Background
The adoption of electronic health records (EHRs) is a key step toward improving the quality, safety, and efficiency of health care delivery. Yet the vast majority of physician practices still rely on antiquated paper records. The purchase of EHR systems can be prohibitively expensive and technically daunting to physician practices that generally have little to no information technology resources. However, studies have shown that physician practices can reap tangible benefits early in EHR implementation and reduce costs associated with EHR system installation and configuration (Journal of the American Medical Informatics Association, May/June 2009, Volume 16, Issue 3).
The adoption of a national data standard can simplify the use of electronic health record systems and provide real-time access to lab results data. In 2005, the California HealthCare Foundation (CHCF) developed the EHR-Lab Interoperability and Connectivity Specification (ELINCS) as a national standard for the exchange of lab results data. Building on this work, CHCF developed ELINCS Orders in 2011 to standardize the electronic exchange of lab orders and close the communication loop between providers and laboratories.
ELINCS Use Cases
Communication between a laboratory and a medical provider can be a fractured process in which orders and results are sent by fax or mail. Lab orders are sent on paper and results must be filed in the patient's paper chart or manually entered into the physician's EHR.
Figure 1 shows how the ELINCS data standard improves the transmission of both the lab order and lab result. In this example, a physician orders lab tests using an EHR system. With the ELINCS standard, the orders are sent electronically to the lab draw station. The specimen is collected and transported to the lab for analysis. Test results are then transmitted electronically, again using the ELINCS standard, to the ordering provider's EHR system where they can be reviewed with the rest of the patient's history, including past lab results.
Collaborative Development
In developing ELINCS, CHCF worked closely with national and international efforts to develop clinical data standards for EHRs to ensure its widespread adoption. These include the Certification Commission for Health Information Technology (CCHIT); Connecting for Health (Markle Foundation); eHealth Initiative (eHI); DOQ-IT (Centers for Medicare and Medicaid Services); Integrating the Healthcare Enterprise (IHE); Public Health Information Network (CDC/PHIN); and Health Level Seven (HL7).
CHCF engaged Sujansky & Associates LLC to lead the ELINCS technical specification development. As technical lead, Sujansky & Associates managed the multiple-disciplinary Technical Working Group, analyzing and documenting relevant use cases and technical documentation, and supports vendor implementations.
The approval of ELINCS by HL7 in 2008 was an important step toward its broader adoption by electronic health record systems and reference laboratories across the United States. ELINCS HL7 Release 1 is consistent with the 2008 Certification Commission for Health Information Technology (CCHIT) criteria for lab interoperability in ambulatory EHRs.
Continuing Progress
As of January 2011, more than 56 organizations across the state, involving over 200 health care provider locations, have implemented ELINCS interfaces or are in the process of doing so. ELINCS-compliant interfaces have been implemented by multiple electronic health record systems, hospital laboratories, national commercial laboratories, independent labs, chronic disease registry systems, and a California state agency.
Lessons learned from some of the pilot projects are documented in an issue brief, Implementing the ELINCS Standard: Technical Experience from the Field (October 2007). The project helped to identify several important challenges in adopting the ELINCS standard, including the need to learn new coding schemes, the lack of a standard for message transport, and difficulty in resolving incompatible data fields.
For further details and the status of the specification development, see the main Web site at www.ELINCS.org.