$5k Per EHR Lab Interface

A provider organization recently reached out to me to discuss the issues they were having trying to get their EHR vendor to do a lab interface with their lab. It was a pretty standard large EHR vendor document where they nickle and dime you for little things like a lab interface. Looking at it always reminds me of when I’ve seen the $5 aspirin charge in the hospital.

The problem with the lab interface charge is that it’s usually $5000 instead of $5. When an organization is choosing to implement an EHR, they often forget about many of the future hidden costs associated with an EHR vendor like the EHR lab interface. Plus, they also forget that the EHR vendor will often charge them $5k for the interface and then the lab will charge them another $5k for that interface. This is often true even when an EHR vendor has created many interfaces with a particular lab vendor before.

In fact, the organization that I mentioned above brought a new light to the cost of lab interface. It turns out that this organization was on its third lab and thus its third lab interface with their EHR. I don’t expect clinics change labs this often, but it is very common for a medical organization to switch from one lab to another. Plus, let’s not even get started on the challenge of getting a hospital lab to integrate with your EHR.

Not all EHR vendors are like those I mention above. In fact, a number of EHR vendors have seen this as a great way to differentiate their EHR from other competing EHR vendors. I know of at least one EHR vendor that’s done a few hundred lab interfaces (all at no cost to the doctor). The large number of labs partially illustrates the challenge associated with lab interfaces. There are just so many of them that need to be done. It’s not like there’s 1 or 2 labs that dominate the market. However, many EHR vendors are offering a free lab interface as part of the EHR purchase. Be sure to ask before you buy.

The sad part of the lab interface story is that because of the items mentioned above, many doctors just end up scrapping a lab interface. They can’t justify a $10k expense to integrate their EHR with the lab. This is unfortunate, because it’s amazing how much benefit can come from a well integrated EHR Lab interface.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

22 Comments

  • Don’t forget hidden _hardware_ requirements. Some docs may have old or incompatible hardware and may have to buy > $1k LIS interface machines. Many of which themselves have contracts.

  • In addition to the cost is getting the EHR Vendor committed to work on the interface project. I’ve heard/seen that the EHR will dictate the schedule, and everyone else has to work around them.

  • HI JOhn, have been busy, but one of the first things that I read is your post which I conveniently get at 5.00 AM. Wishing you and your guest staff a brillinat 2013.

    Everything that needs to be done carry a cost and the cost has to be recovered from one of the parties that benefit from the lab interface. We do not charge the Doc but the Vendors pay for this if its commercially feasible for them. There are, at least in 25% of the circumstances, especially with Pediatrics, the Vendor cannot make a commercial justification. We end up getting our preferred lab vendor to accomodate the ‘less commercially justifiable’ practice to be accomodated, since we help them acquire some commercially profitable clients as well. This is one way of not burdening the practice with the cost of Bi-directional Interface w/ Labs.

    Having said that, the benefits of having a Bi-di interface are well documented and the practices not only increase efficiencies with speeded up patient communication but also reducing cost immensely in terms of labor cost. In any busy Internal Med/ Fam Practice you will normally find a FTE printing the lab results, picking out the right chart, stapling it on the top of the cover, piling it up on Doc’s desk for his/her review; and after the Doc has reviewed, she/he takes it to the front desk to make the calls to patients; and when the patient comes back, the same folder is picked and given to the Doc after which its put in its place again for the n’th time. During this entire process the charts are misplaced at least thrice a day. Its a FTE and the cost can be as high as $24 to $36K. Can the Docs pay for this efficiency. I am sure, in a perfect world, it can happen.

    Other soft benefits including ability to review the lab results from the comfort of home and much more.

    On the EHR Vendor side, its not only the interface build/replicate but also the maintenance of the interface day after day where there are literally 100s of thousands of data going back and forth. Labs understand this and most of them do pay for the work involved related to Interface and also a monthly maintenance fee as well. $5K is almost the industry standard.

    Hope this information helps your readers.

  • Nick – there is no need for LIS interface at the practice end.

