Multi-method system simulation analysis as an implementation and evaluation tool for computerised pathology order entry systems

Background: Computerised Physician Order Entry (CPOE) systems have the potential to lead to improvements in the quality and efficiency of health care delivery. However, CPOE systems have been found to be difficult and complex to implement and there has been an increased awareness of the need for rigorous evaluation techniques. To date pathology CPOE systems have not been widely researched or evaluated. System Simulation (SysSim) is the application of computer simulation to explore, understand and improve the interaction between structure and action in the health care sector. Objectives: This paper describes the methods for designing a robust SysSim model and illustrates how it will be used to examine the impact of CPOE on care delivery and outcomes. Methods: The model development will use integrated simulation methods that incorporate both agent and system dynamic approaches using the Anylogic object-oriented, Java-based software package. The model will be built using a comprehensive, iterative approach incorporating testing and refinement stages that include: conceptual development and construction; model calibration; simulation and policy testing; and performance experimentation. Results: Our review of the literature identified 10 domains which have been the focus of evaluations of the impact CPOE on pathology services and these have used 39 different indicators. The problem however is that the information contained in individual indicators is usually presented in isolation from other important indicator data. Discussion and conclusions: SysSim allows us to link up data and information and demonstrates how indicators interact and as such provides a powerful evaluation technique. SysSim makes it possible to take a holistic view to evaluation and implementation priorities, based on the understanding that many things are connected to each other. It has the potential to improve planning in complex healthcare environments and to a) investigate the impact of pathology CPOE systems; b) develop methods to increase their uptake and efficiency; and c) evaluate possible response scenarios for dealing with the challenges of implementation.