Variation in interoperability across clinical laboratories nationwide

To characterize nationwide variation and factors associated with clinical laboratories': (1) capabilities to send structured test results electronically to ordering practitioners' EHR systems; and (2) their levels of exchange activity, as measured by whether they sent more than three-quarters of their test results as structured data to ordering practitioners' EHR systems.

A national survey of all independent and hospital laboratories was conducted in 2013. Using an analytic weighted sample of 9382 clinical laboratories, a series of logistic regression analyses were conducted to identify organizational and area characteristics associated with clinical laboratories' exchange capability and activity.

Hospital-based clinical laboratories (71%) and larger clinical laboratories (80%) had significantly higher levels of capability compared to independent (58%) and smaller laboratories (48%), respectively; though all had similar levels of exchange activity, with 30% of clinical laboratories sending 75% or more of their test results electronically. In multivariate analyses, hospital and the largest laboratories had 1.87 and 4.40 higher odds, respectively, of possessing the capability to send results electronically compared to independent laboratories (p<0.001). Laboratories located in areas with a higher share of potential exchange partners had a small but significantly greater capability to send results electronically and higher levels of exchange activity(p<0.05).

Clinical laboratories' capability to exchange varied by size and type; however, all clinical laboratories had relatively low levels of exchange activity. The role of exchange partners potentially played a small but significant role in driving exchange capability and activity.