We side with Pine and colleagues [1] against Iezzoni's [2] pessimistic conclusions about electronic laboratory data. Computer-based laboratory reporting systems are present in most hospitals with more than 200 beds, and standards for electronic messages (such as ASTM [American Society for Testing and Materials] E1238 or HL7 [Health Level 7]) [3] are widely used. Mayo Clinical Laboratories and ARUP Laboratories, for example, each have more than 100 standards-based electronic interfaces operating between their referral laboratories and clients around the United States. All of the major vendors of laboratory information systems support ASTM and HL7 (64 of 67 vendors surveyed [4]), as do all of the large referral laboratories. The largest three laboratories account for 50% of the nonhospital laboratory volume. The experience of Davies and associates quoted by Iezzoni may be anomalous.

Until recently, pooling of test results from different sources required expensive mapping of the codes from different sources because standardized test codes did not exist to permit automatic pooling of test results from different sources. That gap has been eliminated with the development of LOINC (logical observation identifier names and codes) codes, which are now available for public use on the Internet [5] (see http://www.mcis.duke.edu/standards/loinc.htm). Veterans Affairs. Intermountain Health Care; the largest commercial laboratories; and the Province of Ontario, Canada, have adopted HL7 and LOINC to standardize laboratory results just as Pine and colleagues would like.

Not all hospitals could today deliver standardized electronic laboratory results, but most could. One to 2 days of work would be needed to map all of the codes used by Pine and colleagues to the LOINC standard, and 2 to 4 months would be needed to map their entire laboratory master file. Shipping this information as HL7 messages to quality reviewers would be practically free thereafter. We could then invest our scarce quality-measurement dollars on the data that cannot now be obtained electronically.