Analysis of laboratory data transmission between two healthcare institutions using a widely used point-to-point health information exchange platform: a case report

Objective The objective was to identify information loss that could affect clinical care in laboratory data transmission between 2 health care institutions via a Health Information Exchange platform.Materials and Methods Data transmission results of 9 laboratory tests, including LOINC codes, were compared in the following: between sending and receiving electronic health record (EHR) systems, the individual Health Level Seven International (HL7) Version 2 messages across the instrument, laboratory information system, and sending EHR.Results Loss of information for similar tests indicated the following potential patient safety issues: (1) consistently missing specimen source; (2) lack of reporting of analytical technique or instrument platform; (3) inconsistent units and reference ranges; (4) discordant LOINC code use; and (5) increased complexity with multiple HL7 versions.Discussion and Conclusions Using an HIE with standard messaging, SHIELD (Systemic Harmonization and Interoperability Enhancement for Laboratory Data) recommendations, and enhanced EHR functionality to support necessary data elements would yield consistent test identification and result value transmission. Healthcare systems can send and receive laboratory results for the same patients seen at different institutions through exchange platforms known as Health Information Exchanges. Laboratory results must contain certain information to help the provider interpret the results such as units of measurement, what kind of sample was tested, and whether the results fall within the expected range for healthy individuals. US law mandates the inclusion of other information with the test results (eg, the name of the patient and the name and address of the laboratory that performed the test). We used a fictitious patient to exchange test results between 2 academic healthcare centers to determine the accuracy and completeness of transferred information in terms of the elements required by law as well as the information needed to correctly interpret the results. In addition, different manufacturers' equipment performing the same test on the same sample can produce different results. We found that, despite being essential for correct interpretation, information on the equipment manufacturer that produced the results and the kind of sample that was tested are never included with the exchanged results.