Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guidelines

Implementation of Laboratory Review of Test Builds Within the Electronic Health Record Reduces Errors

CONTEXT.—

As electronic health records (EHRs) become more ubiquitous, physicians have come to expect that laboratory data from a variety of sources will be incorporated into the EHR in a structured format. The Clinical Laboratory Improvement Amendments have standards for data transmission traditionally met by pathologist review of their own hospital laboratory information system transmissions. However, with third-party laboratory data now being sent through external (nonhospital laboratory) interfaces, ownership of this review is less clear. Lack of an expert laboratory review process prior to changes being implemented can result in mapping and interfacing errors that could lead to misinterpretation and diagnostic errors.

OBJECTIVE.—

To determine the impact of retrospective and prospective laboratorian-assisted review on the volume of interface errors and new builds.

DESIGN.—

A seminal event led to a restructuring of the process for review of EHR laboratory builds, using laboratory expertise.

RESULTS.—

A review of 26 500 test result fields found 61 of 4282 (1.4%) unique codes that could have led to misinterpretation. These were corrected and a process for proactive review and maintenance by laboratory experts was implemented. This resulted in monthly decreases in outbound error message from 4270 to 1820 (57.4%), in new test builds from 586 to 274 (53.2%), and in new result builds from 1116 to 552 (50.5%).

CONCLUSIONS.—

Regular review and maintenance of external laboratory test builds in EHRs by a laboratory review team reduces interface error messages and reduces the number of new builds required for results to file into the EHR.