Impact of a laboratory-led Computerized Physician Order Entry system on test appropriateness, costs, and variability...

To evaluate the impact of implementing a Computerized Physician Order Entry (CPOE) system designed and managed by Clinical Laboratory professionals, on laboratory test demand in Primary Care (PC). The study assessed its effect on laboratory costs, intra- and inter-physician variability, and the use of high-demand tests.

A prospective longitudinal study was conducted at Hospital Clínico Universitario in Valencia, Spain, involving 154 Primary Care Physicians (PCPs) across 28 centers. A before-and-after analysis compared laboratory test requests during a six-month period before (PRE) and after (POST) CPOE implementation. Cost indicators, variability metrics, and request patterns for selected high-demand tests were analyzed using parametric and non-parametric statistical tests according to data distribution.

A significant reduction in laboratory costs was observed following the implementation of the CPOE system. The median cost per request decreased by €5.69 (14%), with 89% of PCPs reducing their test-related expenditures. The number of tests per request also dropped significantly (median reduction: 2.2 tests), with a notable decrease in the use of redundant or low-value tests. Despite stable total request volumes, overall costs and test variability per request were significantly reduced. Individual test analysis showed improved appropriateness, with marked declines in unnecessary use of tests such as PSA, Vitamin B12, Folate, and serum iron. Conversely, appropriate increases were noted in the use of tests like urinary albumin.

CPOE systems managed by Clinical Laboratory professionals are effective tools for optimizing test demand in PC. Their implementation can improve cost-efficiency, reduce clinical variability, and promote appropriate test utilization.