Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice

Abstract

Background and aims: This is a narrative report on the development of specifications and of the stepwise implementation of a computerized physician order entry system (CPOE) in the University Hospitals Leuven, based on order sets integrated in care pathways. Integration of the CPOE into the electronic health record optimally supports those care pathways. Materials and methods: We investigated adherence to consensus-based use of laboratory tests. We analysed data post- versus pre-implementation test requests for departments selected to cover various patient populations, using the Mann-Whitney U test corrected for the False Discovery Rate. Results: We investigated the effect on the number of tests post- versus pre-implementation. In the emergency and inpatient wards, the CPOE implementation resulted in decreases in requests for uric acid, total protein, direct bilirubin, reticulocyte count, and increases in requests for albumin, glucose and calcium. In the outpatient clinics, where the medical specialties already used non-computerized consensus-based test requesting strategies, effects on the number of requested tests were marginal. In all settings, operational improvements could be inferred: the centrally managed CPOE system resulted in fast and well-controlled management of test strategies, digital traceability of the laboratory test requesting process, automatic archiving of requests, assurance of availability of obligatory information. Conclusions: Overall, test requesting strategies improved towards more consensus-based and operational benefits resulted in time gains and improved efficiency of time spend.

Keywords

• Critical pathways
• Diagnostic tests
• Evidence-based practice
• Medical order entry systems
• Practice patterns, physicians
• Utilization review