Research

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

BMJ 2008; 337 doi: 10.1136/bmj.a939 (Published 14 August 2008)
Cite this as: BMJ 2008;337:a939
  1. Simon Collin, research associate1,
  2. Barnaby C Reeves, professorial research fellow in health services research 2,
  3. Jane Hendy, research fellow3,
  4. Naomi Fulop, professor of health and health policy4,
  5. Andrew Hutchings, lecturer5,
  6. Eugenia Priedane, research fellow5
  1. 1Department of Social Medicine, University of Bristol
  2. 2Department of Clinical Sciences at South Bristol, University of Bristol, Bristol
  3. 3Health and Care Infrastructure Research and Innovation Centre, Imperial College, London
  4. 4Health and Health Policy NIHR King’s Patient Safety and Service Quality Research Centre, King’s College, London
  5. 5Department of Public Health and Policy, London School of Hygiene and Tropical Medicine
  1. Correspondence to: B C Reeves, Clinical Trials and Evaluation Unit, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol BS2 8HW barney.reeves{at}bristol.ac.uk
  • Accepted 1 June 2008

Abstract

Objective To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency.

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

Setting Four NHS acute hospital trusts in England.

Data sources Inpatient admissions and outpatient appointments, 2000-5.

Interventions A system for ordering pathology tests and browsing results (computerised physician order entry, CPOE) and a system for requesting radiological examinations and displaying images (picture archiving and communications system, PACS).

Main outcome measures Requests per inpatient, outpatient, or day case patient for full blood count, urine culture and urea and electrolytes tests, and plain x ray film, computed tomography, and ultrasonography examinations.

Results CPOE was associated with a reduction in the proportion of outpatient appointments at which full blood count (odds ratio 0.25, 95% confidence interval 0.16 to 0.40), urea and electrolytes (0.55, 0.39 to 0.77), and urine culture (0.30, 0.17 to 0.51) tests were ordered, and at which full blood count tests were repeated (0.73, 0.53 to 0.99). Conversely, the same system was associated with an almost fourfold increase in the use of urea and electrolytes tests among day case patients (3.63, 1.66 to 7.94). PACS was associated with a reduction in repeat plain x ray films at outpatient appointments (0.62, 0.44 to 0.88) and a reduction in inpatient computed tomography (0.83, 0.70 to 0.98). Conversely, it was associated with increases in computed tomography requested at outpatient appointments (1.89, 1.26 to 2.84) and computed tomography repeated within 48 hours during an inpatient stay (2.18, 1.52 to 3.14).

Conclusions CPOE and PACS were associated with both increases and reductions in tests and examinations. The magnitude of the changes is potentially important with respect to the efficiency of provision of health care. Better information about the impact of modern IT is required to enable healthcare organisations to manage implementation optimally.

Footnotes

  • Members of the steering group were Aileen Clarke, David King, David Lawrence, Charles Normand, Michael Soljak, and Ken Walton. We thank pathology, radiology, and information technology departments in the trusts and trust managers who provided the data or facilitated this process, and Cristina Masseria, who worked on the project for a year.

  • Contributors: BCR, NF, and AH took part in planning the study. SC collected and analysed the data. SC, BCR, JH, and EP took part in conducting and reporting the research. BCR is the guarantor.

  • Funding: NHS service and delivery organisation research and delivery programme (SDO/44/2003).

  • Competing interests: None declared.

  • Ethical approval: NHS Trent multicentre research ethics committee (MREC/03/4/017) and NHS trust local research ethics committees.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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