Electronic Laboratory Reporting Advancing, But Greater Adoption Needed

Two recently published studies indicate that electronic laboratory reporting (ELR) is substantially penetrating laboratory and physician workflow, although much more needs to be done to reach meaningful use stage 2 goals. ELR holds promise for both improving the quality of individual clinical care and speeding the nation’s response to infectious disease outbreaks. State and local public health departments have made substantial progress in ELR in recent years. The number of state and local health departments receiving electronic reports from laboratories has more than doubled since 2005, with 54 state and local public health departments now receiving laboratory reports electronically, compared with 26 in 2005, according to a Sept. 27 study in Morbidity and Mortality Weekly Report (MMWR). Additionally, nearly two-thirds (62 percent) of the 20 million total lab reports received were reported electronically in 2013, an increase of 8 percent in just the past year. “Electronic laboratory reporting can give health officials better, more timely and complete information on emerging infections and outbreaks than they have ever received before,” said Robert Pinner, M.D., associate director for surveillance, programs, and informatics at the U.S. Centers for Disease Control and Prevention (CDC), in a statement. “Implementing these systems is a complex task that requires substantial investment, but ELR will provide health departments the tools they need to quickly identify and respond to disease threats and monitor disease trends now and in the future.” In addition to the Centers for Medicare and Medicaid Services’ financial incentives, since 2010 the CDC has provided funding to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to aid with ELR from clinical and public health laboratories to public health agencies. In this MMWR report monitoring ELR implementation, the CDC and state and large local health departments (Los Angeles County, Philadelphia, New York City, Chicago, Houston, and the District of Columbia) analyzed data from each jurisdiction. In total 10,400 laboratories that send reportable results to public health agencies nationwide were identified, with 52 percent of these laboratories considered priority targets. At the end of July 2013, 54 of the 57 jurisdictions (48 state and six large local health departments) were receiving at least some laboratory reports through ELR. However, only 28 percent of the targeted laboratories reported to at least one public health agency through ELR. Of all reports received electronically, 40 percent come from one of the four large commercial laboratories (LabCorp, Quest Diagnostics, ARUP Laboratories, and Mayo Clinic), 14 percent from the approximately 5,300 hospital laboratories, and 30 percent friom public health laboratories. The proportion of laboratory reports received electronically varied significantly geographically. Fourteen jurisdictions received more than 75 percent of laboratory reports electronically, while nine received less than 25 percent of reports electronically. The proportion of reports received electronically also varied by disease category, with 76 percent of reportable laboratory results for general communicable diseases received through ELR, but only 54 percent of HIV and 63 percent of sexually transmitted disease reports sent electronically, even though overall reporting volumes for these conditions were higher. “Substantial work remains, however, to achieve full and effective ELR implementation. Nearly three fourths of reporting laboratories, including half of those that are priority targets, still are not reporting electronically,” writes lead author Kathryn Turner, Ph.D., from the Idaho Division of Public Health in the MMWR report. “Public health agencies, laboratories, and laboratory information management system vendors should work together to achieve consistent and accurate use of standardized vocabulary, to ensure that all reports are sent and that they are complete, and to reduce inessential state-to-state variability in electronic disease reporting requirements.” Office-Based Electronic Use of Laboratory Results In a second study from the Department of Health and Human Services, researchers from the Office of the National Coordinator for Health Information Technology analyzed data from the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement, a nationally representative sample of more than 4,300 office-based physicians, in order to establish a better understanding of electronic use of laboratory data in private offices. According to the study published online Oct. 23 in the American Journal of Managed Care, the researchers found that in 2011 roughly two-thirds (67 percent) of physicians had the ability to view lab results electronically, 42 percent were able to incorporate lab results into their electronic health records (EHR), 35 percent were able to send lab orders electronically, and only 31 percent exchanged patient clinical summaries with other providers. Again, there was substantial variation in these numbers geographically. Electronic lab ordering ranged from 58 percent (Washington) to 19 percent (Delaware). The ability to receive lab results electronically ranged from 88 percent (Wisconsin) to 44 percent (Louisiana). Incorporating those results electronically into an EHR varied from 73 percent (Minnesota) to 21 percent (Louisiana). As might be expected, larger practice size was significantly associated with the capability to conduct all facets of electronic lab exchange, particularly the capability to incorporate lab results into an EHR. The study noted that a substantial minority of physicians with no EHR also have electronic lab exchange capabilities, suggesting that proprietary portals continue to play in facilitating physician access lab result data. However, very few physicians without an EHR have the capability to electronically order lab tests. Takeaway: While progress has been made in ELR both to public health agencies and in physician workflow, laboratories are far from meeting meaningful use goals.