Help: Frequently Asked Questions

Last updated: August 2011

1. What is ELINCS?
2. Is ELINCS software?
3. Why did CHCF sponsor the development of ELINCS?
4. Who should use ELINCS?
5. What is the current release version of ELINCS?
6. What are the differences between ELINCS v1.1 and HL7-R1?
7. Does ELINCS provide "plug-and-play" interoperability?
8. How can I test and validate my ELINCS interface?
9. Does CHCF officially certify ELINCS interfaces?
10. How many laboratories and EHR vendors have implemented ELINCS?
11. Why does ELINCS HL7-R1 require that only the most common tests be coded using LOINC?
12. Does an ambulatory EHR that supports the ELINCS HL7-R1 specification meet the Phase 1 Meaningful Use criteria for incorporating laboratory data?
13. Who is responsible for the maintenance and further development of the ELINCS specification?
14. What is ELINCS Orders?
15. What is the difference between ELINCS and ELINCS Orders?

Q1: What is ELINCS?
A1: The EHR-Lab Interoperability and Connectivity Specification (ELINCS) is a specification for the formatting and coding of lab result messages from laboratory information systems to ambulatory electronic health record systems. The specification is based on the HL7 version 2.5.1 ORU message type and requires the use of the LOINC coding standard for identifying certain common lab analytes. ELINCS HL7 Release 1 is an official HL7 implementation guide.

Q2: Is ELINCS software?
A2: No, ELINCS is not software. It is an implementation guide that defines the structure of electronic laboratory result messages. The implementation guide contains detailed information about the electronic laboratory message structure, including the required and unsupported data elements and data coding requirements for certain fields. ELINCS itself is not an interface engine but instead contains the information for configuring an interface engine to generate or accept valid ELINCS messages. While ELINCS itself is not software, the ELINCS EDGE tool is a free application that allows EHR vendors and laboratories to validate their ELINCS interfaces. You may download the EDGE testing tool from this site.

Q3: Why did CHCF sponsor the development of ELINCS?
A3: In late 2004, the California HealthCare Foundation (CHCF) was asked by the Office of the National Coordinator of Health Information Technology (ONCHIT) to sponsor and lead the development of the ELINCS implementation guide. Earlier that year, CHCF had developed an implementation guide for the batch reporting of laboratory results in California to facilitate local quality-improvement programs. That implementation guide (CALINX) was well received and is being adopted by commercial labs, provider organizations, and health plans in California. The need for a national interoperability standard for lab reporting and the similarity of the CALINX and ELINCS use cases prompted ONCHIT to ask CHCF to adapt CALINX for real-time lab reporting with the input of national stakeholders.

Q4: Who should use ELINCS?
A4: ELINCS is designed to standardize the electronic transmission of lab test results from laboratories to electronic health record systems used in the ambulatory setting. Hence, the specification should be used by commercial labs and hospital labs that perform outpatient testing and want to send results electronically to ambulatory-care providers in the community. The specification should also be used by the developers and vendors of electronic health record systems that are deployed in the ambulatory setting and can receive laboratory test results electronically. The goal of ELINCS is to simplify and facilitate the interface of these systems for the exchange of outpatient lab results. Although ELINCS may be used for the exchange of lab results among EHR systems or between a laboratory and a regional data-sharing repository, the specification is not expressly designed for these uses.

Q5: What is the current release version of ELINCS?
A5: In July 2008, an updated version of the ELINCS specification passed the HL7 ballot process and was approved for release. ELINCS HL7-R1 is the most recent version of the specification and should be used as the blueprint for any new ELINCS interface implementations.

Q6: What are the differences between ELINCS v1.1 and HL7-R1?
A6: ELINCS HL7-R1 makes changes in five areas of the specification:

1. Migration to HL7 v2.5.1. The HL7 version that the specification is based on has been changed from HL7 v2.4 to HL7 v2.5.1.  This change added support for the new SPM segment and for new optional and required fields.
2. Discrete microbiology with sensitivity reflex reporting rules. Full support for medical microbiology reporting was added to the specification, including detailed rules for linking culture result messages to antimicrobial sensitivity reflex test messages.
3. Unique ordered test identification vs. requisition level test identification guidelines. Special reporting rules have been specified to allow EHR and laboratory systems to interoperate reliably, regardless of whether the EHR or laboratory system supports unique identifiers for every ordered test on the requisition or if only requisition level identifiers are supported.
4. "Copy-to" reporting. The specification now fully supports "copy-to" messaging. Per the ELINCS HL7-R1 specification, laboratories may optionally support "copy-to" messaging. If supported by the sending laboratory, up to five health care providers (identified by the ordering provider) can be sent a copy of a patient's result message.
5. Increased LOINC coding requirements. ELINCS HL7-R1 has expanded the set of tests for which LOINC coding is required. The tests that must be LOINC coded were selected because they represent the 95% most frequently performed laboratory tests.

