Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis

Abstract

IntroductionRelevant clinical information is vital to inform the analytical and interpretative phases of most investigations. The aim of this study is to evaluate the impact of implementation of computerised provider order entry (CPOE), featuring order-specific electronic order entry forms (eOEFs), on the quality and quantity of clinical information included with investigation requests.MethodsThe CPOE module of a commercially available electronic health record (Cerner Millennium) was implemented at a large, tertiary care centre. The laboratory information management system was interrogated to collect data on specimens sent for microbiological culture 1 year before implementation of CPOE (2018), immediately post implementation (2019) and 6 months post implementation (2020). An interrupted time series analysis was performed, using text mining, to evaluate the quality and quantity of free-text clinical information.ResultsIn total, 39 919 specimens were collected from 16 458 patients. eOEFs were used to place 10 071 out of 13 735 orders in 2019 (73.3%), and 9155 out of 12 229 orders in 2020 (74.9%). No clinical details were included with 653 out of 39 919 specimens (1.6%), of which 22 (3.4%) were ordered using eOEFs. The median character count increased from 14 in 2018, to 41 in 2019, and 38 in 2020. An anti-infective agent was specified in 581 out of 13 955 requests (4.2%) in 2018; 5545 out of 13 735 requests (40.4%) in 2019; and 5215 out of 12 229 requests (42.6%) in 2020. Ciprofloxacin or piperacillin-tazobactam (Tazocin) were mentioned in the clinical details included with 421 out of 15 335 urine culture requests (2.7%), of which 406 (96.3%) were ordered using eOEFs. Subsequent detection of in vitro non-susceptibility led to a change in anti-infective therapy for five patients.ConclusionsImplementation of CPOE, featuring order-specific eOEFs, significantly and sustainably improves the quality and quantity of clinical information included with investigation requests, resulting in changes to patient management that would not otherwise have occurred.

Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account

“…There are some published advantages in computerised ordering 18 ; in laboratory blood test ordering, electronic orders significantly and sustainably improved the quality of clinical information included. This resulted in changes to patient management that would not otherwise have occurred.…”

“…14 The UK has lagged behind the international community in developing and implementing CPOE, but CPOE usage is now increasing across the UK. [15][16][17][18] Our aim is to audit uptake of electronic orders over time for diagnostic, therapeutic and support services within the clinically led CPOE system known as the Prescribing, Information and Communication System (PICS) at University Hospitals Birmingham NHS Foundation Trust (UHB). To our knowledge, this is the first study looking at uptake of an ordering system hospital wide within the NHS.…”

“…Much of the literature comes from North America where orders are often connected with billing, which is not needed in the NHS setting 14. The UK has lagged behind the international community in developing and implementing CPOE, but CPOE usage is now increasing across the UK 15–18…”