Online transmission of lab tests mostly a one-way trip

Physicians will access lab results online but have someone else send them, despite industry efforts to get them to do both.

By Tyler Chin, amednews staff. Jan. 17, 2000.

When it comes to the transmission of laboratory tests online, physicians believe it is better to receive than give.

So far, analysts said, physicians are far more interested in accessing results than ordering tests online, which they tend to delegate to staff. That comes despite Internet companies' desire to have physicians use all functions of their products.

For example, Mountain View, Calif.-based Axolotl Corp., said 2,500 physicians around the country use its Web-based clinical messaging system to access results, but only 100 physicians or their employees are transmitting orders over the Internet. The reason for the disparity is that the Internet ordering function was just recently introduced, said Stephen Sedlock, a vice president at Axolotl.

But analysts are skeptical that doctors will order tests over the Internet unless that function is designed to trigger itself automatically when physicians enter a diagnosis code into an electronic system.

If the automatic trigger isn't part of a larger system incorporating doctors' day-to-day workflow, physicians won't order tests themselves, said Raymond Falci, senior managing director at Bear Stearns & Co.

"The results have more impact for doctors in terms of letting them understand what they need to do to take care of the patient," Falci said. "The actual ordering of a test is fairly mundane and can be easily done by someone less skilled than a doctor, but that's not true for [test] results. The doctor is responsible for interpreting them."

Doctors still need Internet education

It's unknown how many physicians are ordering tests and getting results over the Internet, but the number "is probably no more than several thousand at most," Falci estimated.

Few physicians are using the Internet for ordering and retrieving laboratory tests and results because Internet-based products have been on the market only 12 to 24 months, and it's taking vendors "time to educate the medical community," Falci said.

Despite initial physician resistance, many companies are pushing physician order entry. In addition to Axolotl, companies selling Internet-based order entry products include Healtheon/WebMD, ProxyMed Inc., Pointshare Corp., CareInsite Inc., AHT Corp. and Abaton.com Inc., which was acquired by McKesson HBOC Inc.

These companies and more are selling or developing Internet-based order entry products or services because they believe doctors will use them to save time, money and deliver better patient care.

"With some lab results, you have to have people to process the paperwork, send it off in the mail and staff the phone," said Stephen DeNelsky, senior health care analyst at Credit Suisse First Boston. "If the patient calls asking, 'How did my test result go?' the doctor often doesn't know. He asks an assistant to call the lab and say, 'Hey, what's the result?' or find a hard copy of the report. The electronic version of this will eliminate much of this inefficiency."

The companies generally charge a flat monthly fee or a transaction fee.

Others are pushing the envelope

Most of the time physicians don't pay for services. Instead, laboratories, insurance companies, hospitals and health systems are picking up the tab to lower their own costs, said Michael Bedell, marketing officer at ProxyMed, Fort Lauderdale, Fla.

In December 1999, Laboratory Corp. of America Holdings, an independent clinical laboratory in Burlington, N.C., signed a deal with ProxyMed under which its 100,000 physician customers will be able to submit orders and retrieve results via ProxyMed's Web site.

Physicians have several options: They can submit orders to laboratories and retrieve results over the Internet in different ways. Some are accessing results remotely through a vendor's Web site. Others have installed Web-based systems at their practices linking them to the computer systems of hospital-based and clinical reference laboratories.

Robert Keet, MD, an internist at Western Medical Associates, a 28-physician group practice in Santa Cruz, Calif., is using the latter to access results. Dr. Keet also is medical director for Axolotl.

"It saves me 30 minutes a day and allows me to work more efficiently with my health care partners," Dr. Keet said.

"I can look at the data, transfer it to staff, edit it, annotate it, write a prescription, do a secondary order or quickly deliver the data to colleagues for review and comment."

Physicians or their employees are submitting orders to laboratories via fax, messenger, modem and over the Internet. In turn, laboratories are transmitting results back to Western Medical over the Internet.

Once Dr. Keet and his colleagues view the results, they can write a prescription or enter a secondary test order, depending on the initial test result, Dr. Keet said.

The system checks that orders meet the guidelines of Medicare and private insurers, ensuring that he and his colleagues will get paid for their services.