IT) may be able to take greater advantage of this functionality by linking it to clinical quality improvement strategies and clinical decision support. Even with eDOS, a lab can still issue a customized compendium for each provider using its tests or services and the method of creation and transmission still brings many benefits to the providers electronically exchanging information with the lab.
For more information, review this white paper on the use of eDOS from Quest Diagnostics which outlines many details and benefits for all the stakeholders.