The Lab Interoperability Collaborative (LIC) was originally a grant-funded initiative to recruit, educate and connect hospitals to their related public health agency by providing the necessary technical assistance to enable hospital labs to become meaningful users of certified Electronic Health Records (EHR) technology for submission of electronic data on reportable laboratory results to public health agencies.
The LIC is supported by collaboration from the American Hospital Association (AHA) and the College of American Pathologists. The LIC connects hospital laboratories with public health agencies to electronically transmit data on reportable laboratory results.
The LIC encourages all hospital laboratory facilities, laboratory software vendors and public health agencies to participate in the ELR collaboration process.
Hospitals that decide to participate will realize a better understanding of the laboratory requirements; achieve lab data translation and standardization support; and receive the technical support through project planning and oversight all provided by LIC.
LIC Implementation & Operation Services
The LIC supports all federal and state policies and standards for health information exchange – including privacy and security standards (such as HIPAA and state law), technology interoperability standards (such as NHIN Direct and NHIN Exchange) and message types such as HL7.
Electronic laboratory reporting has many benefits, including improved timeliness of reporting, reduction of manual data entry errors, and reports that are more complete. Electronic laboratory reporting has been promoted as a public health priority for the past several years and its inclusion as a Meaningful Use objective for public health serves as a catalyst to accelerate its adoption.
Additionally, we will continue to see a dramatic increase in expectations for LIS-EHR electronic interfaces as physicians implement EHRs to meet specific Meaningful Use requirements. Early adopters under this program will benefit from the services provided by the LIC, and funded under this grant. The program provides opportunities to facilitate interoperability and increase the ability to meet Meaningful Use requirements and qualify for incentives.
ONC has recognized HL7 v2.5.1 and LOINC as interoperability standards and has included them in EHR certification criteria. Many existing laboratory interfaces are on older HL7 version 2.3.1 and will require conversion to v2.5.1 AND many laboratories do not have LOINC codes defined in or linked to LIS. While their use is not required to meet stage 1 meaningful use, it may facilitate it and is expected to be required in future.
The LIC provides the expertise for laboratories in encoding their public health reportable tests in their local data dictionaries with LOINC or assessing existing coding. Furthermore, IHE Lab is working on updating the analyzer-LIS interfacing standards. ONC is also working on updating the lab interfaces from the LIS to the EHR. Both standards organizations will begin rolling out these standards in early 2012, if not sooner and aim to reduce the cost, resources and timeliness of lab interfacing.
The LIC timeline consists of three main components: Outreach-Recruitment, Functional Interoperability/Health Information Exchange, and Implementation. Outreach-Recruitment kicks off in April 2011 and continues during the grant timeline or until slots are filled and resources are utilized. To ensure laboratories have the best chances of receiving the limited benefits of this grant, they are encouraged to fill out their checklist as soon as possible. The Implementation phase will commence with a small group of pilot laboratories selected no later than July 31, 2011. Implementation for the remainder groups will be staged throughout 2011 with some groups being engaged in early 2012.
The LIC has a simple registration process to access toolsets and best practices.
There are two primary areas of the LIC project:
Electronic Lab Reporting has two critical areas: (1) the mapping of LOINC to the hospitals laboratory tests; and (2) transport implementation. Each facility’s needs in these two areas vary greatly and estimating a timeframe will be dependent on a variety of factors.
Generally, these factors include the time needed to LOINC encode the reportable tests within their data dictionary, set-up messaging with each public health jurisdiction and test messaging to public health. This timeframe is also highly dependent on the number of reportable tests. For example Critical Access Hospitals (CAH) may have fewer reportable tests performed in their laboratories and may send many tests to reference labs and therefore may have a small list of reportables. Larger University medical centers may perform many more reportable tests and perhaps report to multiple public health jurisdictions.
The following are examples to consider when estimating time and resources you will need to budget for the project:
A hospital may connect to the transport environment in one of three ways:
The decision on which to use will depend on a number of factors and these options will be reviewed with you by the LIC.
It's likely that there will be interaction with your vendor(s) or assistance required during some point in the process. However, if you already know where to map LOINC codes to your data dictionary, set up HL7 messaging including the filtering requirements to send only reportables to public health, and have your own internal IS support for related changes, vendor support should be minimal. Some facilities are more dependent on their vendor for upgrade support, user guide support including where LOINC codes are mapped to tests in the data dictionary, assistance with setting up filtering in HL7 messages, and connecting to their public health jurisdiction(s).
Some additional considerations include whether your facility is currently working with a health information exchange (HIE) or similar entity and connectivity to your public health agency is already established. In this case, the HIE will work with your vendor regarding the extraction of the reportable lab results from your LIS. Alternately if you elect to use the LIC portal option, the LIC team will work with your vendor to determine the process for extracting reportable lab results from the LIS.
If your laboratory has existing connectivity established either through an interface directly with your public health agency, or though Health Information Exchange (HIE) or by other means, the LIC will utilize that existing connection.
Connectivity options will vary depending on current capabilities of the various players – public health agencies, Vendor and LIS products, HIEs and those of your facility. Some of these entities are not ready to support a direct connection from laboratories to public health agencies at this time.
Both Regenstrief Institute, distributor of LOINC, and the CDC recommend use of the most specific LOINC code as possible for laboratory tests.
One main reason (pro/benefits-specific) is that laboratory personnel know best what methods, units, specimens are utilized in performing laboratory analyses and are best equipped to assign the most appropriate LOINC code to a test. In some situations, downstream end users are attempting to LOINC encode laboratory tests and may incorrectly assign a LOINC code (con-generic) by not having the best information about the testing process.
It also helps to understand how all the downstream end users of laboratory data are utilizing this data. If for patient care activities, what are the risks in not having a specific LOINC code? If for a Health Information Exchange, would an incorrect or inappropriate lab result be returned to a physician in an ER searching for a patient’s previous result if they are incorrectly coded or the ER physician is searching on the wrong LOINC code (con/risks-generic)?
For the LIC, the focus is on electronic lab results reporting to public health. The CDC has requested the most specific LOINC code possible. For HIV testing, there are over 250 LOINC options alone, but there is a difference between a screening HIV test and a confirmatory HIV test and this distinction is important for public health (pro/benefits-specific/con/risks-generic). Other considerations below reflect experiences that the CAP team has gathered from various hospital lab consulting engagements outside of the LIC.
The cons/risks of specific LOINC encoding is that it does require laboratory resources and will likely take more time and laboratory expertise than generic LOINC encoding. The pros for generic LOINC code choices are that it is often easier and faster to map several instances of an analyte to the same generic LOINC code, instead of looking to see if there are different methods or specimens for an analyte necessitating, different specific LOINC codes based on method or specimen differences.
Another use case for choosing between specific and generic LOINC codes is for quality assurance activities within the lab or for quality measures outside of the lab. Within the lab, such as for inter lab quality control, often differences in methods will dictate that a specific LOINC code be utilized to reflect different reference ranges, specimens, and ensuring results are indeed peer compared. A disadvantage of using a more generic LOINC is potentially flawed statistics when tests that are not exactly comparable are grouped together.
For quality measures outside of the lab or when trying to perform statistics on tests where methodology is not important, such as how many glucoses have been performed by all the laboratories in a health system per year, mapping to a more generic LOINC may be desirable. It is recommended that this mapping is performed at the level of the EHR so that the specific LOINC code can be maintained in the LIS, but the power of analyses performed on grouping of LOINC codes can be realized in the downstream information system.