Interoperability in Hospital Information Systems: a Return-On-Investment Study Comparing CPOE with and without Laboratory Integration

Despite its many advantages, using a computerized patient record is still considered as a time consuming activity for care providers. In numerous situations, time is wasted because of the lack of interoperability between systems. In this study, we aim to assess the time gains that nursing teams could achieve with a tightly integrated computerized order entry system. Using a time-motion method, we compared expected versus effective time spent managing laboratory orders for two different computerized systems: one integrated, the other not integrated. Our results tend to show that nurses will complete their task an average of five times faster than their expected performance (p<0.001). We also showed that a tightly integrated system provides a threefold speed gain for nurses compared to a non-integrated CPOE with the laboratory information system (p<0.001). We evaluated the economic benefit of this gain, therefore arguing for a strong interoperability of systems, in addition to patient safety benefits.

[1]  D. Gans,et al.  Medical groups' adoption of electronic health records and information systems. , 2005, Health affairs.

[2]  Nicola T. Shaw,et al.  The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: A review of the literature , 2009, Int. J. Medical Informatics.

[3]  Y. Han,et al.  Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics , 2011 .

[4]  Melissa M. Honour,et al.  Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. , 2004, Health affairs.

[5]  David W. Bates,et al.  Viewpoint Paper: E-Prescribing Collaboration in Massachusetts: Early Experiences from Regional Prescribing Projects , 2006, J. Am. Medical Informatics Assoc..

[6]  Y. Han,et al.  Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System , 2005, Pediatrics.

[7]  David W. Bates,et al.  Primary care physician time utilization before and after implementation of an electronic health record: A time-motion study , 2005, J. Biomed. Informatics.

[8]  Patrice Degoulet,et al.  Assessing the Capital Efficiency of Healthcare Information Technologies Investments: An Econometric Perspective , 2008, Yearbook of Medical Informatics.

[9]  Simon de Lusignan,et al.  Viewpoint Paper: e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice , 2006, J. Am. Medical Informatics Assoc..

[10]  R. Bosman,et al.  Impact of computerized information systems on workload in operating room and intensive care unit. , 2009, Best practice & research. Clinical anaesthesiology.

[11]  D. Blumenthal.  Stimulating the adoption of health information technology. , 2009, The West Virginia medical journal.

[12]  John F Hurdle,et al.  High rates of adverse drug events in a highly computerized hospital. , 2005, Archives of internal medicine.

[13]  Emily Beth Devine,et al.  Technology Evaluation: The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time-Motion Study , 2007, J. Am. Medical Informatics Assoc..

[14]  D. Simel,et al.  A comparison of work-sampling and time-and-motion techniques for studies in health services research. , 1994, Health services research.

[15]  S. Goldhaber,et al.  Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors , 2005 .

[16]  David W. Bates,et al.  Comparison of Time Spent Writing Orders on Paper with Computerized Physician Order Entry , 2001, MedInfo.

[17]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[18]  D. Bates,et al.  Effects of computerized physician order entry on prescribing practices. , 2000, Archives of internal medicine.

[19]  David W. Bates,et al.  Position Paper: Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion , 2004, J. Am. Medical Informatics Assoc..

[20]  Patrice Degoulet,et al.  Impact of Health Care Information Technology on Hospital Productivity Growth: a Survey in 17 Acute University Hospitals , 2007, MedInfo.