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.
We have developed three computer modules: The LTM incorporated into the EHR for placing orders and viewing results, the management module that allows the laboratory to configure its services portfolio in the LTM and the link module for controlling electronic messaging between the different laboratory computer systems and the LTM.
The LTM is integrated into the EHR which allows lab results to be related to the medical episode giving rise to the request and to all the information stored in the
To assess the LTM's impact on healthcare activities, we prepared two surveys aimed at obtaining users’ opinions regarding the module. Both surveys were submitted by e-mail (Note: Full questionnaires are available as supplementary material).
The first survey was sent to the directors of the 27 Andalusian laboratories where the LTM had been implemented. The questions were organised in four sections. In the first two sections, laboratory professionals were asked to rate the module's reliability and
The first survey was responded by 22 laboratories (81.5% response rate). All the laboratories surveyed had between one and two years of experience using the LTM and had reached an average of 89.5% coverage in their Primary Healthcare analytical demand.
All the surveys received stated that the LTM represented an improvement compared to the previously used request system (four had electronic request systems and the rest used manual request forms). The aspects that had most improved for
Our survey results show a high degree of satisfaction amongst LTM users. From their opinions we can deduce that the LTM's functional design is suitable for handling laboratory tests required by primary healthcare for an entire region.
Of the surveys performed to assess the impact of implementing the LTM, it is worth highlighting that the opinions of laboratory professionals as well as those of clinical professionals were very similar. In both cases, important areas of improvement include
Accumulated experience has allowed us to identify different aspects that contribute to the successful implementation of a module such as the LTM in the health care environment:
To have clear functional objectives at the beginning of the project to serve as a guideline throughout their development.
A module created for laboratories must be designed by lab professionals since they are in the best position to know what clinical laboratories need.
The functional supervisor must have enough experience
Félix Gascón is functional manager of the development team for the Diraya Lab Test Module (LTM) and coordinator of the Coding and Nomenclature Group (CNG) of the Andalusian Healthcare Service, Camilo Vázquez is Indra project manager for the development team of the LTM, Pilar Jiménez is coordinator of the implementation of the LTM, José Jiménez is responsible for systems integration of the LTM, Isidoro Herrera is member of the CNG, Claudia Real is member of the Indra development team of the LTM
None of the authors has conflicts of interest with other persons or organisations that could inappropriately influence their work. Summary points What was already known before this study The EHR is a basic tool in health care which improves patient safety and releases time for other activities. EHR users frequently demand the possibility of being able to request lab tests and check their results. The coding of laboratory tests is fundamental for incorporating lab test results into the EHR as
The authors are grateful to all members of the Coding and Nomenclature Group (CNG) of the Andalusian Healthcare Service for their work on the codification of laboratory tests. Also we would like to thank to all members of the Indra development team of the Diraya Laboratory Tests Module and all the healthcare professionals of the Andalusia public healthcare system that have participated in the LTM evaluation survey. Ana Carriazo (Quality General Secretariat of Andalusian Regional Ministry of
However, paper records were found to be more user-friendly and faster to use than electronic records when it came to reviewing results with critical values [40]. Furthermore, technical problems (network, nomenclature) and clinician-user-related problems associated with electronic record and data exchange systems had negative impacts on clinical workflows [40,43,47]. In the post-post-analytical phase, the literature mostly indicated that the impacts of IT use are predominantly positive for most of the TTP activities.
