LRI+-+Challenge+Statement

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3.0 Challenge Statement
There are at least two implementation guides for ambulatory laboratory reporting, neither of which are adopted universally across industry. There are many proprietary specifications for ambulatory lab reporting. Every vendor in this space has its own format for reporting results. Each lab has its own vocabulary for identifying tests, reporting test results and units of measure. The cost and time to initiate new electronic laboratory results interfaces hampers broad adoption of such interfaces but is only one of the obstacles to adoption. Customization of interfaces is common in the acute care hospital setting where the individual hospitals demand result formats customized to meet local requirements. The field-by-field details of HL7 v2 implementation guides used by clinical labs and EHRs vary, creating a need for mapping or configuration per interface, and the prevalence of core subsets of LOINC codes for common tests and analytes also varies, causing downstream issues in decision support and quality reporting.

Labs use result-reporting formats that conform to CLIA standards and in many cases once a lab finds a result format and content acceptable to their CLIA inspector, the labs are hesitant to change that format. Moving labs off these proprietary specifications will be the challenge. Meaningful Use doesn't directly address the reasons why labs use the formats they do today, and does not currently provide incentives to the labs to change current practices. Furthermore, the compelling ROI has yet to be discovered.

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