The impact of computerised physician order entry systems on pathology services: A systematic review
Introduction
Many potential benefits of computerised physician order entry (CPOE) in hospitals have been identified. These include improvements to physician ordering patterns, increased compliance with guidelines, optimisation of clinical time, and facilitation of communication processes in health care [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. If realised, these benefits would logically lead to improvements in patient outcomes, as well as major cost efficiencies. CPOE systems are an integral part of hospital information systems and constitute an important building block for the establishment of the electronic medical record [2], [7], [15]. For these reasons, CPOE systems have been strongly promoted in the United States, Europe and Australia as a means of improving the quality of care, reducing errors and increasing efficiency in health care delivery [16], [17], [18], [19], [20], [21], [22].
Pathology order entry allows physicians (or other authorised staff) to enter laboratory orders directly into a computer [4], [11], [14], [23]. Such systems may include decision support mechanisms such as defined order sets for particular conditions in order to support the selection and appropriate use of tests and treatment; parameter checks to ensure that orders are within agreed test time frames, frequency or dose limits; and more complex rule based alerts that prompt clinicians with information about previous test results, patient characteristics and available test choices [16], [17], [24], [25], [26], [27], [28], [29].
CPOE systems remain costly and complex to design and implement [9], [13]. Despite the potential benefits, there are very few evaluations of the effect of CPOE on clinical outcomes [1], and evidence of the effectiveness of CPOE has focused predominantly on medication order systems in hospital settings [9]. One of the reasons for this may be the limited funding available for such studies. Outside of medication orders a large proportion of orders processed through a CPOE system relate to pathology and imaging services that can have a potentially significant impact on clinicians’ test ordering decisions and pose a new set of challenges and opportunities for pathology managers.
Relatively little research has focused specifically on the impact of CPOE on hospital pathology services, order patterns or patient outcomes. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services and to identify the indicators, which have been used to measure impact.
Section snippets
Methods
A literature review was undertaken to identify all evaluation studies of computerised pathology order entry systems published between 1990 and August 2004. The following databases were searched: MEDLINE, CINAHL, EMBASE, SocScience Index and Cochrane Database of Systematic Reviews. Web-based searches using Google and hand searches of international health informatics journals were completed. The reference lists from relevant articles and additional articles by key authors were also reviewed [30].
Results
The review identified 19 studies of the impact of CPOE systems on pathology. Eleven studies compared CPOE for pathology orders (with and without decision support) to no CPOE (Table 2, Table 3). Of these, four studies compared CPOE without defined decision support mechanisms to settings where there was no CPOE. Eight studies compared CPOE with specific decision support features to CPOE without these features (Table 4). The studies comparing CPOE with no CPOE were conducted in the USA (5), United
Discussion
There is a growing body of research which has examined either the impact on pathology services of CPOE alone, or with decision support mechanisms. We identified 19 empirical studies published between 1990 and August 2004. The geographical scope of the research spread from the USA and Canada, to South Korea, Norway and England, reflecting international interest in this area. Six hospitals (five from the USA and one from England) featured in more than one study. The hospital where most studies
Acknowledgements
The study is part of an Australian Research Council Linkage Grant funded project in partnership with the Centre for Clinical Governance Research in Health from the University of New South Wales, and the New South Wales Health Department.
References (66)
- et al.
Computerized physician order entry: helpful or harmful?
J. Am. Med. Inform. Assoc.
(2004) - et al.
Impact of a physician's order entry (POE) system on physicians’ ordering patterns and patient length of stay
Int. J. Med. Inf.
(2002) - et al.
The clinical workstation as a means of improving laboratory use
Clin. Chim. Acta
(1996) - et al.
Computerized physician order entry in U.S. hospitals: results of a 2002 Survey
J. Am. Med. Inform. Assoc.
(2004) - et al.
What proportion of common diagnostic tests appear redundant?
Am. J. Med.
(1998) - et al.
A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests
Am. J. Med.
(1999) Appropriate utilization and cost control of the hospital laboratory: panel testing and repeat orders
Clin. Chim. Acta
(1995)- et al.
Implementing computerized physician order entry: the importance of special people
Int. J. Med. Inf.
(2003) - et al.
Computer-based physician order entry: the state of the art
J. Am. Med. Inform. Assoc.
(1994) - et al.
Implementation of physician order entry: user satisfaction and self-reported usage patterns
J. Am. Med. Inform. Assoc.
(1996)
Immediate benefits realized following implementation of physician order entry at an academic medical center
J. Am. Med. Inform. Assoc.
Physician satisfaction with two order entry systems
J. Am. Med. Inform. Assoc.
Methodology for evaluating physician order entry (POE) implementations
J. Eval. Clin. Pract.
Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system
J. Am. Med. Inform. Assoc.
Computerized physician order entry systems in hospitals: mandates and incentives
Health Aff. (Millwood)
A randomized trial of corollary orders to prevent errors of omission
J. Am. Med. Inform. Assoc.
Will electronic order entry reduce health care costs?
Eff. Clin. Pract.
Computer physician order entry: benefits, costs, and issues
Ann. Intern. Med.
Computerized prescriber order entry: models and hurdles
Am. J. Health. Syst. Pharm.
Cerner millennium: the Innsbruck experience
Meth. Inf. Med.
National programme for information technology
Br. Med. J.
Computerizing guidelines to improve care and patient outcomes: the example of heart failure
J. Am. Med. Inform. Assoc.
Computerization in clinical laboratories and health care facilities: making decisions in transition
Can. J. Med. Technol.
Computerized physician order entry: Has the time come?
Medscape Gen. Med.
Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review
J. Am. Med. Inform. Assoc.
The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies
Proc. AMIA. Annu. Symp.
Embedding guidelines into direct physician order entry: simple methods, powerful results
Proc. AMIA. Annu. Symp.
Cited by (88)
Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy
2023, International Journal of Medical InformaticsA systematic literature review on unnecessary diagnostic testing: The role of ICT use
2020, International Journal of Medical InformaticsImproving American Healthcare Through “Clinical Lab 2.0”: A Project Santa Fe Report
2017, Academic PathologyMeasuring the effects of computer downtime on hospital pathology processes
2016, Journal of Biomedical Informatics