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ELINCS: Doing Lab Orders Standards Right

by Wes Rishel  |  December 8, 2011  |  3 Comments

On Wednesday the California Healthcare Foundation published Request for Proposals: Using Electronic Data Standards to Communicate Laboratory Orders.

CHCF actually lives up to an important but seldom-followed precept of standards: producing a spec is only the start of getting a working standard. Someone has to nurse it through initial implementations, reflect on the lessons learned and amend the standards accordingly. Connectathon-like testing is moderately useful, but doesn’t get to many real-world issues that come up in deployment.

Ambulatory lab orders have a high potential ROI but are especially tricky. The basic informatics issues are straight-forward but the issues of patient identity, getting orders from a different place than the specimen is collected and dealing with unsynchronized order catalogs are baffling. ELINCS put together a consensus group that included reference labs, integrated delivery networks and vendors. They hashed out the workflows and developed an implementation guide based on HL7 v2. CHCF is now offering $300K in funding assistance to be spread among six or eight sites to test the draft spec. The learning from this effort will go back to a finalized ELINCS ordering spec.

Hopefully, HL7 and the S&I Framework will adopt the final implementation guide virtually as-is since by then there may be dozens of interfaces operating using the spec. It is always hard for a consensus group to accept the consensus of another group, as was demonstrated by the barriers HL7 put up to adopting the ELINCS results specs. Unless a standards organization sets the specific goal of facilitating the use of third-party work the US will never follow what is supposed to be a fundamental principle guiding ONC work: Standards are not created they are adopted.

In the mean time I recommend the CHCF specs to IDNs, EHR vendors and HIEs that are ready now to grapple with lab orders. It won’t be be perfect now, but it is better a better start than a blank sheet of paper. To the credit of CHCF, it stood up to the rough handling it had at the hands of HL7 and came away with a defined path to ease the current orders work. Thanks to that effort HL7 is now talking the talk; CHCF orders will give HL7 be a chance to walk to walk of valuing tested standards  and working with outside consensus groups.

(Updated 12/8 to correct link.)

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Category: healthcare-providers  interoperability  

Tags: ehr  elincs  health-internet  healthcare-interoperability  healthcare-providers  hie  hl7  

Wes Rishel
VP Distinguished Analyst
12 years at Gartner
45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

Thoughts on ELINCS: Doing Lab Orders Standards Right

  1. Hans Buitendijk says:


    There certainly have been challenges in the past reconciling the different points of view. As the community, involving HL7, CHCF, Laboratories, and EHR vendors, is pulling together to settle on an implementation guide that resolves the varied and at times inconsistent views between the initial “HITSP”, “ELINCs”, and “Public Heatlh” guides for Lab Results (even though all deal at the core with the same lab results), I am optimistic that the lessons learned from that will make the adoption of a single Ambulatory Lab Orders IG much smoother while achieving consistency with the Results IG.

  2. Wes,

    Great post. The implementation guide is a step in the right direction for IDNs, EHR vendors, and HIEs that are ready to start working on future lab order interfaces. You identified the fundamental issues with ambulatory lab orders: patient identity, order-specimen workflow, and unsynchronized order catalogs. These are thorny problems – and they’ve arisen because as an industry, we’ve interpreted the HL7 standard (and related lab content) so loosely. Reducing optionality per Doug Fridsma would help. Do you anticipate that unexpected gaps between the HL7 specification in the final lab orders standard and the EHR/lab system installed base will remain? We’re thinking that the ability to simplify the closing of those gaps would be a important part of enabling lab interoperability. I’d appreciate your thoughts on this.

  3. Wes Rishel says:

    Sovita, the issue is whether optionality is being used to make a single implementation guide serve multiple use cases. That strategy, which was used on lab results, doesn’t work because there is no authoritative source on which options are actually “required” for which use case. There are several use cases for lab orders and I believe HL7 (particularly Ken McCaslin and Frieda Hall) has developed a more appropriate approach now.

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