For more information, see Document Downloads "ELINCS HL7-R1 Release Overview" and "ELINCS HL7-R1 Technical Details" on the Specifications page.

Q7: Does ELINCS provide "plug-and-play" interoperability?
A7: No. ELINCS addresses and standardizes the application-level representation of lab-result data and the application-level rules for exchanging lab-result messages only. This scope includes the formatting and coding of lab-result data in electronic messages, and the responsibilities of sending and receiving applications that exchange such messages. ELINCS does not address or standardize aspects of computer networking at the transport and security levels, such as choice of transport technologies, encryption/authentication methods, and message addressing and routing. Although the standardization of all of these aspects is required for full plug-and-play interoperability, the application-level standardization provided by ELINCS significantly facilitates interoperability and moves disparate applications much closer to plug-and-play.

Q8: How can I test and validate my ELINCS interface?
A8: The California HealthCare Foundation (CHCF) has sponsored the development of the ELINCS EDGE Tool, a free application that generates valid ELINCS messages based on provided order data and can be used to test an EHR's ELINCS interface. The application also evaluates ELINCS messages generated by laboratory systems and identifies any errors present in the message. In addition, CHCF offers EHR vendors an implementation test script document that provides step by step instructions for using the EDGE tool to generate a full complement of ELINCS messages that are defined by the specification. Developers can use the checklists included in this test script document to confirm that their EHR product fully meets the receiver responsibilities defined in the specification. See the User Resources page for both these resources.

Q9: Does CHCF officially certify ELINCS interfaces?
A9: No. A formal certification process is not offered by the California HealthCare Foundation. However, support is available for laboratories and EHR vendors at no cost to help resolve any issues that might arise when implementing an ELINCS interface. For ELINCS support, please Contact Us.

Q10: How many laboratories and EHR vendors have implemented ELINCS?
A10: As of January 2011, more than 56 organizations across the state, involving over 200 health care provider locations, have implemented ELINCS interfaces or are in the process of doing so. ELINCS-compliant interfaces have been implemented by multiple electronic health record systems, hospital laboratories, national commercial laboratories, independent labs, chronic disease registry systems, and a California state agency. See the Implementations page for details.

Q11: Why does ELINCS HL7-R1 require that only the most common tests be coded using LOINC?
A11: The LOINC coding system contains over 25,000 codes for laboratory tests. However, the vast majority of reported analytes is covered by a small subset of these codes. To accelerate the adoption of ELINCS HL7-R1 by laboratories that have not yet mapped their test sets to LOINC codes, the specification requires that the top 95% of performed tests (based on data collected from three large provider organizations in California) be reported using LOINC codes. This number has been increased from the top 80% of performed tests required by ELINCS v1.0 and v1.1. At the same time, ELINCS allows laboratories that have completed their LOINC mapping to send all test results using LOINC codes.

Q12: Does an ambulatory EHR that supports the ELINCS HL7-R1 specification meet the Phase 1 Meaningful Use criteria for incorporating laboratory data?
A12: Yes. If the EHR's laboratory result interface fully supports the ELINCS HL7-R1 implementation guide, the EHR will meet and exceed the phase 1 Meaningful Use criteria for laboratory data management (see certification criteria §170.302[g] in 45 CFR Part 170 Subpart C of the Interim Final Rule). In particular, ELINCS HL7-R1 is a structured, HL7 v2.5.1-based laboratory result format that includes LOINC coding and requires EHRs to display test report information in compliance with CLIA regulations.

Q13: Who is responsible for the maintenance and further development of the ELINCS specification?
A13: ELINCS has been adopted by Health Level 7 (HL7), the internationally recognized standards development organization for health information. HL7 has assumed responsibility for the ongoing maintenance and further development of ELINCS.

Q14: What is ELINCS Orders?
A14: ELINCS Orders is an HL7 v2.5.1-based implementation guide that standardizes the format of ambulatory laboratory orders and enables the electronic communication of laboratory orders from EHRs to clinical laboratories. CHCF developed the Orders specification to complement ELINCS HL7-R1, in collaboration with HL7, national reference laboratories, regional and hospital laboratories, EHR vendors, LIS vendors, state health information network organizations, and other stakeholders. View the specification.

Q15: What is the difference between ELINCS and ELINCS Orders?
A15: ELINCS and ELINCS Orders are both HL7 v2.5.1-based implementation guides designed to enable the electronic communication of data between laboratories and physician practices. CHCF developed ELINCS first to promote the widespread adoption of a standardized lab-reporting implementation guide. After ELINCS was adopted by HL7 and successfully implemented by a number of provider organizations, laboratories, and EHR vendors, CHCF developed ELINCS Orders to define a specification for the electronic ordering of laboratory tests in the ambulatory setting that would complement ELINCS. As of August 2011, ELINCS Orders has not yet been adopted by HL7.