Sometimes the best-intentioned regulation backfires. The new Core Stage 2 measure: “Incorporate clinical lab-test results into Certified EHR Technology as structured data” is a good example. On face value this seems like a good idea. Every patient’s lab results now digitized and stored in a database. Think of all the great ways our healthcare delivery system can use that structured data. We can now express lab data in PHR (Personal Healthcare Record) documents. We can trend lab data in flow sheets that help us get a visual interpretation of a set of results. For routine results we can report them electronically on a patient portal and reduce the amount of phone calls between a physician office and a patient. We can warn providers about abnormal results. Yes, we can do a lot of good with structured lab data. So far it seems like a wise regulation, but stay tuned.

Now I can think of only two ways to get structured lab test results into an EHR.

The first is to have a staff member sit in front of a computer and manually enter data from a paper result into the EHR one test at a time. Not a big fan of this method? – Well, neither am I. If you ask CMS they will explain that this method is a viable alternative to meeting the regulation. Here’s the problem – I don’t know any medical practice that could afford to have staff enter every lab result manually. More importantly there is too much room for data entry error that can impact the integrity of the health record.

The second method is to connect electronically to a lab and have your EHR vendor receive lab test results in a structured format. The EHR will incorporate the results automatically into the record for you. Simple, fast, with no data entry errors.

Paper vs Electronic Lab Results

Every provider that wants to meet Stage 2 should want to connect to a lab electronically. Unfortunately, it’s easier said than done. Not every lab wants to connect every Eligible Provider (EP). I have interviewed some of the representatives from the major labs and, frankly, they cannot afford to connect every EP. If a provider completes 5 to 10 lab orders per day then labs will usually devote resources to an electronic connection. BUT, if an EP is a low volume lab user – less than 5 orders per day – lab vendors may choose to not connect the EP. Hence the quandary, the only practical way to meet the Core Stage 2 Lab Results measure is to connect electronically, but an EP needs a lab vendor partner and those lab vendors may not be interested.

If you are a low volume lab user because the very nature of your practice does not dictate the need for many lab orders, meeting Stage 2 Meaningful Use could be a challenge. E xamples of low volume lab users that would otherwise meet Stage 2 measures may include many specialists such as podiatrists, orthopedic surgeons, dermatologists, etc. CMS provides no exclusion for low volume lab users; if you order one test, lets say a panel with 15 – 20 results, the majority of the results (55%) must find their way into the EHR as structured data.

There may be ways for low volume lab users to find a way to connect electronically to a lab. Some providers may have more influence with their local hospital than with the major commercial labs, and can use that leverage to assist in forging an electronic connection. Other providers, like podiatrists, use specialty labs for pathology specimens, and may want to ask those specialty labs for an electronic connection. Whatever strategy your practice devises, it would be wise to begin working on an electronic lab connection today since there is a fair amount of lead-time required to complete a connection.

I wonder if there is a twisted incentive for low volume lab users to become high volume lab users just to meet Stage 2 regulations. Of course more tests mean the cost of healthcare increases, and I thought Meaningful Use was supposed to work in a way to reduce healthcare costs.