At HealthLink’s recent eLab roadshow, Erik Jacobsen (CEO of DMDD) shared pathology test ordering developments and lessons learnt from Denmark, the world’s most advanced eLab environment. eLab (called WebReq in Denmark) is an online lab test ordering system that enables fast and accurate capture of information directly from a GP’s practice management system/EMR into a laboratory information system. In Denmark, 80 labs with 13 different LIS systems and all GPs use WebReq and it is now available through HealthLink as "eLab" in New Zealand and shortly in Australia. www.healthlink.net

1. Pathology test ordering
an International perspective
Erik Jacobsen
CEO DMDD

2. Pathology test ordering
Age nd a
o International perspective
o Denmark - background
o The requirements we needed to satisfy
o The achievements so far
o Briefly how it works
o What the future holds

3. International perspective
o Electronic ordering in Europe and the US (early 90’s and now)
o What Denmark decided to do
o The organizations involved: DMDD, Medcom

4. Denmark - background
o A small country: 43.000 Km²
o Distances: West – East 300 km
South – North 400 km
o Inhabitants (total): 5,5 million
o Major cities: Copenhagen 1,25 mill
Århus 0,25 mill
Odense 0,17 mil
Ålborg 0,10 mill
o 5 regions: Region North
Region Middle
Region South
Region Zealand
Capital Region

6. Laboratories in Denmark
o Biochemistry (KKA) 44
Immunology
o Microbiology (MIK) 17
o Histopathology (PAT) 19
Cytology smear
Hematology
o Other special laboratories 3
• Nearly all are located at - or directly connected to - hospitals.
• Nearly all are directly government founded.
• All laboratories receive EDIFACT messages. Some also use web services.

7. Lab results in Denmark
• All lab results electronical by messaging
• Biochemistry
• Hematology
• Immunology
• Microbiology
• Histopathology
• Cytology smear
• All labs : 80 with 13 different LIS-systems
• All GP´s and private specialists, 21 systems
• All based on national MedCom standards
• Many to many solution
• Certified and approved systems

8. The ordering system: WebReq (eLab)
• Developed by DMDD A/S
– Founded in 2004
– Founded by 4 companies making electronic patient record
systems for the primary health care in Denmark
– Made in cooperation with MedCom Denmark

9. The requirements we needed to satisfy

10. What patients want
o “I only visit my GP, my specialist doctor or the hospital once”
o “All ‘normal’ samples should be taken at that same visit, no matter how many different
labs are involved” (some may be processed at the doctors clinic instantly)
o “No extra unnecessary visits to any other healthcare location”
o “Naturally I expect earlier lab results to be available to all relevant healthcare personal
any time at clinics or at hospitals”
o “I want a trustworthy and reliable test procedure - no faults allowed”
o “Why do the same test again, when it was done recently somewhere ?”

11. What doctors want
o “Read my mind and make the order automatically” 
o “Just one click and my requisition is finished”
o “The keyword is profiles “ (individual clinic, personal or patient)
o “All laboratories must be available and visible for all requestors – but all clinics have
their own default lab”
o “WebReq must support the different kind of workflow in different types of clinics”
o “WebReq must support the different kinds of requisition types”:
- Sampling in GP Clinic
- Ordering in GP Clinic (sampling at laboratories)
- Ordering in GP Clinic (sampling in patients home)
- Ordering in hospital or at private specialists (sampling in GP clinic or in lab - hotel function)

12. What laboratories want
o Minimize costs and improve quality requesting and receiving lab-orders, by:
- correct labeling and identifying of test-tubes - initially marked
- all information about all tests are available at requesting and sampling time
- no keying in any data at the laboratory when receiving tests
- reducing the possibility of faults
- guiding requestors to order the right batteries of tests for the actual purpose
- making it possible to prompt the requestor for the needed extra information
- making it easy to change analysis data - (takes effect immediately)
- not using special laboratory paper forms
o Manage the analysis repertoire and information for external requestors:
- changes of repertoire- and analysis data to take effect immediately
including all instructions of prompts for additional clinic information
- recommended profiles to be distributed immediately
- general laboratory news and information to be distributed immediately

13. What government and society expects
o More healthcare benefits for less costs or same costs:
- national monitoring of the requestors use of lab-tests
- no unnecessary tests
- national guidelines and common disease profiles
- improving quality – check procedures of external devices
- running information and education of requestors
- possibility of scientific research on the fly
- making request- and result data available for all other healthcare personal
- healthcare should be ONE transparent system - just like Kaiser Permanente
o The citizens must use as less time as possible on healthcare, by:
- avoiding visiting healthcare institution unnecessarily
- staying at work and pay more income tax
- getting well as quick as possible
o National codíng of analysis and national shortnames is a challenge
- Common coding of analysis and names - a benefit for all, even for laboratoris 
- “External” testsresults must also be available on central national labresult servers

14. The achievements so far

15. Electronic messaging in Denmark
•Prescriptions
•Discharge letters
•Lab results
•Lab requisitions
•Referrels

16. Benefits
1. Mislabelling reduced
• 209,000/ year
2. Incomplete, unreadable
• 325,000 reduced to 91,000
3. Registration, not necessary
• Savings 32,500 hours
4. Reduced time for reception
• Savings 43,000 hours

17. Benefits
1. Implemented to 90 % in 2 years - (statement 2010)
2. Fully financed by savings in preprinted forms
3. Money reserved for further development
4. Organised in a MedCom usergroup
5. Cost app.
− 22 £ pr. GP clinic pr. month ( incl. 5 £ for development)
− Webreq Form 0.025 cent/each

18. Quality improvements
WebReq
% of all requisitions
Tube labelling - failures %
20
18
15
10
5
2
0
Paper WebReq

19. WebReq Reduce Errors and Costs
•http://www.hl7.org.tw/jith/

20. Briefly how it works

21. Central servers
WebReq laboratory requisition
•WebRe
q
•MEDRPT •MEDREQ
•Web services

22. Getting down to earth!
o What is needed to start using WebReq:
1) PC with an updated browser - with or without an EMR - system
2) Laser printer with a paper magazine
3) Internet access
o You are on!

23. Lab results in a GP-system

24. National Lab result Health Portal

25. Lab results Health portal
• Using MedCom national webservices
• Calling nearly all laboratories.
• Access to all labresults from last 5 years
• Based on Patient ID
• Access using digital certificate
• Access directly from Webreq since 2012-01-20

26. Paper based requisition

27. GP-lab test orders
1. Sampling in GP Clinic
2. Ordering in GP Clinic, sampling in lab
3. Ordering in GP Clinic, sampling in patients home.
4. Ordering in hospital outpatient or by private
specialists, sampling in GP clinic or in lab
1. Web Quality
2. Web Scientific Research

28. WebReq e-orders

29. WebReq e-orders

30. WebReq e-orders

31. WebReq e-orders

32. WebReq universal national
requisition form

33. WebReq e-orders

34. The Future
Cooperation agreement about export to:
New Zealand (2010-2011)
Australia (next 1 - 3 years)
Canada (next 2 - 5 years)
Contact established:
Germany