Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study

Abstract

Objective To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency. Design Quasi-experimental controlled before and after study using routinely collected patient level data. Setting Four NHS acute hospital trusts in England. Data sources Inpatient admissions and outpatient appointments, 2000-5. Interventions A system for ordering pathology tests and browsing results (computerised physician order entry, CPOE) and a system for requesting radiological examinations and displaying images (picture archiving and communications system, PACS). Main outcome measures Requests per inpatient, outpatient, or day case patient for full blood count, urine culture and urea and electrolytes tests, and plain x ray film, computed tomography, and ultrasonography examinations.Results CPOE was associated with a reduction in the proportion of outpatient appointments at which full blood count (odds ratio 0.25, 95% confidence interval 0.16 to 0.40), urea and electrolytes (0.55, 0.39 to 0.77), and urine culture (0.30, 0.17 to 0.51) tests were ordered, and at which full blood count tests were repeated (0.73, 0.53 to 0.99). Conversely, the same system was associated with an almost fourfold increase in the use of urea and electrolytes tests among day case patients (3.63, 1.66 to 7.94). PACS was associated with a reduction in repeat plain x ray films at outpatient appointments (0.62, 0.44 to 0.88) and a reduction in inpatient computed tomography (0.83, 0.70 to 0.98). Conversely, it was associated with increases in computed tomography requested at outpatient appointments (1.89, 1.26 to 2.84) and computed tomography repeated within 48 hours during an inpatient stay (2.18, 1.52 to 3.14). Conclusions CPOE and PACS were associated with both increases and reductions in tests and examinations. The magnitude of the changes is potentially important with respect to the efficiency of provision of health care. Better information about the impact of modern IT is required to enable healthcare organisations to manage implementation optimally.

A Computerized In-Hospital Alert System for Thrombolysis in Acute Stroke

“…16,17 Although this inverse relationship may be, in part, because of patients who arrive very late and only those with short door-to-needle-time get included in the statistics, it also may be related to physicians' behavior. With a 3-hour time limit for IV tissue plasminogen activator treatment, physicians are pressed for time with patients who arrive at the ED later; however, physicians might not be so prompt to administer treatment to those with earlier arrival.…”

“…В связи с этим генерализуемость наших результатов может быть ограничена. Однако поскольку число клиник с автоматизированной системой связи возрастает в геометрической прогрессии [16][17][18], в ближайшем будущем ожидается более широкое использование системы АСНЛ. В программу BEST не включили систему помощи при инсульте на догоспитальном этапе.…”

“…В предыдущих исследованиях было показано наличие обратной связи между интервалами "onsetto-door" и "door-to-needle" [16,17]. Хотя эта связь может быть отчасти обусловлена тем, что в ста-тистический анализ включали пациентов, посту-пивших в стационар в поздние сроки от момента появления симптомов инсульта, а также только тех пациентов, у которых был короткий временно`й интервал "door-to-needle".…”

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“…38,39 Promoting an increased awareness and involvement of key stakeholders in evaluation activities will be of primary importance in this context. Efforts will in due course also need to focus on utilising and disseminating data from these effectively.…”

The NHS Information Technology (IT) and Social Care Review 2009: a synopsis

“…Concentrating resources on improving the administrative functions of prescribing, rather than exploiting the clinical benefits of e-prescribing for patients in secondary care, is not an effective use of the NHS IT budget. 7 3 Allow existing departmental systems that meet the required standards for interoperability and data sharing to remain in operation Locally developed systems that can be adapted to achieve interoperability with the rest of the NHS should not be subjected to a 'rip and replace' strategy. Where there are good systems in place that fulfil local needs, every effort should be made to integrate these systems into the NPfIT so as to avoid unnecessary disruption to patient care and unnecessary expenditure on new systems.…”