Computer Consult

Online labs and EMRs: A marriage that clicks

Software that downloads, files, and organizes test results can streamline your office and help you manage patients.

Hayward K. Zwerling, MD

Once or twice a day, I get on my computer, go to my hospital's Web site, and scan the latest lab results for my patients. Then, with a few clicks, I download the data into my electronic medical record program, which not only files it in each patient's chart, but puts a flag on my "To Do" list about abnormal results. Nifty, huh?

You'd think that this would be a routine chore for doctors with EMRs. Based on my own anecdotal evidence, however, fewer than 10 percent of physicians with EMRs are importing lab results into their systems—and reaping the many benefits.

By automating lab results, you have a tremendous opportunity not only to improve the quality of patient care, but reduce office overhead. I know. I've been filing lab results in an EMR program since 1993, and the payoffs have been dramatic. The program I use, which I also wrote, is ComChart (www.comchart.com ), but you can have your pick of EMR programs. Here's the level of performance you should shoot for.

Why pull charts when you can click?

Managing and filing lab tests and results has long been ripe for computerization because the paper way is so labor-heavy. It used to chew up 10 to 15 hours a week in my solo practice.

Automation reduces hours to minutes. Take test ordering. With one mouse click, you're able to generate a lab slip with all the information you'd ever want about a patient. And there's a safeguard against duplicated orders. When you request a test, your program can automatically inform you when the last one was performed.

Your EMR program should be able to compile a "labs pending" list. And because the list resides in your computer's memory, you can search it for overdue results—all Pap smears that haven't come back, for example. Your chances of being sued for malpractice shrink.

Automation means better doctoring

You also gain a big edge clinically by automating lab results. For one thing, you can access them from any computer in your office or at home. Every day, I copy electronic charts from the office server to my laptop. When I get a call from the ER at 10 pm about a diabetic patient, I'll tap into "blood sugars" while we're speaking. As a result, the ER doctor has more information to work with. If he wants the data in writing, I can fax it to the ER straight from my computer.

A well designed EMR program will not only retrieve test results rapidly, but display them in ways that help you manage patient care. Maybe you're on the run, and you want a quick review of today's lab results. So ask the computer to list only those results that are dated today and are abnormal. Or you can focus on a particular test. What's been Mrs. Horn's history of HbA1c levels over the past few months? The computer's answer may reveal a significant trend.

Computerization sharpens your medical thinking by putting lab results in the context of other clinical information. For example, picture a screen showing test results alongside the patient's relevant medication and dosage.

Sometimes patients are noncompliant because they don't take my warnings, orders, and recommendations seriously. For some reason, I seem to make a more convincing case by displaying their lab results on my computer. A hard-copy reminder increases the likelihood that they'll adhere to my orders.

By automating lab results, you'll better manage entire populations of the chronically ill, not just individual patients. Again, the credit goes to the computer's search function. For instance, the American Diabetes Association recommends that all diabetic patients have an HbA1c of less than 8. I query my EMR program several times a year for a list of all patients whose most recent HbA1c is 8 or higher. Then I drill down to all those patients who aren't due to see me for four months or more. I either ask the computer to print a letter to these patients recommending that they schedule an earlier visit, or I have my secretary call them.

It's only a hop, click, and jump to apply this same computer power to clinical research. You can query lab results for those patients who are taking a particular medication and size up its clinical efficacy. This is outcomes research pure and simple.

There's one other plus to displaying just the information you want. Frequently, physicians need to send specific lab data—mean blood glucose, say—to a consulting colleague. Staffers usually have no way of knowing which data is relevant to the consultant. So they photocopy all the lab data, which wastes time and paper. With a nimble EMR system, they print out or e-mail a chart that shows only the numbers for mean blood glucose.

How to get online with your lab's computer

To exploit all the advantages of automated lab data, you need to hook up with your laboratories electronically. You have four options. If the lab has a Web site, you could download your results from it after supplying a user name and password. Similarly, you could harvest the data from the lab computer via a direct modem connection—again, with a user name and password. Encrypted e-mail and floppy discs are two more ways to transfer data.

Once the lab data is in your computer, your EMR program needs to file it away in each patient's chart, field by field. The question is, can your EMR program do that? Many labs format data to meet the standards of Health Level Seven, a nonprofit group that is trying to make data interchangeable among computers in the health care world. If both your EMR program and the lab's software program comply with HL7 standards, you'll be able to cubbyhole the lab data where it belongs.

However, if neither you nor the lab is HL7-compliant, you'll need to hire a computer programmer to create custom "interface" software. Count on paying up to $150 per hour for as much as 25 hours' worth of programming. Your bill could easily top $3,000.

Don't be afraid to spend the money, however. Computerizing your lab results will more than pay for itself in the long run, and that's not to mention all the benefits that will accrue to patient care. To me, seeing those HbA1c and cholesterol numbers on the screen is reason enough to buy an EMR program.

The author is an endocrinologist in Lowell, MA. Computer Consult is edited by Midwest Editor Robert Lowes.

 

Hayward Zwerling. Computer Consult: Online labs and EMRs: A marriage that clicks. Medical Economics Dec. 3, 2001;78:20.