Introduction
The electronic health record (EHR) has become a fundamental tool in health care. The integration of a large amount of clinical information from different sources has helped to save time in the provision of health care, which is basic for users to perceive the benefits of digitalisation. Also, the computerisation of manual processes reduces the possibilities of error, meaning that EHR helps to improve patient safety [1], [2], [3]. The ordering of lab tests and integration of results is one of the functionalities most frequently requested by EHR users, especially in Primary Care [4], [5], [6], [7], [8].
In Andalusia, an autonomous community in the south of Spain with 8.3 million inhabitants, implementation of a single EHR for every citizen started in 2000, integrating all health information making it available whenever and wherever necessary. This computer development was given the generic name Diraya [9].
The objective of Diraya was to fully computerise the Andalusian public health system (37 hospitals and 1500 medical centres) with common modules sharing information between them in order to achieve a genuinely single health record [10]. As part of these common modules, the lab test module (LTM) was developed.
The LTM was designed with an ambitious objective, to order a lab test from any of Andalusia's public health system medical centres, to give patients total freedom to go to the public laboratory best suited to their needs, and for the results to be available for consultation by any doctor with access to the EHR, irrespective of the doctor placing the request, or the laboratory that conducted the test. The LTM had to integrate the analytical results within the corresponding clinical episode in a standard, structured and usable manner. In addition, the module had to control the complete cycle of the analytical process: Request-Sample taking-Results, maintaining traceability throughout the entire process.
In 2007, the LTM was implemented in the Healthcare Area of the North of Córdoba (ASNC) to pilot its operation in Primary Care. It is currently implemented in 27 health departments, which use 5 different lab information systems (LIS), covering more than 5.2 million inhabitants and by the end of 2012, when its implementation is complete, it will be linked to 37 clinical laboratories of the Andalusian public health system (SSPA).
Given the great importance of this project, it is necessary to assess its impact on healthcare activities. This article aims to assess how the LTM has influenced the work of clinical and laboratory professionals, assessing their experience in daily practices to understand the strengths and weaknesses of the functional design and implementation of an LTM on a regional level.