Most lab results still on paper, impeding push for e-health records

Digitizing medical lab tests is one of the key components of a plan to develop a national electronic health record system, but the majority of lab reports are issued in paper form, one of the top executives heading up the initiative told a health policy panel on Tuesday.

About 200,000 medical labs operate in the United States, including 8,500 in hospitals, 5,200 commercial labs and about 115,000 in clinicians' offices. Most fail to use standards when reporting test results, even when exchanging them electronically, Micky Tripathi, co-chair of the Information Technology Policy Committee's information exchange work group, told the Health Information Technology Policy Committee. The panel is in charge of setting policies for electronic health records.

Labs that have electronic message systems use thousands of custom message formats and operate with a software-based clinical vocabulary that can include as many as 40,000 terms, said Tripathi, who is president and chief executive officer of the Massachusetts eHealth Collaborative.

To ensure the success of a national electronic health record system, Tripathi said labs should strictly adhere to electronic messaging standards developed by the Health Level Seven standards organization and should not add personalized tweaks to their software. Labs also should limit their clinical vocabulary to between 400 and 700 terms, which would cover more than 90 percent of the work they do, he added.

The HIT Policy Committee, a federally chartered advisory group to the Health and Human Services Department, adopted the work group's recommendation that HHS' Office of the National Coordinator for Health Information Technology should require national standards for lab messaging and vocabulary. But David Blumenthal, the national coordinator for health IT, said he could not require the standards because HHS Secretary Kathleen Sebelius has the authority only to adopt standards, not issue them.

In addition, federal regulations should be changed to ensure that patients have speedy access to lab results, said Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, and the other co-chair of the information exchange work group.

A national electronic health record system will require the exchange of data among all clinicians and hospitals through the National Health Information Network.

To do so, HHS or another organization will need to create a phone book for the national network to serve as an automatic directory service that looks up a patient and then electronically directs the patient's health data to clinicians, said David Lanksy, president and CEO of the Pacific Business Group on Health and co-chair of the policy committee's national health information network work group.

Lansky said the electronic records network also must ensure that it can protect health records, including secure routing and authentication between parties exchanging clinical information.