Analysis of laboratory data transmission between two healthcare institutions using a widely used point-to-point health information exchange platform: a case report

Abstract

Objective: The objective was to identify information loss that could affect clinical care in laboratory data transmission between 2 health care institutions via a Health Information Exchange platform.

Materials and methods: Data transmission results of 9 laboratory tests, including LOINC codes, were compared in the following: between sending and receiving electronic health record (EHR) systems, the individual Health Level Seven International (HL7) Version 2 messages across the instrument, laboratory information system, and sending EHR.

Results: Loss of information for similar tests indicated the following potential patient safety issues: (1) consistently missing specimen source; (2) lack of reporting of analytical technique or instrument platform; (3) inconsistent units and reference ranges; (4) discordant LOINC code use; and (5) increased complexity with multiple HL7 versions.

Discussion and conclusions: Using an HIE with standard messaging, SHIELD (Systemic Harmonization and Interoperability Enhancement for Laboratory Data) recommendations, and enhanced EHR functionality to support necessary data elements would yield consistent test identification and result value transmission.

Keywords: clinical laboratory information systems; data quality; health information exchange; health information interoperability; patient safety.

Figure 1.

Laboratory data exchange at 2 institutions. Nine laboratory tests were selected to be resulted for a simulated patient and are representative examples of high priority clinical laboratory tests. The test results were transferred to the other institution through a widely used point to point health information exchange platform. We compared the gaps and similarities in the laboratory test information displayed in the sending EHR system with the information displayed in the receiving EHR. Health Level Seven International (HL7) Version 2 messages between the EHR and LIS (Analysis 1) and analyzer messages between the LIS and IVD analyzers (Analysis 2) were obtained from UNMC for each of the 9 test orders and test results and examined for structure and content. Further details of the Analysis 1 and Analysis 2 of the HL7 messages are available in the supplemental materials.

Figure 2.

Comparison of electronic health record data at children’s health and University of Nebraska Medical Center.