Few problems frustrate a nursing team faster than a lab result that should be in the record and is not. A physician is waiting on a value, a nurse is calling the lab for a faxed copy, and someone is typing results by hand into the chart. Duplicate results cause the opposite headache: two entries, two sets of alerts and confusion about which one is correct.
Most lab interface problems fall into a small number of categories. Knowing them helps administrators and DONs ask the right questions, and speeds up the call to the lab, the EHR vendor or your IT partner.
In general terms, an electronic interface passes orders from the facility's EHR to the lab and passes results back. For this to work, both sides must agree on who the resident is, which order the result belongs to and where the result should land. Any mismatch in these details can cause a result to be rejected, misfiled or held in a queue.
The exact tools and screens differ by system, so check with your EHR vendor on specifics. The principles below apply in general.
If a resident's name, date of birth or identifier differs between the order and the result, the system may not match them. Typical triggers are a name change, a misspelling, a nickname, or a new admission whose registration was not completed before the specimen was drawn.
A lab drawn from a handwritten or phoned-in order may not have a matching electronic order. The result then arrives with nothing to attach to, and sits unmatched.
A result can stall if the ordering provider is not set up correctly, or if the physician who ordered it is not linked to the resident in the system.
Sometimes the problem is technical. A network change, expired certificate, changed credential or lab-side maintenance can interrupt the connection. In that case, many results are missing at once rather than a single one.
A new test, a revised test code or an unusual result format can fail to map. The result arrives but is rejected or placed in a queue for review.
Manual entry plus electronic delivery. A nurse enters a result from a faxed report while the electronic version arrives later.
Resent messages. After an interface problem is fixed, the lab or vendor may resend results that were already received.
Corrected reports. A revised result may be delivered as a new item rather than replacing the original, depending on how it is configured.
Duplicate orders. The same test is ordered twice, once electronically and once by phone.
Single or many? One missing result points to identification or order matching. Many point to the connection.
Check the resident record. Confirm name, date of birth and identifiers match the lab's paperwork.
Check for an unmatched or pending queue. Many systems hold results that could not be filed. Follow your facility's procedure for reviewing them.
Confirm the order exists. Was it entered electronically, and is the ordering provider correct?
Call the lab. Ask whether the result was sent, when, and whether anything was returned as an error.
Note times. Record when the specimen was collected, when it was reported and when it was expected.
Check recent changes. New network equipment, password changes or a software update shortly before the problem began may be the clue.
Complete registration and identifiers before the first draw.
Agree with the lab on one standard process for stat and phoned-in orders, and how those results will be entered.
Decide who owns reviewing unmatched results each day, and set an expectation for how quickly it happens.
Train staff not to enter a result manually without first checking whether the electronic version is pending. If manual entry is unavoidable, label it clearly.
Keep a downtime procedure, so clinicians still get critical values by phone or fax when the interface is down.
Keep a short log of missing and duplicate results: date, resident, test, cause and fix. After a month, patterns tend to appear, such as one lab, one shift or one type of order, and those patterns point to the real fix.
UnityCare IT works with long-term care providers, their labs and EHR vendors to troubleshoot interface connections and tighten the processes around them. When results go missing, we can help determine whether the cause is technical, procedural or both.
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Call or text: 405-285-3845
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