Independent Laboratories

OMB No. 0955-0014
Exp. Date 12/31/2015

VERSION B (NON-HOSPITALS:
REGIONAL & INDEPENDENT)

2012 National Survey
on Health Information Exchange
in Clinical Laboratories
If you have questions, please call 1-800-975-2754

Please answer questions in this survey about:

Your Privacy is Protected. All information that would let someone identify you will be kept private. NORC at the
University of Chicago will not share your personal information with anyone without your OK. Your responses to this
survey are also completely confidential. You may notice a number on the cover of the survey. This number is used
only to let us know if you returned your survey so we don’t have to send you reminders.
Your Participation is Voluntary. You may choose to answer this survey or not.
What To Do When You’re Done. Once you complete the survey, place it in the envelope that was provided, seal the
envelope, and return the envelope to:
National Survey on Health Information Exchange in Clinical Laboratories
NORC
1 N STATE ST, FL 16
CHICAGO, IL 60602-9925
If you want to know more about this study, please call toll-free at 1-800-975-2754 or email LabSurvey@norc.org.

Statement of Burden
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is (0955-0014). The time required to complete this information collection is estimated to average 20 minutes per
response, including the time to review instructions, search existing data sources, and gather the data needed, and complete and review the information collection. In you
have comments concerning the accuracy of this time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services,
OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

DEFINITIONS (Ordered Alphabetically)
Electronic Health Record
(EHR)

An electronic record of health-related information on an individual that conforms to nationally
recognized interoperability standards and that can be created, managed, and consulted by
authorized clinicians and staff across more than one health care organization.

Electronically

Any computerized exchange typically transmitted over the internet or through a network, using
health information technologies such as Electronic Health Records (EHRs) and direct access via a
lab portal. Please do not include fax machines.

Health Information
Exchange

The electronic movement of health-related information among organizations according to
nationally recognized standards.

Health Information
Organization

An organization that oversees and governs the exchange of health-related information among
organizations according to nationally recognized standards.

HL7
(Health Level 7)

A messaging standard that can be used to send laboratory results from a laboratory to an
Electronic Health Record (EHR). Health Level Seven International (HL7) is the global authority on
standards for interoperability of health information technology with members in over 55 countries.

LIMS
(Laboratory Information
Management System)

A collection of computerized methods to acquire, analyze, store, and report laboratory data.

LIS
(Laboratory Information
System)

A computerized clinical laboratory information system (LIS) is a software system used in a clinical
laboratory to computerize laboratory business processes such as test processing, test scheduling,
specimen and sample tracking, inventory control, reporting, quality control and quality assurance
management, and statistical analysis and surveillance.

LOINC test names
(Logical Observation
Identifiers Names and
Codes)

Terminology used to provide consistent naming of datasets that includes standard codes for
laboratory test names; for example, “Test name: Salmonella Stool Culture LOINC Code: 20955-1”

Message standards

A set of rules that allow information to be shared and processed in a uniform and consistent
manner. Messaging standards are particularly important because they define how information
is packaged and communicated from one party to another. Such standards set the language,
structure and data types required for seamless integration from one system to another.

Ordering practitioners

A physician or, when appropriate, a non-physician practitioner who orders services for the patient.

Personal Health Record
(PHR)

An electronic record of health-related information on an individual that conforms to nationally
recognized interoperability standards and that can be drawn from multiple sources while being
managed, shared, and controlled by the individual.

Portal

Hosted and maintained by a provider or payer organization, without transferring access and
control and use of the information to the individual, are not considered PHRs based on this
definition.

Reference laboratories

Usually large, commercial laboratories with locations throughout the country that perform both
routine and specialized laboratory tests. Reference labs often have small, satellite labs serving
several communities that collect specimens to be sent to the larger “parent” laboratory for testing.

SNOMED CT organism
codes (Systematized
Nomenclature of
Medicine)

A standard terminology that includes standard codes for organisms and other results; for example,
“Test name: Salmonella Enteridis, SNOMED CT Code:7352500.”

Structured format

Documentation of discrete data using controlled vocabulary, creating fixed fields within a record or
file, or another method that provides clear structure to information (is not completely free text).

Tests

A clinical diagnostic laboratory service. Service and test are synonymous.

Test results

A laboratory test that is (1) ordered by a provider; (2) performed on received specimens; and
(3) finalized and results have been produced. The laboratory has incorporated and calculated
reference data to produce the results referenced.
2

Q4. What is your job title?

