Electronic health record display of lab results: The need for mass appeal

Dec. 27, 2016 / By Pam Banning

The Lab LOINC committee convened at the Regenstrief Institute in Indianapolis on December 8, 2016 for a day of discussion and decision making. The liveliest topic amongst participants this session was the creation of a laboratory result display recommendation for the public to use in their health information exchange implementations.

To Set the Stage: A common project element of health information exchange is identifying/agreeing among the sharing parties on the viewer display.

The lengths of display have been a source of contention between laboratory information systems (LIS), nursing station viewers and electronic health records (EHRs). Traditionally, the LIS has listings for collection labels, interim worksheets, outbound initial reports and cumulative inpatient reports. These include landscape and portrait footprint viewing.

Some EHR vendors choose to use a lab display other than what was sent in the HL7 message.  This is disconcerting to national reference labs, who have a Clinical Laboratory Improvements Amendments (CLIA) requirement in electronic transmission to retain the originating lab’s information of lab test, value format and performance location. Audits are performed annually to assure compliance; discovery is made of this change of events when an EHR is the end receiver. EHR vendors have a different CLIA requirement: provide 2-3 click access to the original lab information, by hover or click.  It does not have to be the primary view.

The Quest for Public Appeal:

  • As early as two years ago, CDC’s Tiger Team (CDC, CMS/DLS, CAP, COLA, Quest, LabCorp, API, Cerner, Epic and Meditech vendors) had already proposed both a 12-character and a 35-character display for the top 2000 LOINCs. There wasn’t a formula provided for creation of displays by automation.
  • Clinical LOINC chair Stan Huff recommended making a list from common panels for 12-15 characters to have available for adoption in space-critical locations. He wasn’t in favor of populating the entire LOINC database with the extremely short display. Regenstrief wasn’t in favor of manual editing of displays either (too labor intensive with little utilization predicted).

Regenstrief Institute is recommending the use of their Long Common Name in the message:

  • Funding requirements necessitated a need to create UNIQUE display names.
  • What’s sent in the message is only required to be accessible at endpoint.
  • The governance ends with “strong recommendation”; they are not able to “require”.

Optimally, the sender can populate a local triplet (mnemonic, display, local site ID) and an accompanying standardized triplet (LOINC code, LOINC display, LOINC Identifier ^LN). The three human readable options currently available in LOINC are:

  1. Attribute view containing a concatenation of the axes comprising the LOINC term. There are ampersands, carats, plus signs and other special characters, which may disrupt the electronic reading of field delimiters (Example: 46268-9   ABO & Rh group^post transfusion reaction:Type:Pt:Bld^BPU:Nom).
  2. Short Name utilizing the property and specimen in addition to component to create a unique view. There are abbreviations AND there are blank gaps in LOINC for this field (Example for 46268-9:  ABO + Rh p transf rx Bld BPU).
  3. Long Common Name doesn’t have abbreviations – it will be the longest in display length (Example for 46268-9: ABO and Rh group [Type] in Blood from Blood product unit–after transfusion reaction).

3M’s Healthcare Data Dictionary (HDD) is a terminology server holding contexts that account for local displays per originating source, standardized displays from LOINC and the agreed upon health information exchange display.  The client can create the algorithm that tracks the selection and use different contexts to populate the display for each usage.

Pamela Banning, BS, is a senior healthcare data analyst for 3M Health Information Systems.