EHR-Lab Interoperability Project: Does Anyone Care?

Health IT Boosts Patient Care, Safety

A six-year project that would make it easier to program interfaces between laboratories and ambulatory-care electronic health records (EHRs) is close to fruition. But it's unclear whether EHR vendors will pay much attention to it unless the government includes it in future Meaningful Use requirements.

The California Healthcare Foundation (CHCF) started working on its EHR-Lab Interoperability and Connectivity Specification (ELINCS) in 2005. The next year, it made the portion of ELINCS that applies to lab results publicly available. Now the CHCF-funded project has completed the specifications for lab orders.

The ordering specifications will be piloted this fall and winter, Glen Moy, senior program manager for CHCF, told InformationWeek Healthcare. Then CHCF will apply to HL7, the healthcare industry's standards development organization, for approval of the new ordering specs. (HL7 approved ELINCS results for use with its ubiquitous messaging standard in 2008.)

CHCF is also talking to the Office of the National Coordinator of Health IT (ONC) and the private body that advises ONC on health IT standards about including ELINCS in stage 2 of Meaningful Use, Moy said. He expects ELINCS will be released to the public around the end of 2012--which, not coincidentally, is just before the effective starting date of stage 2.

ELINCS is being used by 56 healthcare organizations at 200 sites in California and it has been adopted in parts of the South and the Midwest, said Moy. ELINCS also has the support of national lab chains Quest and LabCorp, which have promoted it in some areas. In addition, OCHIN, a health IT services firm that specializes in community health centers, is using ELINCS on the West Coast and in Ohio, Pennsylvania, and Illinois, Moy said.

ELINCS can significantly decrease the time and effort required to write lab interfaces, noted Moy. But that's not necessarily true the first time around. "The advantage of ELINCS is when you have to do additional interfaces [between a given lab and a given EHR], it significantly shortens the time to do that."

So why hasn't there been more uptake of ELINCS over the past five years?

"We started off trying to work through EHR vendors, and that isn't necessarily the right approach," Moy explained. "There's no incentive for EHR vendors to standardize, because they make money off of interfaces, and it can be a sizeable source of revenue for some vendors. So there wasn't any interest on their part."

While big vendors like Allscripts and eClinicalWorks say they support ELINCS, he added, in practice they will use it only if a client requests it. "If the customer doesn't ask for ELINCS, they're not necessarily going to offer it up."

"The same thing is true on the lab side. LabCorp and Quest both support ELINCS, and in California they make up roughly a quarter of the lab market. But it's been very hard to reach out and make other laboratories aware of ELINCS. And when we do, the labs say, 'We'll implement it if our physician customers ask for it.' And when a physician purchases an EHR, there are so many decisions that he or she needs to make. So when the doctor gets down to exchanging data, he just wants it to work."

Some vendors tell their customers that they have a lab "hub" that will provide all of their interfaces. There may be economies of scale in doing that in a local area where, say, the hospital lab does most of the lab work and would not otherwise connect with a small practice online. But Moy points out that interfaces in the "cloud" are no different than interfaces to an onsite client-server network.

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