Section 1. General Information

1
2

We would like to begin by asking you a few background
questions about you and your laboratory.

3

This survey is being sent to a random sample of clinical
laboratories. Some laboratories are owned by a company
that has multiple locations; others are a single entity and
have only one location.

5

For purposes of this survey, we would like you to only
respond for the location to which this survey was mailed.

8

4

6
7
9

Q5. How many full time equivalents (FTEs) currently

Q1. Does your laboratory have multiple locations or
only a single location?
1
2

Multiple locations
Only a single location (this one)

work only in the laboratory? This would not
include administrative and information technology
staff who are shared with other parts of the
laboratory system.

(Go to Q2)

1

If multiple locations:

2

Q1a. Are the other locations in this state only or in
more than one state?
1
2

3
4

This state only
More than one state

5
6

Q2. Which option below best describes your
laboratory’s organizational affiliation or
ownership? Please select all that apply.
1
2
3
4
5
6

2
3

Fewer than 15
15 to 30
31 to 45
46 to 60
61 or more (if selected, please provide number)
Don’t know
7

Number of full time equivalents

Affiliated with a University/Academic Center
Clinic or Group Practice
Health System
Commercial laboratory
Other (please specify) ______________________
Don’t know

Q6. Which option below best describes the type of
testing your laboratory performs?
1
2
3

Anatomic pathology testing
Clinical pathology testing
Both

(Go to Q8)

Q7. Does your laboratory perform any of the following
types of clinical pathology testing?

Q3. Is your laboratory a reference laboratory?
1

Laboratory Director
Laboratory Manager
Laboratory Information System Director
Medical Laboratory Technician or Clinical
Laboratory Technician
Medical Technologist or Clinical Laboratory
Scientist
Staff Pathologist
Chief Information Officer
Other (please specify) ______________________
Don’t know

Yes
No
Don’t Know

Don’t
know

Yes

No

a. Routine chemistry...............

1

2

3

b. Clinical Microbiology (e.g.,
Virology, immunology)........

1

2

3

c. Hematology........................

1

2

3

d. Genetics.............................

1

2

3

1

2

3

e. Other (please specify)
________________________
________________________

3

Section 2. Current Systems and
Technical Architecture

Section 3. Methods Used to Send Test
(Lab) Results and Volume of Exchange
to Ordering Practioners

We would like to ask you about your laboratory’s
current practices on software-based information
management systems. In particular, we are interested
in learning about your use of Laboratory Information
Systems (LIS) or Laboratory Information Management
Systems (LIMS). To facilitate completion of the
following sections, we suggest working with your LIS
manager.

PLEASE REMEMBER TO ONLY RESPOND FOR THE
LOCATION TO WHICH THIS SURVEY WAS MAILED.
Q12. We would like to ask you some questions about
test results volume for the calendar year 2012. If
you cannot report for the calendar year, please
identify the period of time used to report the
following test volumes and electronic exchange.

Q8. Does your laboratory currently use a Laboratory
Information System (LIS/LIMS)?
1
2
3

1
2

Yes
No
(Go to Q12)
Don’t Know
(Go to Q12)

Month

2
3

Multiple laboratories
Only one laboratory
Don’t Know

Please select all that apply.
2
3
4
5

Commercial system managed by the laboratory
Commercial system managed by a third-party
vendor
Local or internally developed
(Go to Q12)
Other (please specify)______________________
(Go to Q12)
Don’t know
(Go to Q12)

2
3
4
5
6
7
8
9
10
11
12
13
14

Month

To
Day

Year
2 0 1

1

Number of total test results

2

(Go to Q14)

From Records
Estimates
Don’t Know
(Go to Q13a)

Q13a. Please select the range that includes the
number of total test results.

Q11. Which vendor(s) supplies your Laboratory
Information System(s) (LIS/LIMS)?
Please select all that apply.
1

Year

Q13. Approximately, how many total test results did
your laboratory send to ordering practitioners
during 2012? By test results we mean a laboratory
test that is (1) ordered by an authorized healthcare
provider; (2) performed on received specimens;
and (3) finalized and results have been produced.
e.g., a Complete Blood Count (CBC), not its
component parts, should be counted as a single
test result. Please consult your records to answer this
question. If records are not available, please provide
your best estimate.

Q10. W
 hat type of Laboratory Information Systems
(LIS/LIMS) does your laboratory currently use?
1

From
Day

2 0 1

Q9. Does your Laboratory Information System (LIS/
LIMS) support multiple laboratories in the
laboratory system or only your laboratory?
By multiple laboratories we mean either a
laboratory with multiple physical sites or multiple
laboratories located within a single system.
1

2012 calendar year
Other than calendar year. Please enter the periods
this report will cover.

