Toxicology and IT
Toxicology, or urine testing consumers seeking treatment for drug problems, is a top notch tool in substance abuse.
These days, alternatives like saliva testing are available, and to hear the manufacturer talk about it, the oral testing alternative is better. It's certainly less degrading to have a professional monitor an oral swab in the waiting room as opposed to monitoring the drop of a urine sample. As long as the results are accurate enough to be used in measuring outcomes of treatment, who cares which is used?
But what's that have to do with the Electronic Health Record (EHR), you may ask. The volume of toxicology testing results that are passed along to addictions treatment facilities in the course of a normal week can be tremendous. A few hundred consumers, all providing proof of using (or not using) substances on a regular basis multiplies the results data to an unmanageable amount of paperwork pretty quickly. Paying somebody to do that data entry is a really boring job and an unnecessary expense and it might be better to find something of more value for the person to do in the facility. The risk of inaccurate results being recorded manually in the EHR is a lot higher with manual entry than a direct feed of results from the testing machine to an electronic file. And that file can be directly passed to the consumer's electronic record.
Whether a test is oral or urine, it has to be sent to the lab for testing...it's not like the oral swab has a litmus paper test & turns different colors for different drugs. Actual test results that are passed from the testing machine can indicate not only the presence of a substance, but can actually tell how much is in the system, a level of intoxication, if you will.
Difficulty can arise when the data file of results has to be electronically transferred from the lab to the EHR. The standard tool to do this is the Health Level 7 (HL-7) a sort of traffic cop-software that sits between the lab and the EHR, telling the data where to go and what shape it needs to be in to arrive safely and securely. The HL7 can send data in either direction, so if the lab's software needs the patient ID number or any demographic or specific test information it can travel from the EHR to the lab, and results can flow back. The HL7 is a nifty tool, because this can be either a live connection or a "batch file" that's downloaded from a secure site with a secure connection...that security stuff assures no superstar in addiction treatment will see her toxicology results posted on Facebook.
OK, now that you know how wonderful the tool is, what's the downside: When I was in the business of providing HL7 software for folks, it was easy to see a project costing $30,000. That means that sometime in about year three of using the tool in a typically sized addictions treatment facility you'd expect to outweigh the cost with the benefit of freeing up that data entry person I talked about earlier…unless he's doing something that's more valuable instead and generating revenue.
Labs concentrating on toxicology faced this dilemma years ago, and made the decision to make the results available electronically. This was before the HL-7 was a complete standard, and still carried quite a price tag. Consequently, labs had to pay programmers to develop a proprietary program and provide a secure way for the customer to retrieve the results file. A number of treatment professionals use these labs, and the downloaded files have turned out to be a dual edged sword.
Two costs suddenly erupt on the EHR end of the equation: A program to integrate the results into the EHR and ongoing support.
A number of EHR vendors have elected to work with a lab or two to assure their proprietary data can be imported into the EHR and make it back to the correct patient record and test record. Some require payment for this work. In my experience the range of cost is $0 to $15,000 to get started, and from $0 to $2,250 a year to support the program and assure quick response if something doesn't go right with the data transfer.
It's important to a professional to confront a consumer quickly if substance use is suspected; the value of confronting a consumer about their use of substances diminishes as time passes. Without good support from both the lab and vendor, the advantage of an early confrontation can be lost.
In short, the lab and the professional both want accurate results quickly. This is where professionals like yours truly come into the picture. Selecting and implementing a system to deliver results quickly is half the job, the other half is monitoring the system to assure the promise is delivered and the best tracking of outcomes becomes available for analysis in the EHR.
If you're a professional working with an addictions treatment agency considering the purchase of an EHR, be sure to ask both the lab and the software vendor about the transfer of results data into the software. Success and tragic endings can depend upon the initial software purchase & support agreement.