in with the lab orders, which creates big
headaches trying to resolve the issue and
oftentimes ends up making the practice eat
the costs of the tests, Williams says.
;e Ignis software has embedded rules
for order routing, so when physicians click
“send” on an order it’s automatically routed to the internal lab, reference lab or the
lab at McLaren Northern Michigan. In addition, the system also is programmed with
the medical necessity and frequency rules
and requires physicians to ensure the proper diagnosis codes and any other required
information are included at the point of ordering—the test won’t be processed unless
that information is included.
Other valuable tools in the Ignis System
software, Williams says, are programming
that maps lab test terminologies, and the
ability to process standing orders for frequent testing.
Reference and other outside labs often
use di;erent terms for lab tests than physicians do, and the confusion caused by
those di;erent terminologies often caused
miscommunications. Now, when a physician orders a test, it’s mapped to the term
used by the receiving laboratory.
“All in all, I’d say the EMR-Link has cut
the amount of time we spend in the lab just
processing orders by 80 percent, which has
freed us up to focus on actually doing our
testing work,” says Williams. ;e practice’s
lab conducts about 150,000 tests per year,
she adds.
In addition, the Ignis software also allows physicians to set up future and standing orders. A number of Northern Michigan patients are on blood thinners and
need to have Pro Time INR tests on a weekly or monthly basis to measure the clotting
tendency of their blood. In the past, those
orders had to be entered on a test-by-test
basis, which was a big headache for physicians, patients and lab personnel.
Moving closer
Cutting the time pathologists and lab
specialists spend just getting orders
in order, so to speak, is becoming ever
more imperative as more testing is be-
ing done in ambulatory settings, and
more complex types of tests—molecu-
lar and genetic testing—move into more
clinical settings, says David Pecoraro, the
CIO at Denver-based Sisters of Charity,
which operates 11 hospitals, four safety
net clinics, one children’s mental health
center and more than 100 ambulatory
service centers.
Emergence
“We’re seeing molecular and genomic pa-
thology emerging more frequently in the
patient management process, and that
information needs to be processed in a
real-time environment. We have to act on
that data in minutes rather than days to
capture its value for patient care.”
;at value—of genetic and molecular
testing, as well as more sophisticated tra-
ditional tests—is what’s at stake due to the
industry’s uneven approach to messag-
ing standardization, asserts Spinosa from
Scripps.
While I. T. departments are enamored
of tabular data, more re;ned lab testing
requires increased narrative from pathol-
ogists and other lab specialists to be con-
joined with discrete data elements.
Decision points
“Organizations that are using those older
series of standards haven’t gotten that
iterative improvement, and it’s starting
to have an impact,” Spinosa says. “;e
fundamental issue is that test results no
longer have just high or low values, they
include a number of decision points. As
the tests have become more sophisticated, they have more nuances that are open
to interpretation—how you measure glucose now, for example, is really context-dependent.
“We are in danger of not being able to
support the pathology narrative that addresses those nuances, and while many
physicians might be ;ne with that, there
are others who are going to lose narrative
information that they would have used for
treatment decisions,” Spinosa says.
“I already see the need for a hybrid of
narrative and discrete exploding in pathology, and the need is going to get more
acute. We are so focused on discrete data
to create interoperability that we’re trading
a loss of functionality for an illusion. Providers use words that have meaning.”
