The impact of computerised physician order entry systems on pathology services: A systematic review

PURPOSE Computerised physician order entry (CPOE) systems hold the promise of significant improvements to health care delivery and patient care. The implementation of such systems is costly and complex. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services. METHODS This paper presents a review of the literature (1990-August 2004) about CPOE systems and identifies indicators for measuring the impact of CPOE on pathology services. RESULTS Nineteen studies which contained some form of 'control' group, were identified. They featured a variety of designs including randomised controlled trials, quasi-experimental and before and after studies. We categorised these into three groups: studies comparing pathology CPOE systems (with no decision support) to paper systems; pathology CPOE systems (with decision support) to paper systems; and pathology CPOE systems with specific pathology features compared to systems without those features. We identified 10 areas of impact assessment and 39 indicators used to measure the impact of CPOE on different stages of the pathology test ordering and reporting process. CONCLUSION We conclude that while some data suggest that CPOE systems are beneficial for clinical and laboratory work processes, these data are limited, and further research is needed. Few data are available regarding the impact of CPOE on patient outcomes.

[1]  Elizabeth J. Davidson,et al.  Examining the organizational implications of IT use in hospital-based health care: a case study of computerized order entry , 1999, Proceedings of the 32nd Annual Hawaii International Conference on Systems Sciences. 1999. HICSS-32. Abstracts and CD-ROM of Full Papers.

[2]  D. Bates,et al.  Computerized physician order entry systems in hospitals: mandates and incentives. , 2002, Health affairs.

[3]  Jonathan M. Teich,et al.  Research Paper: Implementation of Physician Order Entry: User Satisfaction and Self-Reported usage Patterns , 1996, J. Am. Medical Informatics Assoc..

[4]  G. Kuperman,et al.  Computer Physician Order Entry: Benefits, Costs, and Issues , 2003, Annals of Internal Medicine.

[5]  Randolph A. Miller,et al.  The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies , 2001, AMIA.

[6]  M. Humber.  National programme for information technology , 2004, BMJ : British Medical Journal.

[7]  J. Henry.  Clinical diagnosis and management by laboratory methods , 1979 .

[8]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[9]  G J Kuperman,et al.  What proportion of common diagnostic tests appear redundant? , 1998, The American journal of medicine.

[10]  Manor Pg,et al.  Turnaround times in the laboratory: a review of the literature. , 1999 .

[11]  Jacob Reider,et al.  Computerized physician order entry: has the time come? , 2003, MedGenMed : Medscape general medicine.

[12]  G Lechleitner,et al.  Cerner Millennium™: The Innsbruck Experience , 2003, Methods of Information in Medicine.

[13]  William W. Stead,et al.  Review: Computer-based Physician Order Entry: The State of the Art , 1994, J. Am. Medical Informatics Assoc..

[14]  Hagop S. Mekhjian,et al.  Immediate benefits realized following implementation of physician order entry at an academic medical center. , 2002, Journal of the American Medical Informatics Association : JAMIA.

[15]  L. Homsted.  Institute of Medicine report: to err is human: building a safer health care system. , 2000, The Florida nurse.

[16]  Joan S. Ash,et al.  Implementing computerized physician order entry: the importance of special people , 2003, Int. J. Medical Informatics.

[17]  A H Wu.  Improving the utilization of clinical laboratory tests. , 1998, Journal of evaluation in clinical practice.

[18]  M Peters,et al.  Computerised protocols for laboratory investigation and their effect on use of medical time and resources. , 1992, Journal of clinical pathology.

[19]  J. Marc Overhage,et al.  Case Report: Computerizing Guidelines to Improve Care and Patient Outcomes: The Example of Heart Failure , 1995, J. Am. Medical Informatics Assoc..

[20]  Gordon D Schiff,et al.  Computerized prescriber order entry: models and hurdles. , 2002, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[21]  M Werner,et al.  Appropriate utilization and cost control of the hospital laboratory: panel testing and repeat orders. , 1995, Clinica chimica acta; international journal of clinical chemistry.

[22]  David W Bates,et al.  Will electronic order entry reduce health care costs? , 2002, Effective clinical practice : ECP.

[23]  Kaveh G Shojania,et al.  Classifying laboratory incident reports to identify problems that jeopardize patient safety. , 2003, American journal of clinical pathology.

[24]  Yuchiao Chang,et al.  A utilization management intervention to reduce unnecessary testing in the coronary care unit. , 2002, Archives of internal medicine.

[25]  D Nevalainen,et al.  Evaluating laboratory performance on quality indicators with the six sigma scale. , 2000, Archives of pathology & laboratory medicine.

