1. Leveraging SMART Apps to Improve Lab Orders
Presented by:
Name Placement, Title Placement

2. Please Note
Quest Diagnostics statements regarding their plans, directions, and intent are subject to change or withdrawal without notice at the sole discretion of Quest Diagnostics. Information regarding potential future products is intended to outline our general product direction and it should not be relied on when making a purchasing decision.
The information mentioned regarding potential future products is not a commitment, promise, or legal obligation to deliver any material, code or functionality. Information about potential future products may not be incorporated into any contract. The development, release, and timing of any future features or functionality described for our products remains at our sole discretion.

3. Digital Transformation: Quanum Solutions Experiences & Modular Portal Framework
Quanum Solutions Digital Experiences
Providers
Consumers
Health Systems
Health Plans
Modules
Ordering
Breadth of capabilities we are bringing to market
Decision Support / Quality
Results and Reporting
Messaging and Other Services
Online Supply Ordering
Online Lab Ordering
Clinical Decision Support
Price Transparency
Quality Reporting
Interactive Insights
Notifications
National Test Directory
Specimen Label Print
Advance Beneficiary Notice
Clinical Pathways
Lab Benefit Management
Results Delivery
STARS Lab Reporting
CogniSense
Appointment Scheduling
Specimen Tracking
Online Specimen Pickup
Pre Authorization
Lab Utilization
Connectivity Tracker
One Network Services
Quest Backend Systems

4. The Quanum Solutions Order SMART App targets key deficiencies for a “Perfect Order” within EMRs.
Key capability areas for enabling EHR-embedded lab services 1 2 3
Lab Order Entry and Results
Clinical Decision Support
Revenue/ Risk Management
Functionality
Simplified Electronic Ordering
Advance Benefit Notifications (ABN)
Ask At Order Entry Questions (AOE)
AOE EHR Mappings
Price Transparency
EMR HL7 Order/Result Integration
Order Status Tracking
Online Specimen Pickup
Electronic Supply Ordering
Functionality
Patient Match & History
Order Validation
Clinical Guidelines
Compendium Management
EHR FHIR Data Access
Notifications
Lab Best Practice Recommendations
Specimen Draw and Preparation
Functionality
Price Transparency
Mock Adjudication
Utilization Guidelines
Prior Authorization
Patient Adherence Engagement
Enhance Multi-Lab Routing (Splits)
Leakage Management (Insurance/ACO Routing)
Quest’s Quanum eLab streamlines workflows, reduces errors and waste, promotes conversations around value and supports better clinical insights for both providers and patients. Quanum eLab encompasses lab decision support, price transparency, mock adjudication, prior authorization, interactive reporting, online billing, and many other features. A better user experience is now possible by embedding the Quanum eLab features below into a Quanum eLab SMART App that can be used within the EMR’s workflow to promote interoperability, exchanging and making use of valuable information.
As the healthcare industry shifts to tighter cost controls and paying for value, we are seeing stricter diagnostic coverage rules and prior authorization requirements from payers and a higher demand for information about coverage and cost be available to the patient and their physician at the time of service.
Many current projects are paving the way for improvements in initial lab order data quality including electronic order adoption, eligibility verification, price transparency and clinical edits. This improved data quality is a key factor in meeting our goals. Clients that use Quest’s Quanum products to submit lab orders have the capability to receive pertinent information while the patient is present with the physician, including Medicare Limited Coverage Policies (MLCP), missing information needed for processing and billing lab orders, or other clinical edits. With the advancement of SMART on FHIR, a powerful new way to quickly build, integrate and deploy healthcare applications, Quest and Optum have an opportunity to make these edits and information available to our physician customers and patients through the electronic medical record (EMR) system of the provider’s choice.
Transmitting alerts about insurance information, coverage policies and pricing allows the physician to engage the patient in care decisions. Follow-up communication to the patient providing a link to a payment portal will bolster a commitment to pay. This communication will also confirm to the physician that a valid order was received or additional information will be needed before processing can occur. Clients have long been asking for this transparency and order entry support.
While this proposed pilot describes many potential services that are intended to come to market over time, the scope of the services included in the pilot will be determined jointly with OptumCare, Optum360 and Quest Diagnostics based on voice of the intended customer SMA. The design phase of this project is expected to take weeks and then will move to a user experience phase, taking an additional 12 weeks. Because adoption is critical, the user experience must be designed with user input.
Once a proven concept, the SMART apps can be taken to other entities in different ways. Because of the modern way FHIR is written, it is very easy to deploy SMART on FHIR apps in numerous ways including a stand-alone web page, part of a SMART enabled cloud desktop or as an iPhone or Android app. Large clients that use an integrated IT platform and support can develop and use SMART apps with minimal or no involvement from an EMR vendor, similar to OptumCare. Smaller clients will need EMR involvement but setting standards for SMART implementation and leveraging work already done by the top EMR vendors will help realize an expected 5:1 return on implementation costs.
Bold are targeted for Pilot

5. Log in occurs through the third party vendor (Allscripts in this example)

6. Search for and select a patient so that they will be in context

7. Clicking the ‘i’ icon will display patient demographics and insurance information that will be sent to the Quest lab order app
A patient encounter must be in context to place the order

8. Select and Commit any relevant diagnosis codes
Select and Commit any relevant diagnosis codes. These will be sent to the Quest lab order app in addition to the demographic and insurance information.

9. On the Chart Viewer tab, a button will display to launch the Quest lab order smart app.

11. Online Perfect Order SMART Launch
EHR
Quest Diagnostics
EHR
FHIR Server
Authorization Server
CAS SMART Gateway
HCP SMART OE
Logged in user selects option to create Quest Lab Order
Open new browser window
Call HCP SMART App Launch URL
HCP Redirect to CAS
CAS recognizes SMART launch and coordinates SMART launch
Request URL for authorization server
Call Authorization Server to get access token for needed resources (i.e., patient, coverage, condition (diagnosis) AND request identifier token for the currently logged in user
Authorize HCP SMART OE
Issue new access token for retrieving resource data
Create identifier token for currently logged in user
Bundled access token response
Retrieve HCP user credentials mapped to Allscripts user
Authenticate HCP user
Redirect back to HCP with CAS token, resources access token
HCP SMART OE Launch

12. The patient demographics are populated with the information sent from Allscripts
The diagnosis code or codes from Allscripts are populated on a tab titled with the patients last name (not automatically added to the order)

13. Add a collection date and submit the order to electronically send the order to Quest and push the test, diagnosis, and Quest requisition number back to Allscripts.

15. Back in Allscripts, the order displays on the Orders tab showing the test code and status. The order details show that the Quest req number is the beginning of the Allscripts Order #.

16. Lessons Learned
SMART FHIR APIs - Mapping proprietary APIs and data attributes between systems is complicated. Integration of unique systems with individual APIs is challenging. Pay attention to key identifiers in the systems.
Don’t underestimate the complexities of deployment within EHRs