    Steve – we do literally 100s of interfaces every month; mostly its not the EHR vendor who is responsible for the delay. Its the labs who are inundated with interface requests from 100s of thousand of physicians at the same time. Currently with all the national labs its about 90 days lead time, although literally its a day’s work.

  • Maybe someone can explain to me what costs are involved for a lab that already has an interface to EHR X just to do that for another medical practice or hospital, same question on the EHR side. My guess is that most possible LAB EHR interfaces already exist, that all that is being done is to match up a given location of a lab to a given practice, which is something that the practice ought to be able to do from a pulldown in the EHR. As I understand it, some EHRs – such as PracticeFusion, have already integrated to many labs, and in the case of PF, the doctor just has to put in some identifying info to setup the connection.

    So again, it is hard for me to understand why it might cost a practice $5 or $10k for this.

  • Troy: I was talking mainly about ‘Structured Data’ and not PDF Docs such as what Practice Fusion does. PDF Docs can be input into the system without any additional costs. I believe Practice Fusion just does this w/ PDF format.

    The right and applicable way to deliver results and make it comparable over time, as well as use the data to directly work with the patient chart is to have the structured data come in through bi-di interface.

    What costs are involved; from the lab side and from the web based EHR Vendor side, irrespective of how many interface have been executed, the connection with the practice has to be established, credentials verified, data transfer initiated from both the ends, results verified, workflow (depending on the practice’s workflow) established and verified and finally trial run established for final QA. For a new interface it might take two weeks to build interface and to establish all credentials; in the instance where the interface is already built – for CLient Server EHR, it might take a week to establish secure connectivity to the place of origin and back, test the secure connectivity, etc.

    Hope this helps. There is also the continuous monitoring of the flow of this critical data; as all of you understand that this is critical data for patient care and does warrant 24×7 monitoring.

  • Maybe I’m a bit naive, but using PF as the example, once PF has a lab interfaced, any doctor using PF can set themselves up in minutes to send orders to and get results back from that lab. And PF does not charge anything for doing that. And they don’t have to set up anything special for the practice, nor do they have to ‘monitor’ the data going back and forth on some sort of 24 by 7 basis. And it apparently only takes minutes for the practice to setup the connection.

    I can understand why it would be harder with something other then cloud; one of the reasons that I prefer cloud is that normally all clients of a cloud based system are kept up to date by the vendor. I’ve gone that route in other IT areas where a cloud vendor has a system that software wise and capability wise is identical from user to user excepting what ‘optional’ extras one gets. To me that works far better then having and maintaining your own. And even if you do maintain your own, if well designed updates to add new labs should be independent of your variation on the software.

  • PF does it with PDF and its like faxing a sheet of paper; and that’s a easy thing and does not need much expertise at all; I agree with you.

    The complexity is only with structured data and that’s the way to do it and that’s the requirement of the CMS and all payers as well.

    So far the lab interface standardization (not the way PF does) is half way there; ONC is working on the initiative and they plan to release it for 2014. Till then, to securely send and receive structured data from/to EMR/Labs certain tasks need to be completed and those can be done only by professionals with industry experience.

    Faxing like PF does can be done by individuals themselves and I agree with you on that. Even in that case, a new lab has to still be integrated with PF by PF and till then you may not be able to add a new local lab to your platform.

    Yes; cloud based EHR makes it that much more easier for the Practices to manage their tasks efficiently without having to get invloved with the issues related to Client/Server platform.

  • As I understand it, some labs deliver lab data via PDFs to PracticeFusion but that others return structured data that can be properly integrated into the PF’s lab area.

  • Good job Anthony. It’s great to hear from someone who can explain all the complexities (and benefits) of having a bi-directional lab interface.
    Another overlooked benefit of now having the data structured; most EHR vendors can now automatically populate the data into flow sheets. This is a big deal for internal med/primary care docs. He/she can now quickly see improvements/declines and graph results over time. How much is that worth? That is an intangible that you cant really put a dollar value on.

    To further the point about reducing costs and improving workflow: A 18 provider internal med practice I’m familiar with eliminated 4 fax machines, 2 full time and one part-time employee when they brought the interface up with their local hospital. Is that worth 10K? I would say yes with an annual savings of 80K!

