"Meaningful use" of electronic health records and its relevance to laboratories and pathologists

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The focus of this paper is to highlight and assess the importance of the criteria and requirements in the pathology and laboratory setting and electronic interchange of information between the Laboratory Information System (LIS) and EHR systems, commonly known as LIS-EHR interchange. [1]


We know that in 2004, President Bush tasked our nation with a 10 year mandate to embrace electronic medical records and established and funded the Office of the National Coordinator ONC. This President has continued his support and commitment through the HITECH act, by establishing an EHR incentive program through which individual hospitals and physicians can receive incentive payments for achieving "meaningful use" of certified EHR technology. Of course, this comes with penalties for non-compliance as well.


Our Federal government continues to identify several goals for improving our nation’s health care system and one of the most important among them is to improve quality, safety, and efficiency of healthcare and reduce health disparities.

While there are several numbers floating around on the percent of compliance within the medical community against Meaningful Use, the most recent by the chief scientist of the ONC in an interview with Dr. Mark Braunstein of Georgia Institute of Technology in August 2014 indicates 65% to 70% compliance for Meaningful Use Stage-I (adoption) and much less for stages –II (exchange of data) and III (use of data for DSS). Our government continues to enact regulations to accelerate the implementation of EHR systems and this paper evaluates two areas – pathologists and laboratories and points out that the Core Measures required to become a Meaningful User of Certified EHR technology won’t apply to the practice of pathology since pathologists do not treat patients in an office setting typical of a health care provider and hence neither incentives nor penalties would apply to their services. We now turn our attention to the laboratories.


While there are Core and Menu Set objectives for meaningful use of EHRs for Eligible professionals and Hospitals, the one considered relevant to laboratories is Menu Set objectives. The certification criterion states that the EHRs must (i) electronically receive results; (ii) electronically display test report information; (iii) incorporate results in a structured format (note: the full definition of “structured format” and what it really means has not been provided clearly). It goes on to specify what the test report must include (e.g. patient identification, lab identification, date, test performed and a few other parameters.)

Just like ICD-9 or SNOMED-CT is a standard for clinical problem lists, HL7 is a standard for data exchange with public agencies, LOINC is considered the standard for specifying lab test results. It is also known that the LIS-EHR data exchange is not simply a plug and play and calls for substantial investment for seamless integration. Other operational implications for lab systems include (i) Change control, (ii) Ongoing Trouble shooting of interfaces among others.

It is to be noted however that the following needs careful consideration:

1. Data Normalization: Where the same abbreviated code (e.g. DNR) could mean different things based on context. In a hospital setting, it means "DO Not Resuscitate" whereas in the lab data it means, "Do Not Report".

2. Data Aggregation: Implementation of a Master Patient Index that uses sophisticated algorithms to determine and aggregate a patient's records from various heterogeneous sources in the absence of a common ID like SSN.

3. Master Data Management: Where both approaches (i) Centralized data management and (ii) Federated data management are considered viable options with their own pros and cons so an implementing environment could decide which is the right choice for them.


It is clear that the federal government is doing everything in its power to get various health care systems certified and working together and willing to commit funds and oversight and where necessary, impose penalties to make it happen.

It is clear that CPOE systems are here to stay, no matter how hotly it is debated that it hinders progress of clinicians by virtue of additional time spent or having to work in a very protocol and template based structured environment, thus impeding creativity, since the advantages mentioned above far outweigh their current limitations. Besides, it has been a National priority for two Presidents.

Opinion Summary

While it is encouraging to see the federal government issuing mandates to ensure EHR certification compliance and associating incentives and penalties to improve our nation’s health care as a whole, it is also expected that a 10 year mandate by the then President Bush (in 2004) has gotten us only so far and it is my observation and opinion that it’ll take another decade for all of the systems to work together seamlessly to deliver the expected results in this complex health care ecosystem.


  1. Henricks, W. (2011, February 11). "Meaningful use" of electronic health records and its relevance to laboratories and pathologists. Retrieved March 8, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049251/