Patient matching for orders from Physician EMR to Hospital

[Luke Anderson]

We are looking at a new project between a physician EMR and a hosptial HCS where the clinic wants to send orders to the hospital and I’m curious how other sites that have implemented this type of interface are managing the patient matching between the two systems.  Thanks.

Topic

[Jim Kosloskey]

Luke,

Is the Physician’s EMR a hospital provided application or was it independently purchased by the Physician?

email: jim.kosloskey@jim-kosloskey.com 29+ years Cloverleaf, 59 years IT - old fart.

[Luke Anderson]

Thanks for reviewing.  This would be a scenario where the physician EMR is a different vendor from the hospital HCS.  We would most likely have an ADT feed from the hospital to the physician EMR however.

[Chris Brossette]

Luke, The one thing you have to be concerned with is matching the result back to order in the EMR.  The sending system may have an order number but when you interface the order into the lab system, it might generate one of its own.  So the result would have a different number and not match back.  Also, you have to be concerned is how the billing for the tests are handled.  Will they be clinic-billed or will the hospital have to bill for them?  This brings another layer of complexity when you have a hospital account number and a EMR visit number on the same order….

Several questions to ask before you get too deep into the project…..

[Jim Kosloskey]

Luke,

As Chris indicated there are a lot of issues but the biggest is how are the various sytems going to resolve potentially different identifiers and track each other’s activity.

The HL/7 message set has provisions to assist if the vendors will utilize them. Don’t forget that there is some flexibility in agreeing to let necessary fields/segments repeat.

A EMPI could be of assistance to resolve Patient Identification issues but that is another project all its own.

email: jim.kosloskey@jim-kosloskey.com 29+ years Cloverleaf, 59 years IT - old fart.

[Robert Milfajt]

Here at Northwestern, the clinic uses Epic and the hospital uses Power Chart.  Since you are integrating two ordering systems, you will need to reconcile the order numbers.  What we do is send an ORM^O01 to the hospital HIS, they create their own registration and an ADT which goes to Epic and Power Chart, the HIS forwards the message to Power Chart CPOE, which creates the order and sends us back an ORM^O01 SN message, which we store their order number to ours.  Thus when results come in they match to our order using their order number and MRN.

Good luck….

Robert Milfajt
Northwestern Medicine
Chicago, IL

[Terry Kellum]

In my Lab system, we are reaching the point where we need to have an EMPI to handle all the identifiers.  Right now, I’m segregating patient identifiers by using letter prefixes to keep all of the patient personalities straight.

Using 2 letter prefixes, I’m looking at 26×26 “entities”, but that will eventually run out.  As we get more and more clinics directly attached to our system, it’s becoming more cumbersome to keep the numbers straight.

With the EMRs, I would consider the use case of connecting these to the lab system (and ancillary systems) directly.  These systems can usually carry a single external order number.  You can usually use clinic and doctor to sort out the routing.  If you actually run the orders THRU the HIS, I would check with the HIS vendor to see if they can carry the order number within a field associated with the order (perhaps a “Z” field?).  You could then concatenate these in the engine into the ancillary “external order number” field.  When the result comes back, you can deconstruct this to get it back into the HIS and EMR.  You might also think about the “visit number” field.  I have used this to carry identifiers thru an order, but since it’s a “stay level” identifier, you have to be careful about your use cases.

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