Selecting the best test ordering system must first of all define which systems can be used for test ordering. So, test orders requested by clinicians can be entered from one of the following information systems:
- CIS (Clinical Information System)
- EMR (Electronic Medical Record)
- LIS (Laboratory Information System)
- CPOE (Computerized Physician Order Entry)
All the above systems are directly related to each other and must be interoperable. The aim is to extract as much information as possible about the examinee and his background. The more complete, the better the approach to the necessary tests and the determination of the diagnosis. It is obvious that for the electronic order the connection with the Information Laboratory System (LIS) is obligatory.
Looking for the best option, we conclude that the closer a system is to laboratory IT, the better it succeeds in ordering.
The tests included in the laboratory database are the complete list of tests performed by the laboratories of the Health Organization. Non-laboratory systems usually do not have all the tests of the laboratory. This is because some tests are not needed (eg because they are not charged). One more reason is that a test charged in the laboratory can be analyzed in many individual tests (parameters). A system may also contain tests with the name of their category (eg Electrolytes) and the desired test (eg Potassium, Sodium, etc.) may not be specified.
Order from a non-laboratory system
Ordering from a non-laboratory system cannot print the final sample barcodes for use in automatic analysers. Non-laboratory systems do not handle sample accession numbers. They therefore burden the Agency with duplicate label printing. A first label until receipt by the laboratory and a second, the final one. Usually, the above systems manage the information at the document level (document number – test order). With this number they identify the content of the exams. But in this way it becomes either impossible or very difficult to add tests to the same sample (and to the same referral).
In the Hospitals that use this methodology, the addition of a test to an existing order is usually not treated electronically. The Clinician asks the laboratories to add the additional tests, by telephone. As a result, the additional test des not exist in the order. Discrepancies in the reports and statistics are created.
In addition, in order to achieve the routing of the samples in the appropriate laboratories, the clinical system is ‘obliged’ to support laboratory departments and procedures that are in fact outside its real needs. The result is an alteration in the design of its database with a direct impact on its efficiency. It is assumed that the database of an LIS has a much more specific and vertical design than a HIS / CIS in relation to laboratory data.
ERP’s systems and ordering exams
Many times, systems designed for the financial and administrative purpose, try to expand to include medical data management. It is obvious that their administrative-financial design is not the most suitable for deepening the medical data. As a result, these systems become inefficient.
The Medical Record today is based on interoperability
Today the modern Medical Record is based on interoperability. It consists of the information that the system itself handles as EMR, consisting of multiple sub-clinical systems of different medical specialties. Includes all patient-centered information held by individual systems (CIS, LIS, RIS, AP-LIS, BBMS, PACS, etc.). Modern systems are online and interoperable. The display of medical record information, is done through the collection of the information that is contained in many different medical and non-medical systems. The result is that each Health Organization enjoys the use of optimal ‘best of breed’ systems and their continuous evolution.
- The closer the ordering system is to the Laboratory System (LIS), the more efficient it is for ordering exams.
- It is not recommended to use an ordering system, which is based on and contained in administrative-financial systems.
- The most advanced system and therefore the most suitable test order system is a specialized CPOE (Computerized Practitioner Order Entry) system. If the CPOE is equipped with a CDSS system, then it is the top choice.