Event-condition-action Rule and Database Approach Supporting Clinical Laboratory Test-ordering Protocol Specification, Execution and Management: An

period, the number of tests ordered has increased dramatically. As a result, the cost of clinical laboratory testing has increased considerably [1]. This has prompted the introduction of research and initiatives aimed at controlling clinical laboratory utilization without affecting the continued improvement of the quality of patient care. The solutions that have been attempted with limited success include feedback , participation, education, cost awareness, financial incentives, penalties or risk sharing, administrative change and rationing [2] [3] [4]. One of the most effective and proven approaches to clinical laboratory utilization management is the use of clinical test-ordering protocols [5]. Clinical protocols are formalized medical knowledge about how to handle specific clinical problems and performing specific tasks such as planning treatment and ordering appropriate and relevant tests [6]. Some of the issues that have been the focus of attention within the medical informatics community include distribution, sharing, modelling, representation and execution of clinical guidelines [7]. The major challenges being faced are those of modelling and specifying clinical guidelines and protocols in a manner that facilitates their integration into information systems, their subsequent management and their linking with the electronic healthcare records. According to Smith and McNeely [8], to have a marked effect on costs and to be functional , clinical test-ordering protocols must: q address high-volume ordering areas q be amenable to a few simple rules that can easily be remembered by clinicians q be conveniently expressed in the test order q be easily carried out by clinical laboratory staff q require general agreement among clinicians, laboratories, and payment agencies. Smith and McNeely further noted that these constraints have severely limited the number of areas in which clinical test-ordering protocols can be implemented. Furthermore, a drawback to the use of test-ordering protocols for laboratory utilization control is that clinicians do not show a test-ordering behaviour change in response to the deployment or dissemination of clinical guidelines even when they are in agreement [9] [10] [11]. Despite the above drawbacks, it is beneficial to provide computerized support for clinical test-ordering protocols as this would give rise to a number of desirable outcomes, which include: q reduction of unnecessary test orders, which will reduce laboratory costs [12] [13] [14] [15], Supporting clinical laboratory test-ordering protocol specification, execution and management: an event–condition– action rule and database approach The cost of clinical laboratory testing has increased considerably during the past decade. This has prompted research and …