Medlab Central laboratory eOrders system - Sysmex New Zealand

Medlab Central laboratory
eOrders system
Sysmex eHealth Solution Case Study, April 2012

Medlab Central laboratory eOrders system
Medlab Central
laboratory eOrders
system
Medlab Central Limited provides laboratory
services to community and hospital
healthcare providers across the central area
of the North Island of New Zealand. Medlab
Central implemented the Sysmex eOrders
system to streamline the request--> test-->
report cycle benefiting primary healthcare
providers, their patients and the laboratory.
Paving the way for eOrders for laboratory
tests, Medlab Central are the first laboratory
in New Zealand to achieve electronic
diagnostic test requesting.
GOAL
Medlab Central’s goal was to provide community
healthcare providers with a secure, seamless system
to electronically place orders for laboratory tests for
their patients. The system needed to integrate with
the community healthcare provider’s practice
management systems (PMS) and Medlab Central’s
laboratory system (Sysmex’s Delphic LIS). The
laboratory’s goals to achieve a fully electronic
paperless order entry, receipt and registration
process would enable a number of benefits for
Medlab Central while also benefiting the clinicians.
PROBLEM
Prior to implementing the solution, paper-based
ordering was used for all test requests. For GPs, the
tests were selected in the PMS and the form printed
and handed to the patient but no HL7 order message
was sent to the laboratory. When specimens arrived
at the laboratory, manual processing steps were
required for registration and data entry of all order
and test details.
The known problems with paper-based orders
include:
- Possible data entry error
- Illegible hand-written paper order forms
- No ability to follow-up on unfilled order/auditing
capabilities
- Duplication of data entry work and
administration processes at the laboratory end.
While Sysmex’s product Eclair included an eOrders
module it had not yet been integrated with the PMS.
Prior to the new solution, GP’s were able to log on
and access the system separate to their PMS to view
results and place orders but the need to access a
further application was yet another step and required
the GPs to re-enter the patient details already open
in their current session. This seemed like duplication
in work to the doctors using the system.
SOLUTION
The solution for Medlab Central consists of key
components of the Sysmex software products Delphic
LIS and Eclair:
1. An interface between the GP’s desktop practice
management system and the Eclair orders
module. This would be essential to the success
of the system.
2. Implementation of the Collection Room module
to easily and efficiently manage the specimen
collection process.
3. The implementation of HL7 Orders receipt in
Medlab Central’s laboratory system.
1. PMS interface
The new interface meant that GPs could seamlessly
and securely access Eclair Orders directly from their
patient management system using a simple, intuitive
workflow.
- Eclair is automatically launched from within the
PMS when the GP clicks the ‘order’ icon.
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Medlab Central laboratory eOrders system
- Eclair queries the PMS to extract information
about the GP’s logon account and the patient
details to use in context between applications
- Patient details are transferred from the PMS
and checked in Eclair
- The Eclair order form automatically opens for
entry of the required laboratory tests and Eclair
identifies current results for the patient and any
orders processing.
- The order is placed in Eclair and an HL7 message
is forwarded to the PMS outbox with all order
details.
Bruce Lockett, Managing Pathologist at Medlab
Central says "the development of the interface
between the two applications was a huge step
forward, and added momentum to the roll-out of
eOrders to our community requestors. With easy
access to the laboratory order form and the ability
to carry across the patient and doctor details from
the PMS to the Eclair orders module, online ordering
is seamless and accurate. This provides many
advantages to the user at the point of care as well as
the laboratory (Medlab Central) for processing order
requests."
2. Collection Room module
Once the order has been placed by the GP the
patient takes the order form to the collection room.
The order form contains all the collection details
including what specimens need to be collected and a
barcode with the order ID. Although the form is not
actually essential, as the order exists electronically, it
is a useful reminder for the patient and carries
relevant collection information such as fasting may
be required prior to specimen collection.
The orderer can modify the request at any stage up
to the time of collection. When the patient presents,
phlebotomy staff scan the order ID barcode into the
Eclair Collection Room module and verify that the
request is unchanged.
3. HL7 message sent to the laboratory
Once the specimens have been collected an HL7
order message is sent to Medlab Central’s lab system
for processing.
When the specimen is received in the laboratory it is
acknowledged in the Delphic LIS.
Status updates provide the healthcare providers with
visibility of the order and they are able to track
progress. The specimen testing is performed and the
patient’s results are reported back to Eclair from
Delphic.
RESULTS
The implementation of the eOrders system has
delivered a number of benefits.
Bruce Lockett, Managing Pathologist at Medlab
Central, describes the drivers and benefits of the
move to ‘close the orders loop’ by placing orders
online; the system has provided advantages at
multiple levels:
1. Ensuring orders are always made on the correct
patient removes problems with incomplete
information and incorrect interpretation by the
lab
2. Decision trees and information made available
to the orderer at the time of ordering reduces
utilization
3. As the registration step has already been
completed by the orderer, it removes this task
from the lab, saving on resources
4. Being able to access all results and outstanding
orders on a patient reduces unnecessary test
ordering
5. It is possible for the orderer to audit unfilled
orders, completing the order loop.
Electronic ordering of laboratory tests reduces
duplication of data entry work and simplifies
administration processes at the laboratory end. Order
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Medlab Central laboratory eOrders system
details are entered only once using standard
laboratory test codes, helping to ensure that the
correct tests are undertaken.
The new orders system is also able to indicate to the
healthcare provider when tests have previously been
ordered or already analysed, so it’s less likely that
patients are sent for a repeat test unnecessarily. Plus
it’s easier for providers to match orders and results,
enabling them to see if a patient has failed to have a
test done, and follow up if necessary.
Sysmex comments, ”the system is superior to other
eOrders or eLab systems due to the ability to view a
patients past results and any processing lab tests
across the Medlab Central region”. Comparative
products currently do not have this ability to access
the results repository for current data as they require
new interfaces to enable this. With Eclair it’s the
same system for results and orders. This is where the
value is added with the information that can be made
available at the point order. It enables the perfect
order, closing the request-test-report cycle.
Sysmex and Medlab Central are working with the
PMS providers to enable integration with other GP
desktop systems such as Houston. “Houston
integration is almost there and we look forward to
bringing these last few Houston GP sites on board
shortly.”
Regarding implementation in the hospitals for which
Medlab Central provides laboratory services, Bruce
Lockett comments, “Concurrently, we are still
assessing the implementation of electronic orders in
the hospital environment. This presents a whole set
of unique challenges and we will be feeling our way
with trial sites at various locations within the
hospitals we serve. The potential benefits for all
concerned are huge".
Further Information
www.sysmex.co.nz/Eclair
www.medlabcentral.co.nz
Contact Colin McKenzie
PROJECT ACHIEVEMENTS
In December 2011, paper requests from GPs using
the MedTech PMS in the Palmerston North
metropolitan area were ‘switched off’. This accounts
for 60% of the Medlab Central workload. Medlab
Central reported considerable workflow
improvements to the pre-analysis phase of the
laboratory. Orders are also available in the
Wairarapa DHB with plans to roll out to the
Whanganui and Tairawhiti DHBs.
FUTURE INITIATIVES
Looking ahead to 2012, Medlab Central plans to roll
out the eOrders system to all regions for which they
provide laboratory services. Bruce Lockett comments,
“We hope to have completed roll out in our last
remaining area, Tairawhiti, by the end of April 2012.
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