Bryan Bauman

Mrs. Warneke
English 12
6 Oct, 2015

Problems with Communication:

Laboratories and Physicians
According to an publication by the World Health Organization a medical laboratory three
main groups of responsibility. The patients, colleagues and society (Cordner, 13). Clear
communication between laboratories and others in the profession is a key part to being
successful. In regards to the patient, nobody wants to spend more time in a hospital than needed.
A common question from the patient is when am I released. If the doctor says that the stay has
been prolonged due to errors caused by misunderstandings affecting the patient, which may or
may not be harmful, is irritating. These errors are often caused by a miscommunication between
the testing requests, data interpretation, or others forms of information. Miscommunication is a
problem for patients and cause problems for them, but creating a system(s) that can be
commonly used to reduce errors will help with communication. Two solutions to this problem
are the Computer Physician Order Entry system, and the hand-off method.
Pointing out a problem is the easy part but understanding why a problem occurs is the
first step to creating an effective solution. As pointed out before the problem is
miscommunication. In an article written by Dr. Butterly and Dr. Horowitz, Controversies in
Laboratory Medicine: A Series From the Institute for Quality in Laboratory Medicine, they list
some reasons why miscommunication occurs. Failure to provide useful information, performance
of the wrong test, and standardization of units to name a few. In another article written by

Christopher M. Blanchette and his team of researchers that errors caused in medical facilities are
caused by multiple factors. A few factors include knowledge deficit, distractions, inexperience,
and faulty computer interface. These factors can create negative consequences for the quality of
treatment provided such as unnecessary tests, or causing the patient harm, either with temporary
or permanent results. There are always going to be problems, but a solution is a start to reducing
them.
The Computer Physician Order Entry (CPOE) system was created to help reduce the
amount of errors created by miscommunication between physicians and laboratories by making
electronic orders of tests and other procedures. When creating an order form errors are
especially likely to occur at the prescribing stage (Blanchette). By using the CPOE system it
makes things more efficient while reducing the errors, in certain clinical situations the
introduction of new and more effective laboratory tests has influenced the management of
patients and related clinical outcomes directly. (Panteghini, 209). Sending the information put in
by the physician by electronic message will travel faster than the paper copies that it would be
replacing. Typing the order would replace handwriting the documents, which doctors could have
messy and illegible writing. If the laboratory personnel cannot read it then how do they know
what the task is. The CPOE system also reduces errors by accessing a Clinical Decision Support
System (CDSS). The CDSS helps prevent doctors from making errors by giving warnings that
could harm the patient if they proceed with the request. Some tests cannot be performed if a
patient has a predetermined condition. According to a some statistics that were arranged by
Christopher M. Blanchette and his team, although not conclusive, having a CPOE system has
shown patterns to help reduce errors. There is also much support to put CPOE systems into
hospitals, and other healthcare facilities. Supporters include; Federal HITECH Act of 2009,

National Quality Forum, and The Leapfrog Group (Computerized Provider Order Entry).
These are big names in the healthcare world, therefore there must be a great reason why they
would be backing the CPOE system. The CPOE is widely used by facilities but it is not the only
way to help lower miscommunication.
The CPOE system is not a perfect solution. Alone CPOE systems only order tests. This
can cause problems if it does not have a CDSS. High rates of adverse drug events persist in
some hospitals with entirely computerized order entry systems (Computerized Provider Order
Entry). These events will cause the patients stay to be delayed. Another problem that CPOE has
is that is not a uniform system as many different versions exist. The result of having many
different versions is not all of them are compatible with each other. If an outside company that
conducts laboratory tests has a different CPOE system, orders may not go through. Chaos and
confusion run wild. Like any solution it is a work in progress.
The hand-off method is being tested with the intention of reducing communication
between different departments of patients care and ultimately increase the quality of care given.
The main goal of the hand-off method is to get everyone involved in the treatment of a patient on
the same page by sharing important and relevant information. Missing information makes it hard
to interpret data correctly effectively for the laboratory to produce fruitful results the physician
can use. One of the points that the hand of system does is providing details of the patients
history to the receiver (Facts about the Hand-off , 2). If all the pieces are available for the
laboratory to use they can be more efficient. In a report by some of the researchers of this project
there was a 56% reduction in failed hand-offs from the start of the period to a period after
(Improving Transitions of Care). Constantly improving the system is something that will
always need to be done as new problems arise. Like the CPOE, since it is still being tested, there

are many different procedures and versions out there that differ between each facility that is
currently researching this method. As time goes on there should be better versions that influence
and shape other versions to become more uniform.
Miscommunication is a hard problem to solve in the medical field and will probably
never be completely solved with advancing technology always evolving. Both the CPOE and
hand-off systems target the root of the problem and try to lower the errors that are created with
poor communication, but I think that the CPOE is the better solution to go with. The CPOE is
already widely used in many of the medical and related facilities. It may not be perfect by itself
but by adding programs and upgrades to accompany it it can increase its efficiency and
capabilities. Ideas such as the hand-off method are great ways to add parts to the CPOE system.
Having different parts added to it means it can also be used in many different areas/departments
throughout the healthcare system.

Works Cited
Blanchette, M. Christopher, et. al. Potential Benefits and Problems With Computerized
Prescriber Order Entry. Medscape. 2006. n. pag. Web. 30 Sept. 2015.
Butterly, John R., and Horowitz, Richard E. Controversies in laboratory Medicine: A
Series From the Institute for Quality in Laboratory Medicine. Medscape. 2006. n. pag.
Medscape. Web. 25 Sept. 2015.
Computerized Provider Order Entry. AHRQ PSNet. U.S. Department of Health and Human
Services. 2014. Web. 30 Sept. 2015.
Cordner, Stephen, et. al. Ethical Practice In Laboratory Medicine and Forensic
Pathology. WHO Regional Publications Eastern Mediterranean Series 20. 1999. Web. 24
Sept. 2015.
Facts about the Hand-off Communications Project. Joint Commission Center for Transforming
Healthcare,n. d. PDF file. 30 Sept. 2015.
Improving Transitions of Care: Hand-off Communications. Joint Commission Center for
Transforming Healthcare, 22 Dec. 2014. PDF file. 30 Sept. 2015.
Panteghini, Mauro. The Future of Laboratory Medicine: Understanding the New
Pressures. The Clinical Biochemist Reviews 25.4 (2004): 207215. Web. 24 Sept. 2015.