Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice
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 electron...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-01-01
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| Series: | Informatics in Medicine Unlocked |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352914823001545 |
| _version_ | 1797690899701956608 |
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| author | Matthias Weemaes Jeroen Appermont Joris Welkenhuysen Ivo Salden Peter Leemans Nicole De Wel Katja Vanoosterwijck Jef Vanderoost Herman Arnauts Leen Antonio Brigitte Decallonne Dirk Vanderschueren Chantal Mathieu Marc Van Ranst Florent Vanstapel Ann Verdonck |
| author_facet | Matthias Weemaes Jeroen Appermont Joris Welkenhuysen Ivo Salden Peter Leemans Nicole De Wel Katja Vanoosterwijck Jef Vanderoost Herman Arnauts Leen Antonio Brigitte Decallonne Dirk Vanderschueren Chantal Mathieu Marc Van Ranst Florent Vanstapel Ann Verdonck |
| author_sort | Matthias Weemaes |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T02:05:45Z |
| format | Article |
| id | doaj.art-00c221815756492cb3d28548e4774867 |
| institution | Directory Open Access Journal |
| issn | 2352-9148 |
| language | English |
| last_indexed | 2024-03-12T02:05:45Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Informatics in Medicine Unlocked |
| spelling | doaj.art-00c221815756492cb3d28548e47748672023-09-07T04:44:12ZengElsevierInformatics in Medicine Unlocked2352-91482023-01-0141101308Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practiceMatthias Weemaes0Jeroen Appermont1Joris Welkenhuysen2Ivo Salden3Peter Leemans4Nicole De Wel5Katja Vanoosterwijck6Jef Vanderoost7Herman Arnauts8Leen Antonio9Brigitte Decallonne10Dirk Vanderschueren11Chantal Mathieu12Marc Van Ranst13Florent Vanstapel14Ann Verdonck15Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumIT department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumIT department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumCentre for Human Genetics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumIT department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumIT department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumQuality Service department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Emergency Department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Ambulatory Consultations, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, BelgiumDepartment of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory of Clinical and Epidemiological Virology (Rega Institute), Catholic University Leuven, Oude Markt 13 - bus 5500, 3000, Leuven, BelgiumDepartment of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Public Health, Biomedical Sciences Group, Catholic University Leuven, Oude Markt 13 - bus 5500, 3000, Leuven, BelgiumDepartment of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Corresponding author.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.http://www.sciencedirect.com/science/article/pii/S2352914823001545Critical pathwaysDiagnostic testsEvidence-based practiceMedical order entry systemsPractice patterns, physiciansUtilization review |
| spellingShingle | Matthias Weemaes Jeroen Appermont Joris Welkenhuysen Ivo Salden Peter Leemans Nicole De Wel Katja Vanoosterwijck Jef Vanderoost Herman Arnauts Leen Antonio Brigitte Decallonne Dirk Vanderschueren Chantal Mathieu Marc Van Ranst Florent Vanstapel Ann Verdonck Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice Informatics in Medicine Unlocked Critical pathways Diagnostic tests Evidence-based practice Medical order entry systems Practice patterns, physicians Utilization review |
| title | Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| title_full | Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| title_fullStr | Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| title_full_unstemmed | Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| title_short | Implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| title_sort | implementation of a care pathway based computerized order entry system streamlines test ordering and offers tools for benchmarking clinical practice |
| topic | Critical pathways Diagnostic tests Evidence-based practice Medical order entry systems Practice patterns, physicians Utilization review |
| url | http://www.sciencedirect.com/science/article/pii/S2352914823001545 |
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