An investigation into the implications of electronic ordering systems for pathology laboratories

PhD student: Andrew Georgiou

Supervisor: Professor Johanna Westbrook
(Health Informatics Research and Evaluation Unit

Co-supervisor: Professor Jeffrey Braithwaite
(Centre for Clinical Governance Research in Health)

Issue/aim of research:

By providing clinicians with the ability to enter orders directly (eg pathology, imaging, and medication) into computers Computerised Physician Order Entry (CPOE) systems have the potential to improve the efficiency and quality of health care delivery. However, these systems are costly and risky investments and have the capacity to have a major (often unexpected) effect on hospital departmental relationships, workload, communications and culture with significant (and possibly adverse) consequences for patient care. Presently research evidence about the impact of CPOE on hospital ancillary services such as pathology laboratories is scant and variable. Very little of this research examines or contrasts the complex and diverse areas of the pathology laboratory, eg microbiology, haematology, clinical chemistry, which each have their own specific needs and expectations of CPOE. This implies that the factors that influence success or failure are not clearly understood or acted upon.

Research Questions

• What is the impact of electronic ordering on key indicators of laboratory performance?
• How do the results of these indicators relate to each other?
• What is the effect on the functioning and organisational dynamics of the laboratory?
• What impact does it have on work processes and communication patterns within the hospital?

Description of research:

This research will utilise a pre- and post-implementation multi-method design to examine the pathology laboratory test ordering process and its clinical interface. It will include quantitative analysis of relevant laboratory and hospital data alongside observation of laboratory processes and interviews/focus groups with key laboratory-based and clinical informants. This approach will enable the triangulation of data and is designed to enhance the robustness of results and maximise the study’s ability to deal with the diversity and granularity required to improve understanding of information systems and their effect on the organisations and the wider community.

Research outcome and recommendations:

The study will draw on critical realist research approaches which seek to find the inherent mechanisms that generate events in order to understand what works, for whom and in what circumstances. This involves identifying: a) how causal agents (ie CPOE) work and the mechanisms through which they function; b) the context (local, historical and/or institutional) in which they operate; and c) the resulting outcomes (eg performance, organisation, clinical).