    And finally, let’s not forget who is receiving the stimulus incentives. It certainly isn’t the EHR companies. I’m also familiar with an 11 provider group that received over $210,000 in Medicaid incentives in 2011 and are due that same amount for 2012. That’s over $400K! AND, the hospital they are affiliated with paid 100% of the interface cost. I have no doubt there are instances of “double dipping” by EHR and/or lab companies, but I believe in most cases, the practice will benefit and get an excellent ROI in the long run.

  • I thought HIE can take the place of all these bidirectional point to point interfaces?

    Does a HIE ‘connection’ not allow for structured data receiving/order sending??

    Here in Hawaii the main commercial labs are part of the state sponsored HIE and I just assumed that full structured data was part of the service.

  • Being able to chart lab results PLUS charting them against medication dosages and timings is extremely important in some situations. This is especially true in under documented illnesses where this little information on their treatments over time. I once used Excel to chart 2 years of treatments and tests for a certain illness and found patterns that the very capable physician had missed – and I’m not a doctor. But all he had to work with was his paper records.

    So an EHR that makes this easier does get a vote from me!

  • I keep forgetting that the comment email notification isn’t working right on this website. Great discussion. Thanks Anthony for commenting and glad you enjoy the 5 AM emails. I try to get it out there so people can start their day with that email.

    Charles,
    I don’t think that HIEs will work to replace most lab interfaces. HIEs will likely get the lab results, but when you’re doing orders and want to get specific results back for that orders, you’ll want a lab interface. I don’t think an HIE will support that.

    Someone else in another social media channel also reminded me that many lab interfaces also have a monthly maintenance cost.

  • I have *never* seen a reference lab (LabCorp, Quest Diagnostics, etc.) charge a customer to setup an interface. In fact, they usually pay any vendor implementation fees on the customer’s behalf. Reference labs want the business, so they make it easy as possible for the EMR user to connect. If you have a reference lab that refuses to cover the $5k fee to implement an interface with your EMR (much less one that is trying to charge YOU), look for another lab.

    If a practice has its own lab and LIS system (Merge, Orchard Harvest, LabDAQ, etc.), then yes, the practice will be responsible for the labor to install and test interfaces between the two systems. After all, the practice is benefiting financially from its own lab orders.

    However, even though you talk about cost, you fail to address the value of the interface. How much labor does it save a practice to not have employees typing lab orders into the LIS?…or to not have someone typing discrete lab data into the EMR? How much time does it save a provider to have those discrete results flow directly into the patient’s chart – and to not have to open some scanned document to get lab values from the patient’s last visit?

    No lab manager would ever question the value of having all the analyzers communicate with the LIS. Why is it so hard to see the value of completing the loop all the way to and from the ordering provider?

  • Thanks Mike; I am glad you pointed out the value of Lab Interface. John, you are right. For something like Lab Results which are important and data density is high, its preferable to do the direct interface and HIE is not the way to go.

    ONC is working on standardization; but I believe its something to look forward to in 2014.

