The HIT Policy Advisory Committee's information exchange workgroup learned Tuesday just how difficult it's going to be for doctors to exchange electronic lab results to qualify for federal "meaningful use" bonuses.

Physicians can earn a potential $44,000 under the American Recovery and Reinvestment Act (ARRA), beginning Oct. 1, 2011, but they will have to show meaningful use of data, including the use of electronic laboratory results.

One of the problems is that state laws regulate the exchange of electronic laboratory results, and standards don't exist to allow this information to flow easily between labs and physician offices. According to experts, labs are required to pay for the exchange of data, so they build connections with larger providers first – leaving small physician practices on their own, since there aren't enough lab results to justify the interface.

Deven McGraw, co-chairman of the workgroup investigating potential barriers to HIT adoption and lab data exchange, said the committee will be deliberating the issue for weeks and will take public comment through the end of October.

McGraw said the group hopes to strike a balance in its recommendations, creating enough structure to allow uniform data exchange and enough freedom so as to not stifle innovation.

The group hopes to deliver recommendations to the full HIT Policy Committee by Nov. 3. It will then work on e-prescribing recommendations, McGraw said.

Many of the expert witnesses in Tuesday's day-long hearing agreed that data exchange will save lives and cut costs by preventing duplicate testing, but most said it won't be easy for physicians to just plug in and "go live."

Laura Rosas, with the New York City Primary Care Information Project, said her organization is the largest public health project to use electronic health records. Laboratory interface is the organization's "biggest challenge," she said.

"There is no standard compendium or even standard naming convention for orders," she said. "Insurance files are specific to the practices, and vary widely. Laboratories also vary in how they identify providers."

In addition, she said, practices don't have the bandwidth to perform insurance file and lab compendium mapping on an ongoing basis.

Kelly Cronin, director in the Office of the National Coordinator (ONC) for Health Information Technology, said the Department of Health and Human Services is poised to make the laboratory data exchange work.

"On a strategic level and on a specific level, this will involve many different objectives on lab data, and even many quality measures, as defined to date, that are dependent on lab measures," she said. "There are pockets of exchange in lab data, but not anywhere near where we need to have it."

During Tuesday's meeting, patient access to laboratory results emerged as a topic of concern.

Joy Pritts, a research associate professor from the Georgetown University Health Policy Institute, said varying state laws will pose a problem for electronic laboratory data exchange. In some states, labs are permitted to release test results only to the person ordering the test. This means, for example, that specialists to whom a patient has been referred may not be able to access test results directly from a laboratory.