in the industry. “All the detritus is starting
to float to the top,” says John Spinosa, M. D.,
chairman of pathology at Scripps Memorial Hospital in La Hoya, Calif., and a former
chief of staff at the hospital.
“The industry hasn’t really taken the existing standards seriously, and the effects
are starting to be felt. It’s getting very difficult for pathologists to communicate all
the information they need to in lab results,
and that problem’s going to grow acute as
more complex testing becomes the norm.”
Scripps Memorial is part of Scripps
Health, a San Diego-based health system
that comprises four acute care hospitals,
more than 2,600 affiliated physicians and a
sprawling network of ambulatory settings.
Physician understanding
Spinosa says that physicians have an
understanding of how critical labora-
tory/EHR connectivity is to their clinical
operations. Scripps Health has, like its
health systems peers, taken on the role
of interface between ambulatory EHRs
and the health system’s labs (which run
on laboratory information systems from
Tucson, Ariz.-based Sunquest Informa-
tion Systems), as well as reference labs.
Getting into that line of work has been an
eye-opener for the Scripps informaticists,
he says.
Nothing comes easy
The variance in the use of messaging stan-
dards by EHR vendors is one big roadblock,
but another issue holding back lab/EHR
connectivity is their fundamental lack of
UnitedHealth Group’s Center for Health Reform & Modernization surveyed the landscape for
genetic testing in the United States, and following are some of the insights from its March
paper, “Personalized Medicine: Trends and prospects for the new science of genetic testing
and molecular diagnostics”:
• Estimates suggest that there are 1,000 to 1,300 genetic tests currently available, and new
tests are regularly emerging at a rate of several per month. The current genetic tests and molecular diagnostics apply to about 2 percent of the population, analysis suggests, but have the
potential of benefiting more than 60 percent of the population in the future.
• The cost of genetic testing for UnitedHealth Group members was about $500 million in
2010. Of this total, nearly 40 percent was testing for infectious diseases, 16 percent for cancer,
and the remainder for other conditions including inherited disorders. The Center for Health
Reform & Modernization estimates that spending per member on molecular and genetic tests
increased by about 14 percent a year on average between 2008 and 2010.
• About three-quarters of doctors also said that there are patients in their practices who would
benefit from a genetic test but have not yet had one. Looking ahead five years, physicians on
average said that they expect 14 percent of their patients will have had a genetic test.
• Seventy-five percent of physicians responding to a survey described themselves as “
somewhat knowledgeable” about genetic science, with 7 percent reporting that they are “very
knowledgeable” and 16 percent “not knowledgeable.”
Genetics Snapshot
understanding about lab-related work-
flow, says Williams at Internal Medicine of
Northern Michigan.
A straightforward example: the group
practice treats patients covered by a
multitude of health insurers, and each
insurer has their own set of rules around
laboratory testing. Many require that
certain types of lab tests, based on CPT
codes, be conducted by national reference
labs instead of the practice’s in-house
lab. As a result, the practice sends some
tests that it can’t perform in-house to the
laboratory at the local hospital, McLaren
Northern Michigan.
All in all, nearly 30 percent of the group’s
tests are sent to outside laboratories, Williams says. Physicians, she says, don’t need
to know where a test order is going, they
just need to be able to order tests during
their clinical workflow. But when Williams
explained that complexity to EHR vendors,
their response was that they would build a
drop-down menu within the application
that would enable physicians to choose the
order’s destination.
That solution, Williams says, is no solution at all. “A drop-down menu would
basically require the physicians to know
what the payer rules and our capabilities
are for each order they place, and then
pick the correct destination. That’s not realistic,” she says.
Internal Medicine of Northern Michigan has addressed that and other lab/EHR
disconnects by installing interface software,
called EMR-Link, from Portland, Ore.-based Ignis Systems. The software helps
fill some of the “huge holes” Williams has
found between her laboratory information
system and the practice’s EHR.
Unnecessary confusion
Another wrench in the works is the medical necessity and test frequency rules for
test ordering. To order many tests billed to
Medicare (which covers more than 70 percent of Northern Michigan’s patients) the
physician needs to include the diagnosis
code to validate the order request. But physicians frequently forget to put the codes
