Inside the Lab Industry: Labs Plugging Into Health Information Exchanges; Solstas, Quest, LabCorp All in Deals

Rochester, N.Y., has seen better days as a commercial hub. The upstate city near the Canadian border has lost most of its big employers over the decades, and its flagship company, Eastman Kodak, filed for bankruptcy last year. But just as the photography giant simplified and streamlined the sales of film and cameras 125 years ago, another enterprise in Rochester may be doing the same to the ordering and delivery of laboratory tests. The Rochester Regional Health Information Organization (RHIO) is one of scores of provider consortiums that have sprung up in the last decade to simplify the sharing of digitized patient medical records over broad geographical regions. In 2008, it launched the record-sharing service among providers in a 13-county area. The following year, it created a digital delivery service for laboratory results. Although Rochester has only 210,000 residents and the surrounding metropolitan area barely tops 1 million, its RHIO is delivering nearly 500,000 lab test results a month to about 1,000 providers. It plans to launch an ordering service later this year, initially in conjunction with the region’s biggest laboratory, ACM. “Lab is a no-brainer for this,” said Jessica Hasler, the Rochester RHIO’s director of community services. “It [contains] such a high volume of results, and is such a critical portion of the physician workflow.” RHIOs, which also go by the acronym for health information exchanges, or HIEs, have been particularly productive in the past few years. Their growth has been spurred in part by the Health Information Technology for Economic and Clinical Health Act (HITECH), a health care-related part of the economic stimulus legislation signed into law in 2009 that has dangled tens of thousands of dollars in incentive payments to individual physicians to install electronic medical record (EMR) systems. And as the RHIOs/HIEs continue their development, they could wind up remaking the decades-old mashup of faxes, courier deliveries, and reams of easily misplaced paper that still comprise a large part of the laboratory industry’s ordering and delivery infrastructure. “What we do is provide the final mile,” said Dan Porreca, executive director of HealthELink, an HIE/RHIO that serves Buffalo, N.Y., and handles the patient records for about 1.5 million individuals. HealthELink’s delivery service populates electronic medical records with lab results directly. Porreca estimated that HealthELink handles about 95 percent of the lab records produced in the region. Although Michigan Health Connect in the Detroit area has just started up its lab record delivery service, its executive director, Dan Dietzman, sees it as a potential timesaver not only for providers but also as a tool to help improve patient outcomes as well. “Folks often stick a [lab order] in their purse or their car, and don’t go for a couple of weeks,” for draws, he noted. Having everything on a fully electronic system provides better tracking—and quicker compliance. Moreover, the exchanges also have the capability of coding many of the results in LOINC, a database for lab names and codes, whether the specific providers use that coding or not. That allows for better tracking of statistical and demographic data for both the labs and providers, Porreca said. Although many RHIOs/HIEs are undertaking the painstaking work of marrying the myriad of EMR systems into a single accessible portal for providers—Michigan Health Connect has done so with 40 different applications, Rochester with 19, and HealthELink with 10—most of these organizations are nonprofits and subsist primarily on state and federal grants and the relatively modest participation fees they charge providers. As a result, they are catching the attention of laboratories whose management may be seeking alternatives to investing millions of their own dollars into IT infrastructure to better serve their customers. Big Labs and HIEs Officials with three large national laboratories—Quest Diagnostics, LabCorp, and Solstas Lab Partners—were not particularly forthcoming about their plans for HIEs/RHIOs. However, several officials with those networking organizations confirmed they have either inked contracts or are in discussions to participate in their infrastructure. One such RHIO/HIE covers the entire Tar Heel State. The North Carolina Health Information Exchange is launching its record-sharing system within the next few weeks, and it will do so with data-sharing agreements in place with Solstas and LabCorp, both of which are headquartered in North Carolina. LabCorp Chief Executive Officer David King sits on the North Carolina HIE’s board of directors. “Solstas has been an excellent partner from the start—they just jumped right in,” said Whitney Baker, the North Carolina HIE’s manager of marketing and customer advocacy. Solstas reached a participation agreement with the North Carolina HIE last May, according to Baker. Although Solstas declined comment for this article, in a press release it issued at the time of the agreement, its chief information officer, Bryan Firestone, noted that “accessible health information is at the center of the next wave in patient care. This collaboration with the North Carolina HIE is in direct correlation with that initiative, as well as Solstas’s core values of enhancing patient care.” As part of the agreement, Solstas and LabCorp will post “courtesy copies” of laboratory reports as part of the patient records that will be shared between the providers in the consortium. They will show up whenever a provider calls up a patient record. In addition to those two national labs, the North Carolina HIE is currently in negotiations for a similar agreement with Quest Diagnostics, according to Baker. In an e-mail response, Quest spokesperson Wendy Bost termed such negotiations “rumors.” However, Bost added that “we are in discussions with providers regarding potential participation in several exchanges. Quest Diagnostics has many capabilities, such as electronic connectivity and strong physician and hospital relationships, which closely align with the requirements of an effective health exchange.” Such attributes are prized by Dietzman. He added that his HIE/RHIO is in talks with both Quest and LabCorp, although no definitive agreements have been reached. “I kind of want the Quest deal. Everything with a hospital relationship is built from scratch. With a national lab, it would be like flipping a switch,” he said—primarily because they are already well-prepared to interface with a variety of EMR systems. Currently, Michigan Health Connect is in the first stages of delivering lab records—it is only moving about 6,000 per month, primarily through the laboratory at Saint John Hospital Medical Center in Detroit. But Dietzman expects deliveries to grow quickly, particularly as more of the 47 hospitals participating in the exchange join the service. However, he sees one significant challenge with the hospital labs themselves: Changing their operations and cultures. “The biggest challenge in the ordering is not the technology, it is how the lab operates,” he said. “If you’re used to paper in the bag, and now you say, ‘we have to start using electronic messages, coding messages, and insurance tables,’ how do you efficiently accommodate the operations? The technology makes it easier, but making the adjustment is a little bit more of a steeper curve.”