To improve physicians' productivity and reduce medical errors, the Health Information Technology for Economic and Clinical Health Act (HITECH) now is turning its attention to the often time-consuming and potentially risky ways in which medical practitioners currently manage laboratory results, creating an ambitious timeline to incorporate the electronic exchange of lab results into state- and country-wide health information exchanges (HIEs).
After all, the failure to inform patients in a timely manner of abnormal results and the failure to document whether patients actually were notified are the two most frequent causes of indefensible malpractice claims, according to the June 2009 Archives of Internal Medicine. In one study published in the same magazine, 7% of abnormal tests results from primary care offices were never shared with patients and at one unnamed large academic center that figure grew to a whopping 23%. In addition, managing, reviewing and sharing laboratory results - important elements in the diagnostic process - consumes a large amount of physicians' time, according to the June 2009 Archives of Internal Medicine. Today, medical facilities typically fax or mail lab results to physicians who, in turn, notify patients of results. This method is prone to misdirected or unsent faxes, misplaced envelopes, lack of sharing data with patients or misfiling.
Recognizing the inherent perils of paper-based reporting and the opportunity to streamline and improve the accuracy of an electronic transfer of lab results, at its Dec. 15, 2009 meeting, the Health IT Policy Committee invited the Information Exchange Workgroup to share its findings about the obstacles to creating an electronic lab-delivery system and the problems surrounding the integration of these systems into the planned national HIE. The electronic exchange of laboratory results is impossible without standards-based lab transactions, the IE Workgroup determined. Currently, also, there is no financial incentive to create electronic laboratory ordering and results delivery systems, it found.
The IE Workgroup did, however, suggest that the Centers for Medicare & Medicaid Services (CMS) become the leadership authority for the adoption and adherence to a national standards-based lab system. CMS regulates 200,000 laboratory entities through the Clinical Laboratory Improvement Amendments (CLIA). There are laboratories in 8,500 hospitals, 400 public health organization, and 170,000 ambulatory practices. These entities provide lab results to 150,000 physician practices and 170,000 ambulatory practices. Laboratory results are transmitted by letter or fax to physician practices and ambulatory care centers. Medical Laboratory uses an electronic laboratory delivery systems only when contractually obligated by a medical provider. CLIA can hold laboratories responsible for how results appear in the electronic medical record (EMR), the workgroup proposed. In addition, legislation is needed to establish in law or regulation how a patient can access lab results, the group stated.
During its meeting, the IE Workgroup identified an aggressive timeline, recommending that in 2011 all hospitals should have a certified in-house laboratory interfacing to their EMR. In that same year, physician and ambulatory care facilities should receive lab results electronically, and all lab orders should be electronically transmitted by 2013. In addition, the IE Workgroup suggested that states' HIEs must use standards-based lab transactions in HITECH-funded Medicaid incentive agreements, and the Centers for Medicare & Medicaid Services (CMS) require it for eligibility under the HITECH Medicare incentive payments.
The American Recovery and Reinvestment Act (ARRA) of 2009 allocated $20 billion for HITECH, designed specifically to "improve quality and coordination of patients’ health information by developing a nationwide health information technology infrastructure," according to HITECH. The HITECH legislation uses financial incentives through Medicare and Medicaid programs to encourage doctors and hospitals to use of certified electronic health records - and, eventually, penalize them financially if they do not use these electronic record. Physicians are eligible for incentives of between $40,000 and $65,000 and hospitals could receive several millions of dollars if they meet specific criteria and timelines for the adoption and use of health information technology. The legislation also mandates that the federal government takes a leadership role in the development of a policy framework for the adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information, including lab results. The Health IT Policy Committee, a Federal Advisory Committee, made these recommendations to the National Coordinator for Health IT.
Under the HITECH Act, all states must create HIEs. But as of December 2009, Maine’s nonprofit HealthInfoNet was the nation's largest state-wide HIE, and Delaware and Vermont were the only other regions operating statewide exchanges.
The Federal government has leverage under the HITECH Act. The enforcement of standards-based electronic laboratory ordering and results delivery systems can be monitored under the "meaningful use" requirement for 2011. For additional information about the Medicaid and Medicare incentive programs see Entering the EHR technology rush through Medicare, Medicaid grants.