The Impact of the Implementation of Electronic Ordering of Pathology Requesting and the Quality and Effectiveness of Hospital Pathology Services – Building a Robust Evidence Base and Benefits Framework for Successful e-Health Diffusions (Current)
Description
This project is developing performance indicators to evaluate the quality and effectiveness of electronic test ordering in a range of hospitals in metropolitan, regional and rural settings. It is being conducted in three stages, and the evaluation will examine the quality of pathology test orders, laboratory turnaround times, re-testing and add-on testing.
Grant Recipient
University of New South Wales (UNSW)
Aim
to provide research evidence, employing key indicators of pathology ordering efficiency and effectiveness, of the impact of electronic test ordering on the utilisation and delivery of hospital pathology services across five hospitals in different demographic settings (major metropolitan, regional, country) within the South Eastern Sydney (Prince of Wales, Royal Hospital for Woman and St George) and Illawarra Shoalhaven (Wollongong, Shoalhaven) Local Health Networks.
Objectives
provide key comparative (across hospitals) and longitudinal (over time) evidence about the effect of electronic ordering systems
produce a suite of benefits realisation indicators that can be used to monitor what works (or what doesn’t work), where, and in what circumstances
utilise a set of performance indicators to evaluate the impact of electronic ordering on the quality use of pathology across the following areas:
the legibility and completeness of laboratory test orders and the impact on Central Specimen Reception work processes (quality of test orders)
the timeliness of the pathology laboratory process (laboratory turnaround times)
the volume and mix of tests ordered examined by such factors as Diagnosis Related Groups, ward location or department, and adjusted for clinical activity where appropriate
the impact on re-test and add-on test rates.
This project is current and the aim and objectives are in the process of being achieved.
Outcomes
By early December 2011 the following activities had been achieved:
ethics approval granted
extraction of first data for analysis concentrated on:
Laboratory Information System (turnaround times, test order volumes, re-test rates and add-on rates)
Central Specimen Reception
analysis of Central Specimen Reception work processes have been undertaken to investigate the effect of electronic medical record and incident reporting on the laboratory test processing procedures, such as ward/laboratory communication and efficiency.
Computer Assisted Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 1 (iNvestigate Project) (2010)
Description
This project sought to develop a software platform for use in pathology case studies for junior doctors. The iNvestigate website is: http://investigate.med.unsw.edu.au/
Grant Recipient
University of New South Wales (UNSW)
Aim
to develop a fully functioning software platform to use as a base for an on-line educational program for junior doctors.
This aim was achieved by this project.
Outcomes
An alpha version of the software program was demonstrated to the Quality Use of Pathology Committee (QUPC) on 24 February 2010. Since that time first-pass testing of all components of the software commenced with senior undergraduate medical students recruited to evaluate two beta versions. This led to major changes to selected areas of the program.
One cycle of feedback from academic staff in pathology at the UNSW and from Dr Wendy Pryor at the Royal College of Pathologists of Australasia (RCPA) identified issues similar to those noted by students, as well as suggestions for enhancing the content.
Further feedback after the second major revision of the beta version was deployed from Professor Fred Dee, the originator of the LabCAPS concept, which highlighted further changes required to the interface for the User role.
The Case Builder interface was tested which led to iterative changes to certain capabilities.
Manual coding for each item solved the problems associated with linking Medicare Benefits Schedule (MBS) data to individual test items.
The process of entering results when building a case was simplified by creating a set of ‘default’ normal values for all of the tests available within iNvestigate.
A complete system of self-registration of new users has been implemented.
A graphic designer was employed to create a logo/banner for the iNvestigate website.
Providing a consistent user interaction for aggregated test items proved to be a significant challenge, mostly due to these aggregated tests not being consistently represented in the RCPA Manual. This was solved by an extensible, easy-to-use system available to users with Administrator rights to aggregate tests as needed. This catered for existing groupings and allowed the creation of new grouped items as required.
All other RCPA Manual items have been included in the fully developed iNvestigate website.
To promote interest in and the use of investigate, junior medical officers (JMOs) were engaged with directly and the developers have sought to embed iNvestigate into JMO training.
Various elements which enhance the education value and/or functionality not envisaged as part of the original design have been incorporated into the software package including:
a running tally of the cost of tests ordered based on indicative data from the MBS
an effective and visually pleasing user interface
a range of valuable administration tools including a novel and simple test aggregation tool.
Recommendations
Take steps to make iNvestigate a recommended resource disseminated nationally via the Australian Curriculum Framework for Junior Doctors Project.
Funding has been requested from the Quality Use of Pathology Program (QUPP) to create a library of 20-25 educationally rich case scenarios with input from a specialist pathologist employed on the project.
Key Project Learnings
All of the senior students who tested the website made it clear they would not read a help file or click through a help system to learn how to use iNvestigate. They suggested any relevant help should be provided on the page itself. This led to the original plan to provide a complete hyperlinked help system to be abandoned, and the user interface was re-designed so that context-relevant help was provided at the top of each page.
Feedback about problems with the dataset and omissions identified were provided to Professor Brett Delahunt, Chair of the RCPA Manual Editorial Committee. In future this is anticipated to lead to co-operative interaction and improvement of the RCPA dataset, which will in turn lead to the improvement of test availability within iNvestigate.
It is more appropriate to ask JMOs to undertake testing when a library of cases has been developed.
Follow on Initiatives and Projects
iNvestigate: Online Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 2 (2011).
