Lab Result Data Entry Outsourcing vs Automation

Lab result data entry outsourcing vs automation comes down to who reads the page. Outsourcing pays a service whose staff key each result into your system. Automation uses software to read the report and leaves your staff to check what it was unsure of. Both need a business associate agreement first, and the right choice depends on volume and formats.

What lab result data entry outsourcing includes

Lab result data entry outsourcing means paying an outside company whose staff read your incoming lab reports and type the results into your EHR or a file you load. The service usually covers receiving the reports, keying each value, and sending back the work, with turnaround and quality rules set in a contract.

A typical outsourced service has four parts. Intake is how reports reach the service: a shared folder, a secure upload, a fax line forwarded to them, or remote access to your document inbox. Entry is the keying itself, where a person reads each test name, value, unit, range and flag and types them into fields. Quality control is how the service checks its own work, often by having a second person re-key a sample of reports and compare. Delivery is how the results come back, either typed straight into your system through remote access or returned as a file for your staff to import.

Ask any service to spell out each part in writing. Two things are easy to miss. The first is what happens to reports the service cannot read, such as a faded fax or a page with a missing patient name. The second is what the service does when it finds a result that looks wrong, such as a value with no unit. A clear answer is "we flag it and send it back to you". A vague answer means the problem may be keyed as written.

Outsourced staff are handling patient records on your behalf, so the contract matters as much as the price. The federal definition in 45 CFR 160.103 on business associates covers a person who creates, receives, maintains or transmits protected health information on behalf of a covered entity, and names data analysis, processing or administration among the functions. A data entry service falls in that description. How business associate agreements work in general is covered in the HIPAA and PHI category.

What does automating lab result data entry still leave to staff?

Automating lab result data entry still leaves staff to set up the rules, review the fields the software was unsure of, handle reports it could not read, and file the results against the right patient and order. Software removes most of the typing. It does not remove the judgment about whether a value belongs in the chart.

Automation here means software that reads a lab report, finds each result, and returns it as fields. The work that remains falls into five groups:

• Setup. Someone decides which document types to process, which fields to capture, and how sure the software must be before a field skips review.
• Review. A person checks each field below that threshold against the original page, then approves or corrects it.
• Exceptions. Reports with a missing page, two patients in one file, or an unreadable scan still need a person to sort out.
• Filing. Matching the result to the correct patient and order is a step of its own, described in the guide to entering outside lab results into an EHR.
• Upkeep. When a lab changes its report layout or adds a test, someone checks that the fields still come out right.

Panels add a special case. A complete blood count or metabolic panel prints many results under one heading, and a dropped row is easy to miss. The guide to extracting panel results like a CBC or CMP shows how to check that every analyte arrived.

The amount of review depends on the documents. Digital PDFs from a lab system usually leave less to check than scanned or faxed copies. The threshold you set changes the load too: a higher threshold sends more fields to a person and fewer straight through.

Outsourcing vs automating lab result entry: a comparison table

Outsourcing and automating lab result entry differ on turnaround, how errors are caught and where patient data goes. Outsourcing moves the work and the records to another company's staff. Automation keeps the review in-house and sends the records to a software vendor. The table compares them on the points most offices ask about.

Neither column is free of human work. Outsourcing pays for people you do not manage. Automation asks your own people to review a smaller set of fields. The question is which mix fits your team.

The audit trail differs too. With outsourcing, you often see only the final result in your system. With automation that logs each approval and correction, you can see who confirmed a value and when.

Lab data entry costs to count beyond the per-page price

The per-page or per-report price is only part of what lab data entry costs. Both options also carry setup time, staff review time, error correction, contract and security paperwork, and the cost of results that wait. Counting these makes the comparison fair, because the cheapest headline price can turn into the most expensive option.

Count these costs for each option:

• Setup. Writing instructions for a service, or configuring fields and thresholds in software.
• Staff time on review. Reviewing outsourced work by sampling, or reviewing fields the software flagged.
• Corrections. The time to find and fix a wrong value after it was filed, which is usually longer than catching it before.
• Exceptions. Reports returned as unreadable, chased with the lab, and re-sent.
• Paperwork. Negotiating the business associate agreement, answering security questions, and keeping the contract current.
• Delay. Results that sit in a queue overnight instead of reaching the chart the same day.
• Exit. Getting your data back, or confirming it was destroyed, when the contract ends.

The exit cost is easy to forget. The HHS business associate contract rules at 45 CFR 164.504(e) require the contract to provide that, at termination, the business associate will return or destroy the protected health information if feasible. Ask each vendor how that works in practice before you sign.

A worked example comparison

This example uses made-up figures only. A clinic receives 1,500 lab report pages a month. An outsourcing quote is $0.60 a page, or $900 a month, plus 6 staff hours a month to sample the returned work. An automation option is priced at $350 a month for up to 2,000 pages, plus 15 staff hours a month reviewing flagged fields. At an example staff cost of $30 an hour, outsourcing totals $900 plus $180, or $1,080. Automation totals $350 plus $450, or $800. Change the review hours or the page count and the answer can flip, which is why the worksheet below asks for your own numbers.

For a real automation quote, compare plans priced by pages per month. Schema Care's Clinic plan, for instance, lists 2,000 pages a month at $299 with a BAA, three reviewers, an audit log and exports. Plan details are on the Schema Care pricing section. How to measure the return on automation more broadly, including in billing, is covered in the revenue cycle automation category.

When is outsourcing lab result entry the better choice?

Outsourcing lab result entry is the better choice when your team has no time to review, your volume is too small or too irregular to justify setting up software, or your reports are mostly handwritten or very poor scans. It also fits when you need extra hands for a short backlog rather than a lasting process.

Outsourcing tends to fit these situations:

• A one-time backlog. Hundreds of old reports to enter once, with no ongoing flow.
• No reviewer available. Automation still needs someone in-house to check flagged fields.
• Very poor source pages. Faded faxes and handwritten notes may need a person throughout.
• Tiny volume. A few reports a week may not justify the setup of any software.

Automation tends to fit when the volume is steady, most reports come from a few labs, and you want each value traceable to the page it came from.

Some offices split the work instead of choosing one side. Digital PDFs from the two or three labs that send most reports go through software and in-house review. The leftover handwritten pages and poor faxes go to a service, or to one staff member who keys them by hand. A split like this keeps the review queue small and stops the hardest pages from slowing down the routine ones. It also gives you a fallback if either side falls behind, at the cost of two sets of paperwork and two processes to watch.

Whichever way you lean, run a short trial before you commit. Send the same set of de-identified sample reports to each option, then compare the returned values against the pages yourself. Count the wrong values, the missing rows and the reports sent back as unreadable. That small test tells you more than any quote.

A decision worksheet

Fill in the middle column with your own figures, then read across. The right column says which way each answer usually leans.

A business associate agreement is required on both sides of this worksheet. Neither option should receive a real lab report before one is signed, and a pilot on de-identified sample reports is a safe way to test either.