1
2

Cerner
CPSI
EPIC
Healthland
HMS
McKesson
Meditech
Middleware Vendor (e.g., Merge)
Orchard
SCC Soft
Siemens
Sunquest
Other (please specify)______________________
Don’t Know

3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

4

0
1 to 9,999
10,000 to 19,999
20,000 to 29,999
30,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 69,999
70,000 to 79,999
80,000 to 89,999
90,000 to 99,999
100,000 to 249,999
250,000 to 999,999
1 million to 1.99 million
2.0 million to 2.99 million
3.0 million to 4.99 million
5.0+ million

Q17. Did your laboratory send test results
electronically in a structured format during
2012 to an ordering practitioner’s Electronic
Health Record (EHR)?

Q14. Did your laboratory send test results to ordering
practitioners during 2012 using any of the
following methods? Please answer a-d.
Yes

No

Don’t
know

1
2

a. Mail and/or Fax...................

1

2

3

b. Electronic non-discrete data
(free-text format) including
email communications,
scanned faxes or
documents, text files, and
PDF files.............................

1

2

3

c. Electronic discrete data (no
free-text format) including
excel files, and LIS output
reports................................

1

2

3

d. Electronic mixed format
(free-text and non-free text
format), e.g., delivery of
pathology or microbiology
results.................................

3

Q18. Approximately, how many test results did your
laboratory send electronically in a structured
format during 2012 to ordering practitioners using
Electronic Health Records (EHRs)? Please consult
your records to answer this question. If records are
not available, please provide your best estimate.
1

Number of test results

2
1

2

3

Yes

No

a. Web portal provided by your
laboratory ..........................

1

2

3

b. Web portal provided by a
third party...........................

1

2

3

1
2
3
4
5
6
7
8
9
10
11

1

2

12

3

13

d. Interface to Health
Information Exchange
(HIE)/Health Information
Organization (HIO).............

1

2

3

e. Interface to Electronic
Health Records (EHRs)......

1

2

3

14
15
16
17

Q16. Is your laboratory currently capable of sending

test results electronically in a structured format
(that is, using the HL7 messaging standard and
a vocabulary standard such as LOINC) to an
ordering practitioner’s Electronic Health Record
(EHR)?
2
3

Don’t Know

(Go to Q18a)

Q18a. Please select the range that includes the
number of total test results.

Don’t
know

1

(Go to Q19)

From Records
Estimates

Q15. H
 ow did your laboratory share test results
electronically with ordering practitioners? Please
consider only results transmitted in 2012 for the
following methods. Please answer a-e.

c. Third party middleware
vendor.................................

Yes
(Go to Q18)
No
(Go to Q19)
Don’t Know
(Go to Q19)

Yes
No
(Go to Q19)
Don’t Know
(Go to Q19)

5

0
1 to 9,999
10,000 to 19,999
20,000 to 29,999
30,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 69,999
70,000 to 79,999
80,000 to 89,999
90,000 to 99,999
100,000 to 249,999
250,000 to 999,999
1 million to 1.99 million
2.0 million to 2.99 million
3.0 million to 4.99 million
5.0+ million

Section 4. Lab Exchange Standards

Section 5. Barriers to Exchange

In the following section, we will refer to “HL7.” HL7
(Health Level 7) is a messaging standard that can
be used to send laboratory results from a laboratory
to an Electronic Health Record (EHR). To facilitate
completion of the following sections, we suggest
working with your IT staff or your LIS manager.

We would like to learn about barriers to laboratory
information exchange.

Q21. Which one of the following issues concerning

electronic delivery of laboratory test results in a
structured format is the primary challenge your
laboratory is currently facing? Please select one
box.