  • Let me describe my experience with this. My practice in NorCal has been trying to connect ECW to all my labs for over a year since we installed ECW. Then we gave up and just tried to connect at least one lab, to no avail. The real costs were quoted more than $10k per lab and my volume of labs is relatively high. Being a primary care practice, its really vital to me to get real life feeds and I don’t use just one lab. My office uses more than 20 blood, radiology, pathology, and more specialized services like Aviir, Pathology Inc. and Counsyl, besides Radnet, Breast Imaging, Quest, LabCorp, Hunter. The list goes on and on. I switched to Informedika and overnight – I got all my labs in one place. I even get the XRays, US, CT and MRI imaging. Then I started getting all my nursing home’s labs, SNFs and assisted living facilities where some of my patients get care. I get El Camino and Stanford hospitals records that used to be faxed to me through Informedika now. I get all specialists consults and referrals documents and records released through Informedika. The best news is that all these records matched by Informedika into my patients’ charts and classified by type. My staff now focuses on providing care instead of scanning, sorting and filing faxes. I get critical lab alerts and I can see my ENTIRE patient external documents on my phone on Informedika portal. I still rely on Eclinical Works for my internal progress notes and my office uses Informedika for all external medical records and communications to create a complete patient chart. In my view, it would have been impossible to connect ECW to all these sources, let alone do it overnight. Even if I connected a single lab to ECW – there is no place to capture all this data coming from Informedika in ECW, it does not have the screens to display anything like that. So my staff simply links my ECW charts to Informedika charts through these “hot links”, as Informedika calls them. Instead of using ECW and 25 different portal logins and hundreds of faxes daily I now use ECW and Informedika together. We place all our diagnostic orders through Informedika with a single click. This alone saves my office many hours daily and I can track all open orders. By the way, Informedika started generating claims for me for the work we do anyways: care plan oversight reviews, lab reviews, etc. so Medicare and some insurances now reimburse my office for taking care of my patients after hospital discharge, work I always did but didn’t bill for before. Best of all, the quality of care has been greatly improved and Informedika costs me nothing. All of my colleagues are using Informedika; I highly recommend this as an instant solution. Hope this helps this discussion.

  • elitemedicalcenter, does all the demographic data and insurance info flow from ECW to Informedika when ordering labs? I’m assuming you have an interface with ECW and Informedika, yes?

  • ECW is one of the most expensive interfaces out there when it comes to interfacing with your lab. Mapping, pulling over demographics, man hours on both sides, conf calls, kick off calls are all part of the process with the lab which is why they charge the lab or the physician. Working at a national lab I find it very difficult to work with some vendors. As far as the charge usually the lab will cover the cost but that’s only if the lab is getting your ffs/ppo business not just hmo managed care work. PF does a great job and its meeting meaningful use criteria. its a free interface for both the lab and the PF and implementation for the interface is as asy and 123. Our lab can turn on the results interface in 2 days. Win Win for both sides. Before you spend thousands on an EMR first ask yourself what are you using it for? What is your 5 year plan? Maybe take it slow and go with PF free solution.

  • I can pull the data from informedika into ECW, but actually didn’t want the data inside the ECW. My reasons are obvious: ECW lab screens are horrible for one; secondly, ECW cannot display most data that I get from Informedika: ALL labs, radiology imaging, nursing homes, refills, discharge summaries, hospital face sheets, consultations, care plan oversights, etc etc. I cant imagine where ECW would put this data?? Besides the fact that ECW is periodically down and slow. I used to have ECW and over 25 different portals (Quest, LabCorp, Hunter, RadNet, Counsyl, several nursing homes and three hospitals, etc) I had to login to read my patients data. Now I have ECW where I keep all my internal progress notes and informedika portal where I get all my external data. Most of my patients are already in informedika since the data is coming from labs – I don’t have to create their records again. I can place orders in Informedika using real lab menus, while ECW has one compendium for all labs, which causes many phone calls with my staff and test rejections with labs. By the way – Informedika generates revenue for my practice by producing claims for my time already spent on care plan oversights and lab reviews for home health agencies patients. All documents automatically added to my charts and claims produced every 2 weeks.

    To MJ: before ECW was subsidized by the hospital, we used Practice Fusion. I still have the account there – and still waiting for my lab connectivity. I got one lab connected and it was all PDFs, and no ordering. I am an internist and geriatrician so I use 20+ facilities to order from daily. But you are missing the point, Informedika is EMR-independent and truly patient-centric data system. I am so tired of dealing with labs that want more volume of orders to go their way, EMRs that want to charge me, or empty promises for interfaces. Just read the PF forum on labs – I read it… And by the way – because I use informedika – I can actually switch between EMRs much easier now; I do like PF better so when I am ready to pull the plug on ECW (next time it goes down) – I can switch to PF and still have all my data in informedika intact. I use surescripts for e-prescribing and now I use informedika for e-requisitions, that’s a win-win for me and a solid 5 year plan. No EMR was able to do it for me, but I am less dependent on any EMR now. And did I mention informedika is free?

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