title: The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes.
abstract: BACKGROUND
  - A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS).
  
  
  OBJECTIVE
  - To determine the impact of an interfaced EHR-LIS on laboratory processes.
  
  
  METHODS
  - We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR.
  
  
  RESULTS
  - The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests.
  
  
  CONCLUSIONS
  - An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.
authors.forename: Athena K
authors.initials: AK
authors.lastname: Petrides
authors.forename: Ida
authors.initials: I
authors.lastname: Bixho
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Goonan
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Shimon
authors.initials: S
authors.lastname: Shaykevich
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Adam B
authors.initials: AB
authors.lastname: Landman
authors.forename: Milenko J
authors.initials: MJ
authors.lastname: Tanasijevic
authors.affiliation: From the Departments of Pathology (Drs Petrides, Tanasijevic, and Melanson and Mss Bixho and Goonan), Medicine (Ms Bixho, Drs Bates and Lipsitz, and Mr Shaykevich), and Emergency Medicine (Dr Landman), Brigham and Women's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts (Drs Petrides, Bates, Lipsitz, Landman, Tanasijevic, and Melanson and Mr Shaykevich). Dr Petrides and Ms Bixho contributed equally.
authors.forename: Stacy E F
authors.initials: SE
authors.lastname: Melanson
mesh_terms: D002984:Clinical Laboratory Information Systems; D057286:Electronic Health Records; D006751:Hospital Information Systems; D006801:Humans; D007755:Laboratories, Hospital