Discuss implementation of the Reference Lab Interface in RPMS Clarence Smiley OIT Federal Lead, RPMS Laboratory Information Systems

Reference Laboratory Interface Released in 2006 as RPMS Lab patch 1021 Uses a “Generic Interface Engine” to electronically connect your facility to the reference laboratory 2 types of interfaces; bidirectional and unidirectional OIT only recommends implementing the bidirectional version of the interface

What does the Reference Laboratory Interface accomplish? Automates the electronic ordering of labs and the automatic receipt of laboratory test results from a reference lab (ex. Quest Diagnostics) using EHR. Laboratory test results are stored in the RPMS Laboratory Information System and in PCC.

Design of Interface Design of the Interface (bi-directional) Provider Orders Tests in EHR Lab Accessions test(s) in RPMS LIS 1.Electronic Order Created 2.Shipping Manifest Printed GIS Interface LAN-LAN VPN Orders received by Reference Lab Information System Testing performed Results released Results received in RPMS LIS Results verified using lab package Results available for provider review in EHR & results sent to PCC

Implementation Cimarron Medical Informatics (CMI) performs all of our implementation efforts Currently in the middle of a 2 year ARRA contract to implement 75 sites throughout IHS Implementation of the interface is time-intensive & requires the coordination of several parties; the facility, OIT network staff, ref lab project staff, and CMI staff Past experience: Takes approximately 6-12 weeks from the time CMI actually initiates the implementation to the time a site can order and result one lab order

Implementation Prior to implementation, contact your reference lab representative. The ref lab representative will then: 1.Submit a project request plan to their respective national office 2.Reference laboratory will begin process of appointing a project team 3.Provide your site with test utilization reports 4.Provide your site with a test compendium listing laboratory order and result codes used by the reference lab 5.Steps 3 and 4 will be used by CMI to build and map laboratory reference tests in your RPMS LIS 6.Each reference laboratory company has its own unique set of order and result codes, insurance codes, mapping codes, etc…making implementation a complex process

Bidirectional vs Unidirectional Bidirectional allows a site to use EHR to order and view lab results using the EHR Lab Tab – Results populate RPMS LIS – Providers can take advantage of EHR graphing capabilities – Results also populate PCC Database – “CPOE” lab entry allows MU calculation Unidirectional does not allow a site to use EHR to order and view lab results via the EHR Lab Tab – Results do not populate RPMS LIS – Results populate PCC database – Cannot use MU software to calculate lab ordering (pre PCC patch 7)

Bidirectional vs Unidirectional Unidirectional interface does not allow a site to use EHR to order labs – Lab results are not available in EHR Lab Tab – Results are available on Reports Tab of EHR (ex. Health Summary) – Results are available for statistical/clinical reports

Labs ordered using Ref Lab workstation for ordering labs Reference Lab Information System receives laboratory order and performs testing Generic Interface System (GIS) PCC Database (V LAB) RPMS Server Unidirectional interface design RPMS Laboratory Information System Telecommunications interface

Unidirectional issues EHR is not used to order labs RPMS LIS does not store laboratory results Labs entered into PCC does not count toward MU counts (pre PCC patch 7) PCC patch 7 should fix some issues with MU counts, will go into beta testing soon Results only available via Health Summary & database searches (ex. Q-Man) Patients have to be manually added to the reference laboratory work station, which has caused patient identification issues (RPMS and RPMS LIS not used)