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 enable real-time communication of lab 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 lab orders and lab results. 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 diverse stakeholders 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); American Clinical Laboratory Association (ACLA); 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.

Continuing Progress 

With the Health Information Technology for Economic and Clinical Health (HITECH) Act, the electronic communication of lab data is a key component of “meaningful use” requirements. The Office of the National Coordinator for Health IT’s Standards and Interoperability Framework (S&I) leveraged the ELINCS standard to establish the Laboratory Results Interface (LRI) and Laboratory Orders Interface (LOI) specifications, a set of national standards that vendors must adopt in order to meet EHR certification requirements.

CHCF has made the ELINCS specifications and resources available including guidance to help organizations migrate lab interfaces from ELINCS to LRI; see the zip package under Document Downloads.

For more information, contact Sujansky and Associates.