Q19. W
 hich of the following messaging standards

are currently in use by your laboratory for result
reporting? Please select all that apply.
1
2
3
4
5
6
7

1

HL7 2.3.1
HL7 2.5.1
Other HL7 version (please specify)
______________________
Proprietary
Other (please specify)______________________
None
Don’t know

2
3
4

5

Q20. W
 hich vocabulary standard for laboratory result

reporting is currently in use by your laboratory?
Please select all that apply.
1
2
3
4
5
6
7

6

LOINC (Logical Observation Identifiers Names
and Codes)
SNOMED CT (Systematized Nomenclature of
Medicine)
Both of the above
Local Codes
Other (please specify)______________________
None
Don’t know

7
8
9

EHR systems are unable to receive structured
results
Insufficient information on exchange options
available
Lack of harmonization of industry accepted
standards
Inability of Laboratory Information System
(LIS) to generate/receive electronic messages/
transactions in structured and standardized format
Subscription rates/fees for exchange service
providers (including lab hub, third party
middleware vendor, and Health Information
Exchange providers) are too high
Compliance with Clinical Lab Improvement
Amendments (CLIA) regulations
Other (please specify)______________________
No challenges experienced in delivering structured
laboratory results
Don’t know

Q22. W
 hich one of the following issues concerning

laboratory interfaces for electronic delivery of
test results in a structured format to ordering
practitioners is the primary challenge your
laboratory is currently facing? Please select one
box.   
1
2
3
4
5
6
7

8

6

The time required to build interfaces
The costs associated with building interfaces
Lack of harmonization of industry accepted
standards
Lack of specific implementation guides
Lack of trained staff (human capital) needed to
implement the interfaces
Other (please specify)______________________
No challenges experienced in developing
laboratory interfaces for delivery of laboratory
results
Don’t know

Q23. Which of the following issues concerning
adoption of LOINC codes for sending results best
describes the current situation in your laboratory?
Please select all that apply.
1
2
3
4
5

6
7
8
9
10

Q25. Does your laboratory allow patients or their legal
representatives direct access to their laboratory
results?
2
3
4

Q25a. If YES, please indicate which of the
following methods of delivery your
laboratory uses to deliver results directly to
patients or patients’ legal representatives.

Section 6. Implementation of
Guidelines and Regulations
In the following question, we will refer to the “LRI
guide.” The “LRI guide” is the implementation guide
developed by the Office of the National Coordinator’s
(ONC) Standards and Interoperability Framework
Laboratory Results Interface (LRI) Initiative. It is an
implementation guide for electronic submission of
laboratory results to ambulatory EHRs. LRI is required
for Meaningful Use Stage 2. For more information
about the S&I Framework initiatives, including the LRI
initiative, visit http://wiki.siframework. org/Lab+Results
+Interface+(LRI)+Initiative

2
3

Don’t
know

Yes

No

a. Mail and/or Fax...................

1

2

3

b. Web portal solution
provided by laboratory........

1

2

3

c. Transmission of results to a
designated Personal Health
Record (PHR).....................

1

2

3

d. Through a community
Health Information
Organization that
provides patient access to
information .........................

1

2

3

e. Through a physician’s
EHR that provides patients
access ...............................

1

2

3

Q26. Please enter your laboratory’s Medicare Provider
Number below.
1

Q27. Please provide a contact email address and phone
number for the person who completed this survey.

Q24. Has your laboratory implemented the LRI guide
for laboratory result content and format?
1

No
(Go to Q26)
It is not legal in my state to send lab results
directly to patients (Go to Q26)
Yes
(Go to Q25a)
Don’t Know

1

Our laboratory information system (LIS) is not able
to store LOINC codes
Our laboratory does not have LOINC codes/
mapping for some of our tests
Our laboratory does not have LOINC codes/
mapping for all our tests
Our laboratory has insufficient resources to
maintain LOINC mappings over time
Our laboratory information system (LIS) is not
able to send LOINC codes, as it does not have an
interface to send laboratory reports with LOINC
codes
LOINC is not robust enough to support local code
EHRs do not have the ability to accept LOINC
codes
Other (please specify)______________________
No issues experienced in using LOINC codes to
send laboratory reports
Don’t know

EMAIL ADDRESS 1 ____________________________
EMAIL ADDRESS 2 ____________________________

Yes
No
Don’t know

PHONE NUMBER 1 ____________________________
PHONE NUMBER 2 ____________________________

Please check this box if more than one
person helped complete this questionnaire.

7

End of Questionnaire

Thank you.
Please return the completed questionnaire in the enclosed postage-paid envelope to:
National Survey on Health Information Exchange in Clinical Laboratories
NORC
1 N STATE ST, FL 16
Chicago, IL 60602-9925
If you prefer, you may:
Fax your completed questionnaire to: 877-504-6296 or e-mail it to LabSurvey@norc.org.
Please make sure to include the survey cover page in your fax or email.
If you want to know more about this study, please call toll-free at 1-800-975-2754
or email LabSurvey@norc.org.

VERSION B (NON-HOSPITALS: REGIONAL & INDEPENDENT)

8