[26]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[27]  P. Dodek,et al.  Computerized physician order entry of diagnostic tests in an intensive care unit is associated with improved timeliness of service , 2004, Critical care medicine.

[28]  P J Howanitz,et al.  Physician satisfaction and emergency department laboratory test turnaround time. , 2009, Archives of pathology & laboratory medicine.

[29]  S Thomas,et al.  Computerization in clinical laboratories and health care facilities: making decisions in transition. Part II: Understanding user friendliness, computer assisted physician ordering, patient informational needs. , 1994, Canadian journal of medical technology.

[30]  Julie M. Fiskio,et al.  Research Paper: Improving Response to Critical Laboratory Results with Automation: Results of a Randomized Controlled Trial , 1999, J. Am. Medical Informatics Assoc..

[31]  Kevin B. Johnson,et al.  The Impact of Peer Management on Test-Ordering Behavior , 2004, Annals of Internal Medicine.

[32]  M D McNeely,et al.  The influence of an expert system for test ordering and interpretation on laboratory investigations. , 1999, Clinical chemistry.

[33]  C J McDonald,et al.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. , 1990, The New England journal of medicine.

[34]  Paul Wallace,et al.  Embedding guidelines into direct physician order entry: simple methods, powerful results , 1999, AMIA.

[35]  M Peters,et al.  Effects of a computerised protocol management system on ordering of clinical tests. , 1994, Quality in health care : QHC.

[36]  K E Willard,et al.  The clinical workstation as a means of improving laboratory use. , 1996, Clinica chimica acta; international journal of clinical chemistry.

[37]  Joseph L. Kannry,et al.  Research Paper: Physician Satisfaction with Two Order Entry Systems , 2001, J. Am. Medical Informatics Assoc..

[38]  C. van Walraven,et al.  Population-based study of repeat laboratory testing. , 2003, Clinical chemistry.

[39]  C. McDonald,et al.  Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. , 1993, JAMA.

[40]  Anne Moen,et al.  Introducing a Module for Laboratory Test Order Entry and Reporting of Results at a Hospital Ward: An Evaluation Study Using a Multi-Method Approach , 1997, Journal of Medical Systems.

[41]  M Khoury,et al.  Error rates in Australian chemical pathology laboratories , 1996, The Medical journal of Australia.

[42]  P Valenstein,et al.  Outpatient order accuracy. A College of American Pathologists Q-Probes study of requisition order entry accuracy in 660 institutions. , 1999, Archives of pathology & laboratory medicine.

[43]  Peter J Stuart,et al.  An interventional program for diagnostic testing in the emergency department , 2002, The Medical journal of Australia.

[44]  Douglas A. Talbert,et al.  A computer based intervention on the appropriate use of arterial blood gas , 2001, AMIA.

[45]  P. J. Howanitz,et al.  Laboratory results. Timeliness as a quality attribute and strategy. , 2001, American journal of clinical pathology.

[46]  Paul N. Gorman,et al.  Computerized physician order entry in U.S. hospitals: results of a 2002 survey. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[47]  D. Witte,et al.  Errors, mistakes, blunders, outliers, or unacceptable results: how many? , 1997, Clinical chemistry.

[48]  M Plebani,et al.  Mistakes in a stat laboratory: types and frequency. , 1997, Clinical chemistry.

[49]  Suzanne Bakken,et al.  Impact of a physician's order entry (POE) system on physicians' ordering patterns and patient length of stay , 2002, Int. J. Medical Informatics.

[50]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

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

[52]  J. P. Kichak,et al.  Computerized physician order entry: helpful or harmful? , 2003, Journal of the American Medical Informatics Association : JAMIA.

[53]  P J Howanitz,et al.  Changes in emergency department turnaround time performance from 1990 to 1993. A comparison of two College of American Pathologists Q-probes studies. , 1997, Archives of pathology & laboratory medicine.

[54]  Mario Plebani,et al.  Errors in laboratory medicine. , 2002, Clinical chemistry.

[55]  Michael Weiner,et al.  Research Paper: Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry System , 1999, J. Am. Medical Informatics Assoc..

[56]  T. Brennan,et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. , 2000, Medical care.

[57]  Glen Geiger,et al.  Methodology for evaluating physician order entry (POE) implementations. , 2003, Journal of evaluation in clinical practice.

[58]  D W Bates,et al.  A computer based intervention to reduce unnecessary serologic testing. , 1999, The Journal of rheumatology.

[59]  D. Bates,et al.  Does the computerized display of charges affect inpatient ancillary test utilization? , 1997, Archives of internal medicine.