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ELINCS: The National Lab Data Standard for Electronic Health Records May 2009 
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 will simplify the use of electronic health record systems and provide real-time access to lab results data. In 2005, the California HealthCare Foundation (CHCF) set out to develop the EHR-Lab Interoperability and Connectivity Specification (ELINCS) as a national standard for this important data interchange. ELINCS Use Case
Figure 1 shows how the ELINCS data standard would improve this process. In this example, a lab requisition form is written by the provider on behalf of the patient and delivered (typically by the patient) to the lab draw station. The specimen is drawn and transported to the lab for analysis. With the ELINCS standard, results will be transmitted electronically 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. See the ELINCS development milestones listed in the sidebar. 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. Implementations and Lessons Learned As of April 2009, more than 40 organizations across the state, involving over 165 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, small local labs, and chronic disease registry systems. 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. Document Downloads
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Implementing the ELINCS Standard: Technical Experience from the Field