# American Health Information Community

**Workgroup: Electronic Health Record**

**Laboratory data information exchange**

**Agenda**

**Date:** **Wednesday, April 26, 2006**

**Time: 10am ET --** **12pm ET**

**Mary E. Switzer Building,**

**330 C Street, SW, Washington DC.**

**Room 4090**

1.  Call to Order

    -   Co-Chairs:

> -Jonathan B. Perlin, MD, PhD, MSHA, FACP
>
> Under Secretary for Health
>
> Department of Veterans Affairs
>
> -Lillee Smith Gelinas, RN, MSN, FAAN
>
> Vice President, Clinical Performance
>
> VHA Inc.

2.  Brief review of Call-in procedures and FACA guidelines -- *Dr.*
    *Karen Bell*

3.  Introduction of participants -- *All*

4.  Review and acceptance of minutes from March 21 meeting
    \--*Co-chairs*

5.  Review and Discussion of Workgroup Recommendations-- *Dr. Karen
    Bell*

**[Goals:]{.underline}**

-   Refine recommendations to be very clear and concise. Consider
    feasibility and inclusiveness.

-   Pay particular attention to "Who", both public and private entities,
    the recommendations are calling to action.

-   Ensure recommendation and responsible entity alignment. Merge
    similar/ supporting recommendations (eliminate redundancy)

-   Prioritize recommendations for AHIC consideration

> **[Preliminary questions to begin recommendation
> discussions:]{.underline}**

I. Laboratory Results: Central focus

-   What other stakeholders in addition to ONC can ensure lab result
    data are available in a patient-centric manner?

-   How can we broaden the "Who" responsible for achieving the
    breakthrough?

> II\. Laboratory Results: Standards

-   Can recommendation 2.2 be included in 2.0?

-   For recommendation 2.1, which stakeholders would be targeted for the
    promoted standards use: laboratories, purchasers &/or CCHIT?

-   Who are the responsible entities for achieving the breakthrough?

III\. Laboratory Results: CLIA/ HIPAA Options

-   How is recommendation 3.0 different from 3.1 and 3.2?

-   Should we consider broadening/ redefining the stakeholders
    responsible for carrying out these recommendations?

> IV\. Laboratory Results: Privacy and Security (cross-cutting issue)

-   For recommendation 4.1, who should be the primary responsible party
    for carrying out this recommendation?

-   Which groups should carry-out recommendation 4.2: HITSP, HISPC,
    others?

V. Laboratory Results: Assessment, Monitoring & Research

-   Are there additional areas that need to be assessed, monitored &/or
    studied to achieve the goal of patient-centered laboratory results
    data availability?

6.  Timeline for Recommendations*:*

-   [Today]{.underline}: Finalize Recommendations

-   Week of April 24: Workgroup complete and review recommendation
    letter

-   NLT May 1: Finalized recommendations available for distribution

7.  Review and Discuss Outstanding Issues: See Attached

**OUTSTANDING ISSUES:** Comments from WG members during vetting process:

1.  **Need for standardization of laboratory test ordering?**

> ***[Comments from WG members]{.underline}:***

-   Necessary, but will be very difficult. This begins to enter the area
    of web services. For example, it may be possible to create a
    standard that is limited to returning the order information to the
    EHRs after the order is placed on the labs web portal. This will
    avoid the need to standardize the entire process. In any event, I
    would recommend that this process start with the development of
    business requirements with extensive input from laboratory industry
    as the ordering process could be very complex. We could consider
    starting with and refining the CCHIT functional criteria (with lab
    industry input to meet the business requirements in this area) that
    are then to be addressed by HITSP standards agree with CLIA note,
    also this raises LOINC coding issues as well.

-   Standardization is needed -- ELINCS' *[next]{.underline}* task is to
    address laboratory test requisition and consideration should be
    given to the incorporation of that standard once developed.

2.  **How to address physician office laboratory equipment?**

> ***[Comments from WG members]{.underline}:***

-   It is unrealistic to expect POLs to LOINC code results consistently;
    it will have to be mapped by the test kit manufacturer.

-   POLS may not actually have equipment, but only use test "kits" or
    systems (like pregnancy or occult blood kits). Also remember that
    there are many facility types as indicated in attached document.
    Also, there are over 10,000 test systems all in use in POLs, Nursing
    Homes, ESRDs, Pharmacies, Health Fairs, etc. There are about 195,000
    laboratories all using different test systems.

3.  **Incentives:**

> ***[Comments from WG members:]{.underline}***

-   For labs, providers and patients?

-   CMS should charter a group to do a full analysis of the capital
    expenditure mapped to the market segment that will reap the
    financial benefits. This is much broader than the CMS incentives/
    disincentives approach, but could be used to direct the CMS
    incentive/ disincentive activities in the future.

4.  **First Responder EHR Discussion**