2.2. Problem statement
Clinicians rely heavily on laboratory data to make medical
decisions. Even though there is evidence that the Electronic Medical Record
(EMR) introduction in the clinical setting has improved the management of
patient related medical record, there is still some problem to solve. One of
them is the follow up of the laboratory test result by both the referring
clinician and the patient and the exchange of information between care givers
in the facilities.(POON, KUPERMAN, FISKIO, & BATES, 2002)
Although the CPOE for laboratory result has improved the
management and access to the test result, many studies have shown that passive
retrieval of information in CPOEsystem since the clinician have to use the
computer to pull the information from the test management system has created a
loss of follow-up of the lab result, especially for outpatient comparing to
inpatient and those in emergency department.(Callen et al., 2011)
Another commonly cited problem in lab information management,
is the breakdown of communication between actors that are involved in the
patient care. The traditional practice of telephoning results to the referring
clinicians is time-consuming with potential for errors, and left other actors
like nurse out of the communication process meanwhile they are those who gave
treatments to the patient based on the guideline recommended by the clinician.
Most of laboratory management information system also do not take into account
the cross-boundary communication process with integration of the
actorsinvolved. The patient should also be associated by getting informed on
the action that should be taken for his care. Thus, sharing the right
information in time between actors involve in the patient care allow to improve
the outcome of patient care since critical test result will be shared between
actors and serviceswithin the health facility (Callen et al., 2011)
Provision of reliable internet connectivity to support use and
deployment of web based EHR as well as integration of web based Application
Programming Interface (API) is a challenge in rural area due to the lack of
interest of internet provider to invest in expensive equipment for area of low
economics opportunity.
A desktop computerized provider order entry system that will
provide an effective and efficient managementcapabilities of laboratoryorderand
facilitates the exchange of lab test information across clinical service
boundary, can be used as part of solution to this problem. Patient and
physician interactions and communication experience with the laboratory in the
proposed solution are based on the use of SMS over GSM and email to send alert
and notification.
2.3. Framework of the laboratory test order management
system
The Integrating Healthcare Enterprise (IHE) initiative defines
the laboratory order schedule workflow based on a description of interaction
processes and exchange of information in the form of use-cases, actors,
transactions. The IHE schedule workflow provide international standard of
software requirement in radiology, imaging and laboratory diagnostic
techniques.Itinvolves intensive collaboration and communication among actors by
using transaction to meet the identified process management in clinical
setting. (Spronk, 2012)
The IHE schedule workflow identified actors in term of their
applications roles in the system and the interaction between them is based on
exchange information protocol like Health Level 7 (HL7).According to the IHE,
the mains transaction identified are: patient registration and update
management, order place management, order fill management, test result
management, work order management, order result management. (Spronk, 2012)
The transactions between different actors across the clinical
setting ensure the laboratory data workflow and failed to establish one the
transactions in the system requirement implies breakdown communication of
workflow that lead to the problems cited above such as: patient
misidentification, specimen misidentification and collection error, lost to
follow up of order, poor communication between clinical services and poor
patient communication with the health facility(Plebani, 2010).
According to the requirement of a district hospital in Ghana,
the following adapted workflow (Figure 1.1) will be used as the study
framework. The framework of laboratory order in the district hospital
identifies different interactions between actors involves in the test
management processes.The Computerized Provider Order Entry (CPOE) system is the
hub of the flowchart diagram and aims to establish link between actors in term
of process management. The actorswho are involved in the lab test management of
the proposed workflow are: the patients, the nurses, the physicians, the
laboratory technicians and the public health departments.
The interaction of patient is done in the system in term of
visit at the Outpatient department and in term of reception of notification of
laboratory result. The patient can also interact with the laboratory service
without passing through the OPD in case that the laboratory order come from
another health facility. Physician, nurse and lab technician interactions are
done through the test order, the lab test management and patient appointment
with the physician inside the specific department. Public health department
receives periodic report for decision making and to produce report on disease
surveillance event (Ghana Health Service).
Figure 1.1:Adapted framework of CPOE system in the district
hospital
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