The Implications of e-ordering for the communication environment of hospital laboratory services

Objective: To examine the impact of a new Computerised Provider Order Entry (CPOE) system on the organisational communication environment of the Central Specimen Reception (CSR) area of a large hospital pathology service. Design: A formative study using iterative feedback channels for the collection of qualitative data from focus groups (n=5), interviews (n=67) and ethnographic observation sessions (n=22). Theoretical sampling techniques were used to extend the sampling base and to develop and test emerging hypotheses and ideas. Setting: This study was carried out during the implementation of the new system between November 2005 and October 2007. It concentrated on the CSR department of a pathology service based at a major tertiary referral and teaching hospital in Sydney, Australia. Main outcome measures: The study utilised Huber and Daft's communication environment framework of information load (quantity and variety), complexity (diversity and interdependence of the information) and turbulence (the degrees of instability and randomness) as a lens through which to analyse, evaluate and present its findings. Results: Pathology services are information intensive units that rely on the timely communication of information to contribute to the delivery of patient care. The new CPOE system impacted on the organisational informational load of the CSR department requiring it to assume greater responsibility for monitoring requests. The introduction of new tasks associated with greater levels of CSR accountability for rescheduled or cancelled test requests, in turn, increased the complexity of the communication environment. The findings also demonstrated increased turbulence in the communication environment exemplified by the initial period of instability created by changes in work routines and modifications of the ordering process. Conclusion: The communication and processing of information are key facets of how organisations function. Investigation of the organisational communication environment should be an integral part of the challenging task of implementing CPOE systems in healthcare settings.