3.6. The common categories of Computerized Provider Order
Entry
In the study conducted by Timothy Huerta and others in 2013,
to evaluate the contribution of an automated laboratory test order management
system (eLAB)on the duplication and unnecessary ordering of laboratory and
diagnostic tests within U.S hospital, they have identified three major class of
CPOE prior the analysis. The first and the most frequently discussed in
litteratre is the electronic prescribing (ePrescribing or eRx).due to the focus
on patient safety, and the significant role that medication errors play in
compromising care quality. The second isthe CPOE involves the standardization
of clinical order set entry that describe the activities of care that a patient
should receive prior or after an intervention. We can cite the dietary
restrictions, physical therapy and wound care. The use of the second class
CPOEhas been the slowest due to the complexity and workload to manage that
category of data.(Huerta, Thompson, Ford, & Ford, 2013)
The third class of CPOE, and the subject of our study, is the
use of electronic Lab order Entry Management(eLAB )systems for ordering of
diagnostic tests that are conducted in a controlled manner such as imaging and
microbiology test. eLAB systems provide a structured and auditable framework in
which laboratory data may be captured and communicatedthrough the establishment
of a single point of contact for laboratory ordering and results.The basic
principal of eLAB systems is that redundant tests can be minimized and clinical
decision-making is further supported.(Huerta et al., 2013)
3.7. Works on the design and implementation of Health
Information system
3.7.1. Design of
the Open Medical Record System (OpenMRS) to support HIV treatment in Rwanda
In the study conducted by Chritian Allen and others in Rwanda
in 2007, to support the process of patient registration, therapy initiation and
treatment monitoring' of HIV-affected person, the research team has developed
and implemented the OpenMRS system to support their user's requirements. Open
Medical Record System (OpenMRS) is a web-based electronic medical record system
that has been developed to address the problem of configuring EMR systems to
suit new sites, languages and diseases after the deployment. (Allen et al.,
2007)
The user's requirements of Rwanda was based on the management
of HIV patient on active anti-retroviral (ARV)treatment and Tuberculosis
treatment (TB). In their methodology to find the system that will meet the need
to support new HIV and Multi drug resistance (MDR)-TB treatment projects, the
research teamneeded a system that isvery flexible and scalable andthat will not
require expert programming skills to add new forms or tailor it to new sites,
languages or diseases requirements.The system should alsoshould be web based
andshould allow local «offline» data entry. (Allen et al., 2007)
After looking for an existing EMR systems,they found thateven
though some commercial EHR system could fulfill a part on their requirements,
they areclosed, proprietary and, typicallyexpensive and not designed to be
extended on the sites after the system deployment. And, the small number of
open source EMR available do not have the characteristics required for the
project. So the team decided to develop a new system architecture called
openMRS.(Allen et al., 2007)
The OpenMRS system is built in Java using the Spring
application framework and the Hibernate for back-end data persistence over
MySQL database or any Relational Database Management System (RDBMS) that
support hibernate. The originality of OpenMRS comparing to other open source
system is the integration of a comprehensive data dictionary for all clinical
data that allow new data model to be added without programming and altering the
database structure.(Allen et al., 2007)
The laboratory data collection and management system was not
part of the initial project and the specific need of order entry system did not
allow the integration of this module in OpenMRS. To solve this problem, a Java
standalone systemhave been developed as asimple laboratory data collection
application using MySQL database to meet thestandard needs of the country.This
module willallow to search the patient, to register lab orders and results, to
send sent alerts as an SMS message to a clinician's mobile phone using the
Skype™ Application Programing Interface (API). The lab data can be
synchronized with openMRS using health level 7 (HL7). Other functional modules
as Report module and pharmacy data management have been also integrated later
easily with the use of HL7. (Allen et al., 2007)
But the main challenge in the openMRS system architecture is
the data synchronization of all local site with the main server on line, since
OpenMRS need reliable internet connection to correctly synchronize the
data.(Allen et al., 2007)
| 
