Integration of the EMR and LIS:

Integration of the EMR and LIS: Why it should be done and how to manage the process. Why the sudden interest in the electronic medical record, commonly known in the medical industry as an EMR? The following quote from President Bush was all it took to create a frenzy of interest in the EMR,ÓWithin ten years, every American must have a personal electronic medical record,' Bush said at a conference in Minnesota of the American Association of Community Colleges. 'We've set out money to encourage demonstration projects that will show the health-care providers the need to use electronics to make their records system more modern.' So, this leads to the question, why integrate an EMR to my existing Laboratory Information System (LIS) and how do I manage the process? For years, administrators have experienced the frustration of having separate islands of information that did not speak to each other. Valuable time was wasted entering redundant patient information in different systems. Initially, administrators wanted the lab to receive demographics and send charge information to the billing system. More recently the trend has been to receive orders and send laboratory results to the HIS or EMR as well. The LIS is expected to act as a central hub, housing all the lab data. Benefits from integration of the EMR, LIS and the Practice Management System (if it is not part of the EMR) or HIS, will greatly increase physician office productivity and efficiency while reducing human errors. Data transcription errors can be eliminated, which will allow for accurate billing. Data such as demographic information will only be entered once, avoiding duplication of a manual process freeing up office staff. Other benefits include, data mining, reduced paperwork, and instant access to patient clinical data by exporting to the EMR. With an understanding of why the EMR and the LIS should be integrated, it is important to note what can be integrated and the importance of each aspect. Integration of demographic and insurance imports allows the information to be imported to the LIS directly from the EMR eliminating the manual task of data re-entry and the errors that accompany data entry. Completed laboratory results can be transmitted to the EMR from the LIS. Not only does this help make a physicianÕs office ÒpaperlessÓ it also make the patientsÕ charts easier to manage and organize. In addition to the laboratory results, the charges for laboratory testing can be passed to the billing system allowing the billing information to be available for the front office staff to complete the billing process or for the billing service to complete the process. Integration is not limited to systems within the four walls of the physicianÕs practice. Through a bi-directional interface, information can be communicated to national, regional or local reference labs. This includes sending orders to a reference lab, printing the requisition and labels and receiving the results from the reference lab. This allows the LIS to have virtually all patient results accessible for comprehensive analysis, and avoid errors from having multiple points of data entry. Once the results are stored, the LIS can export their entire lab record to the EMR. One of the most important steps, that can easily be overlooked, is defining the goals of integration. Make a list of the most important items for each of the area of the office. Hold departmental meetings that include key decision makers in the office. Like anything else in life, having a plan for which includes timelines and milestone achievements, will help to make integration a manageable process. The successful implementation of an interface requires that all parties (lab manager, IT staff, billing staff, clinicians and software vendors) be on the same page before starting. The physician office should prepare for any changes in workflow. Questions should be asked about how the transition will affect office tasks. What system will be used to register patients and schedule visits? How will medical necessity, ABNs and labeling be handled? How do the providers want to access information? For every practice the questions will be different and every employee will bring a different perspective to the plan. All are equally important. Because implementing an EMR and LIS integration can be a challenging process, understanding where to start will help make the process manageable. Most practices already have a Practice Management System (PMS) in place. Prior to purchasing an EMR, it is important to ensure that the practice management system can interface to both the EMR and the LIS. If a new PMS is going to be placed during the integration process, it usually makes sense to have the PMS installed first, because it controls cash-flow. The next step is to implement the LIS since the majority of the information that a physician uses to formulate a diagnosis comes from the lab. If the LIS is not operational, this crucial information will not be populated in the EMR. For most offices, utilizing the lab module or portion of the EMR is the first step in implementing EMR usage. As a physician becomes more acclimated to the EMR system, modules should be added. In the end, the process of integration is in your hands, but make sure to stay involved with the software vendors. When looking at vendors, ask for a list of vendors with they have successfully integrated with. DonÕt hesitate to ask for references from practices that have already gone through the integration process. If the vendors have not integrated before, you should get references from each source to ensure that they are capable of completing the interface. When it is time to move forward, make sure that the vendors have agreed on specifications in order to complete the integration process. After selecting your vendors, contact your key contacts are at each vendor and get a plan of action showing implementation timelines. In order for the process to go as smoothly as possible, make sure you know which vendor is responsible for each task and when the tasks need to be completed. If you donÕt, you may find yourself in the middle of two vendors stating that they are waiting on the other in order to proceed. Change is never easy. In order to make the integration process as easy as possible, take the following steps: Document your goals for integration. Select software systems that are highly reliable, have strong technical support, and can grow with your practice. And, if possible, take time to plan your implementation process. Stay involved in your implementation process. Select vendors that have experience interfacing with each other. In the end, your planning and dedication to detail will result in a smoother process and integrated systems that meet the needs of your office.