Last week I talked with a colleague in Alberta about his use of an EMR for clinical care coordination. As a member of a primary care network, he has the benefit of ancillary care providers, such as diabetic nurses and counsellors, who are funded to provide service within the network. He is a regular user of the Netcare portal (Alberta provincial EHR) and has come to depend upon lab results being directly imported into his EMR into a patient record; the same cannot be said for diagnostic reports.
Lab results were one of the first major integration projects to move ahead in most provinces, initially enabling the delivery of lab results from private labs directly into EMR systems, attached to the correct patient’s file, followed by work on the delivery of regional lab results. For the most part, this works extremely well. Lab result delivery is smooth and fast. The second part of this transaction — the ability to order lab results electronically from within the EMR — has not yet taken place. Some practices have developed partial electronic workarounds by pre-populating a scanned lab order form within an EMR with demographic data and lab test orders on the form, printing the form, and handing it to the patient. While this makes lab investigation ordering easier, it remains a small part of the equation. It is interesting to note that most lab testing and results in the U.S. from private labs (Quest and Labcorp) are bi-directional. Labs can be ordered electronically and delivered electronically back into the patient’s chart.
However, diagnostic reports (such as mammograms or X-rays) are a different kettle of fish. The work that has been done with lab results is not duplicated with diagnostic reports. Facilities that provide diagnostic services generally have no mechanism to deliver diagnostic reports electronically into EMRs attached to a specific patient’s file. The standard process involves receiving a diagnostic report via fax or mail, scanning that document as a pdf file, and manually attaching the report into the patient’s record. Because this process requires scanning, there are bottlenecks that can occur at multiple points within a medical office — in the receipt process, during review, or when being scanned into the system.
Once critical mass has been reached in terms of EMR adoption, it is likely that labs will tell physicians they will no longer deliver results in paper, and will transition completely to electronic lab results. This will be much more challenging for diagnostic imaging. The work that has been done to integrate labs has not taken place with DI. This can no longer be delayed or it will remain the weak link in the chain as practices work hard to automate.
Do you have electronic DI report delivery, or have you developed workarounds within your practice that you can share? Click on the “Comments” link below to add your thoughts.