EDI provides strategy for laboratory results reporting

Healthcare Financial Management, Jan, 1994 by Marcia McLure, Phyllis Barnett

Historically, results of laboratory tests have been transmitted from hospitals to physicians' offices by mail and telephone. Two problems inherent in this system are the difficulty in notifying the physician and in the timeliness of delivery of results. Telephone messages may fail to reach the physician. Hard copies of reports may be misfiled, lost, or delayed in the mail. Today, test results can be transmitted between physicians' offices and hospitals via facsimile machines and electronic data interchange (EDI). This article examines the cost effectiveness, confidentiality, and opportunity for growth these alternative methods of transmission offer.

The easy and quick exchange of information between physicians and hospitals is vital for efficient, cost-effective healthcare delivery. Every day, physicians receive discharge summaries, operative reports, face sheets, and laboratory reports. The reporting of laboratory test results to physicians is an important subset of this clinical data information exchange.

The number of laboratory tests that physicians order has increased dramatically over the past 10 years, both for tests used for diagnostic screening purposes and for those used for monitoring treatment. Traditionally, laboratory personnel have telephoned the physician's office to report any abnormal or "stat" test results. A hard copy of the test results is then sent by mail several days later. Two problems inherent in this system are the difficulty in notifying the physician and in the timeliness of delivery of results. Telephone messages may fail to reach the physician. Hard copies of reports may be misfiled, lost, or delayed in the mail. Often, a patient will be referred to a specialist who will not have access to all the patient's test results because the reports are filed at another hospital or physician's office.

About 10 percent of all tests are reordered because laboratory test data for a particular patient are not available.

Test result reporting strategies

In recent years, more hospitals and physicians have begun using the facsimile machine to exchange information.

Fax transmission is a low-cost, user-friendly means of data transmission and is easily implemented if the hospital laboratory information system has fax capability. Most systems with this capability allow users to customize each physician office-laboratory link by specifying when to send reports and the type of reports desired.

Using a fax machine to exchange information offers several advantages. Transcription errors that can occur when test results are relayed verbally over the telephone are eliminated. Moreover, sending a fax is fast, and many physicians' offices already own a facsimile machine that is used for other purposes.

Fax transmission, however, does have its disadvantages. The image quality of the thermal sensitive fax paper used by many fax machines is often poor and degrades quickly. And facsimile transmissions do not provide confirmation that the data sent were actually received. While facsimile machines may be an improvement over mail and telephone in the way information can be transmitted, there are better ways.

One of those better ways is to install a laboratory information system terminal in the physician's office. This approach provides a direct electronic two-way link between a physician's office and the laboratory. Instead of reading a week-old printed report sent by mail or an hours-old fax, the physician has access to real-time data.

While this strategy is used occasionally, it is limited in its application. Hospitals must have security controls in place to limit the access of the physician's office to records of only those of the physician's patients. In addition, password protection may be required to restrict individuals in the physician's office that can use the system. Some systems require a high level of employee training, and the cost of training and providing support for the terminals in the physician's office can be significant.

Another alternative to installing a dedicated terminal in a physician's office is to furnish software that allows the physician to access the hospital's system via a PC and a modem (which the physician's office may already possess as part of its practice management system). This alternative has the advantage of allowing access without affecting the performance of the hospital's laboratory information system, but it does not allow the physician to know when results are available, nor can the physician customize laboratory reports. The system also can become slow when multiple users attempt simultaneous access. These failings may prompt physicians to revert to receiving test results via telephone.

A partial solution to the problem, as illustrated in Exhibit 1, is a system where reports are down-loaded from the laboratory information system into a computer (usually a PC) at the hospital. The PC is available for dial-in access through the physician's computer using software that can be installed and customized at the physician's office. Having a separate computer dedicated to laboratory reporting allows the number of users to grow without affecting the hospital's laboratory information system performance.