The Electronic Medical Record

Electronic ordering systems (also known as Computerised Provider Order Entry [CPOE]) enable the integration of clinical and patient data systems across the hospital. They provide clinicians with the ability to order diagnostic tests directly via a computer terminal thus eliminating the need for paper test orders which inherently have considerable potential for error.³ Electronic ordering systems are also seen as the building block for the hospital-wide electronic medical record.⁴ There has been considerable support for the introduction of electronic ordering systems across healthcare settings internationally, not least because of the significant advantages they provide pathology services and their contribution to the well-being of patients.⁵ These systems can be used to reduce the duplication of test orders, eliminate legibility problems and significantly decrease the possibility of misidentification of patient specimens and order forms.⁶ In short they can contribute to greater efficiency, effectiveness and safety in pathology services.^{7 8} Electronic ordering systems may also incorporate decision support features which can help clinicians choose the correct test, and make evidence-based decisions that improve the quality of care provided to patients.⁹

Despite the potential for electronic systems to improve effectiveness and efficiency across hospital departments, there has been slower than expected diffusion of these systems across healthcare settings over the last decade,^{10 11} and there is evidence that important features of these systems remain underutilised or poorly implemented.^{10 12} There are many reasons for this – implementation of health information and communication systems is difficult, involving a number of complex organisational and professional challenges beyond the ubiquitous technical issues.^13-15 These challenges include problems associated with reaching agreement about standards across departments (e.g., commonly agreed laboratory order sets or diagnostic algorithms relevant for specified patient conditions).¹⁶ There is also the possibility of clinical resistance to electronic ordering systems and decision support prompts¹⁷ that may be related to problems with usability, and incompatibility with existing systems and processes for performing clinical and laboratory work.¹⁸