Integration of clinical systems has always been challenging. As the number of physician practices deploying electronic medical record (EMR) systems increases, so does the demand for electronically exchanging orders and results between the hospital system and the practice EMR. Without an interface, practices must manually enter results into the EMR, which is both labor-intensive and error-prone.

Achieving connectivity between physician EMR systems and hospital-based lab systems typically requires an interface from the EMR vendor, at a cost ranging anywhere from $1,000 to $25,000. Due to the large number of current EMR vendors, however, any specific laboratory information system (LIS) vendor may have limited expertise connecting to a particular EMR. Additionally, the connection must provide appropriate security. While virtual private network (VPN) connections are one option, they take time to establish and require ongoing support and maintenance -- making an alternate solution more preferable.

In contrast, a health information exchange (HIE) provider has an established rapport with multiple EMR vendors, resulting in a more efficient integration process since both the HIE provider and EMR vendor have previously worked together. An HIE provider can also offer a connectivity application that provides the security of a VPN without the need to establish a direct connection to the practice's network.

Since most physician practices do not have dedicated IT departments, EMR-related IT issues are typically handled by consultants or the vendors providing practice management and EMR systems. While some vendors perform system implementation and testing, others simply install the EMR system and leave deployment to physician office staff members who often do not have the time or skill sets necessary to perform thorough testing of the interface. An HIE provider can manage both implementation and ongoing support, enabling practice staff to focus on patient care.

 Addressing integration challenges

When evaluating integration applications, hospitals should consider a number of potential issues, such as:

·        Partial and abnormal results - The ability to manage partial results varies among EMR systems. Some append partial results to the prior lab report, leading to a cluttered, difficult-to-read report. To simplify results reporting and minimize confusion, many practices prefer to receive only final lab results. Also, some EMR systems lack the sophistication of an LIS in handling abnormal results indicators, making it more difficult for physicians to interpret results. An EMR integration system should have the flexibility to manage partial results according to each practice's preferences and offset any EMR deficiencies in the notation of abnormal results.