Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study
2008

Impact of IT Systems on NHS Efficiency

Sample size: 4 publication Evidence: moderate

Author Information

Author(s): Collin Simon, Reeves Barnaby C, Hendy Jane, Fulop Naomi, Hutchings Andrew, Priedane Eugenia

Primary Institution: University of Bristol

Hypothesis

What is the impact of CPOE and PACS on clinical and operational efficiency in NHS hospitals?

Conclusion

CPOE and PACS were associated with both increases and reductions in tests and examinations, indicating mixed effects on healthcare efficiency.

Supporting Evidence

  • CPOE reduced the proportion of outpatient appointments where certain tests were ordered.
  • PACS was associated with a reduction in repeat plain x-ray films at outpatient appointments.
  • CPOE led to an almost fourfold increase in urea and electrolytes tests among day case patients.
  • PACS increased the number of computed tomography requests at outpatient appointments.
  • Both systems showed mixed effects on various efficiency outcomes.

Takeaway

This study looked at how two computer systems used in hospitals changed the way tests are ordered. Sometimes they helped reduce unnecessary tests, but other times they led to more tests being done.

Methodology

Quasi-experimental controlled before and after study using routinely collected patient level data.

Potential Biases

Potential for residual confounding and misclassification of tests as redundant.

Limitations

Data quality could not be verified, and the study was susceptible to confounding due to differences in case mix between trusts.

Participant Demographics

Four NHS acute hospital trusts in England.

Statistical Information

Confidence Interval

95% confidence intervals reported for various outcomes.

Digital Object Identifier (DOI)

10.1136/bmj.a939

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