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Computerized Clinical Lab

Accurate and efficient clinical laboratory testing is a critical component of high-quality patient care. The laboratory testing process consists of many steps, beginning with test selection and ordering, followed by sample collection and transport, sample processing and analysis, and finally, result reporting and interpretation. Errors or inefficiencies at any step of this testing chain can undermine the entire process and lead to suboptimal patient management. While laboratory staff are heavily involved in managing much of this process, they have traditionally been less directly involved in test selection, leaving the primary responsibility for this key first step to clinicians. However, without sufficient support in test selection, clinicians face several challenges, perhaps the most significant of which is that the menu of available tests has expanded, in both number and complexity, particularly with new molecular assays. Compounding the expanding menu are time pressures placed on physicians.

Most clinicians simply cannot be expected to stay up-to-date with every complex test and diagnostic algorithm outside their specialty. Clinicians may compensate for not knowing which test to order by ordering many tests, some of which are unneeded, putting patients at risk for wasteful or even harmful follow-up care. Alternatively, clinicians may fail to order needed tests, leading to delayed or incorrect diagnoses.

Electronic systems that allow ordering providers to directly input laboratory test orders, known as Computerized Provider Order Entry (CPOE) systems, may provide a key leverage point to improve laboratory test ordering efficiency, laboratory utilization, and patient care. Appropriate implementation and use of CPOE systems can help to overcome many of the aforementioned challenges to test selection. Herein, we present an overview of laboratory CPOE systems, including descriptions of multiple CPOE features and implementations. We focus on the demonstrated benefits of CPOE and the strategies employed to achieve these benefits. The article is based upon a combination of our experience with the implementation and use of CPOE systems and a review of the literature. Representative studies are cited to illustrate or support key concepts and provide examples of CPOE strategies and benefits.