Integration of Paper-based Send Out Laboratory Reports in an Electronic Medical Record
Richard M. Hill MBA; Cleveland Clinic; Kavous Roumina PhD; Cleveland Clinic; Shirley A. Stahl BS; Cleveland Clinic; Sandra L. Krall BS; Cleveland Clinic; Walter H. Henricks MD; Cleveland Clinic;
Content:
Laboratory test results received on paper from reference laboratories ( send out tests) represent an important potential gap in laboratory data management in the era of electronic medical records (EMRs). Establishing electronic laboratory information system (LIS) interfaces to all referral labs is not feasible. Many reports are complex and include charts, tables, or graphs and therefore cannot be transcribed into the LIS. We present our experience with implementation of document imaging to integrate paper-based send out laboratory reports into an EMR system.
Technology:
Document imaging system (OnBase, Hyland Software, Westlake, OH); EMR system (Epic Systems, Verona, WI); LIS (Misys Healthcare Systems, Raleigh, NC); Scanning device (Fujitsu 5750C, Tokyo, Japan).
Design:
Entry of an order for a send out test in the EMR triggers an order to the LIS and sends patient demographics and partial order data to the imaging system. When a paper test report is received from a reference laboratory, a generic result is entered for the pending order in the LIS, and this result crosses to the EMR. The report is scanned and indexed based on data elements which are automatically populated from data provided by EMR (e.g. patient identification number). Acceptance of a report image by the imaging system triggers a message to EMR, resulting in linkage to the original order. A hyperlink to the imaged report is displayed in the EMRs result screen for that particular test order.
Results:
Over two months, 6241 reports totaling 8212 pages 1.32 pages per report were imaged and available in the EMR the same day to clinicians. Two scanning devices were used. Time commitment for scanning and indexing is approximately 1-2 hour/day. Physician response was overwhelmingly positive, as send out results were made readily available, and they no longer needed to track down paper copies of reports.
Conclusion:
Paper-based send out test reports can be integrated into the EMR through the use of document imaging and careful attention to all steps of the ordering and reporting process. Integrating scanned images of paper-based send out reports improves result availability and addresses a deficit in laboratory result reporting in an EMR environment.
