Doctor of Philosophy / Computerised Provider Order Entry (CPOE) systems provide clinicians with the ability to electronically enter hospital orders for laboratory tests and services. CPOE is able to integrate with hospital information systems and provide point of care decision support to users thereby making a potentially significant contribution to the efficiency and effectiveness of care delivery. The evidence of the impact of CPOE systems on pathology services is not extensive and insufficient attention has been paid to their effect on organisational and communication processes. This thesis aimed to investigate the implications of CPOE systems for pathology laboratories, their work processes and relationships with other hospital departments, using comparative examinations to identify the tasks they are involved in and the particular needs the laboratories expect to be filled by the new system. This longitudinal study of a CPOE system was carried out over three years using multiple cases from a hospital pathology service based at a large Sydney teaching hospital. Multi-methods using quantitative and qualitative data were employed to achieve triangulation of data, theory and methods. The findings provide evidence of a significant 14.3% reduction of laboratory turnaround times from 42 to 36 minutes when laboratory data for two months were compared before and after CPOE implementation. The findings also reveal changes in the pattern and organisation of information communication, highlighting transformations in the way that work is planned, negotiated and synchronised. These findings are drawn together in a comprehensive organisational communication framework that is highly relevant for developing a contingent and situational understanding of the impact of CPOE on pathology services.

Doctor of Philosophy / Computerised Provider Order Entry (CPOE) systems provide clinicians with the ability to electronically enter hospital orders for laboratory tests and services. CPOE is able to integrate with hospital information systems and provide point of care decision support to users thereby making a potentially significant contribution to the efficiency and effectiveness of care delivery. The evidence of the impact of CPOE systems on pathology services is not extensive and insufficient attention has been paid to their effect on organisational and communication processes. This thesis aimed to investigate the implications of CPOE systems for pathology laboratories, their work processes and relationships with other hospital departments, using comparative examinations to identify the tasks they are involved in and the particular needs the laboratories expect to be filled by the new system. This longitudinal study of a CPOE system was carried out over three years using multiple cases from a hospital pathology service based at a large Sydney teaching hospital. Multi-methods using quantitative and qualitative data were employed to achieve triangulation of data, theory and methods. The findings provide evidence of a significant 14.3% reduction of laboratory turnaround times from 42 to 36 minutes when laboratory data for two months were compared before and after CPOE implementation. The findings also reveal changes in the pattern and organisation of information communication, highlighting transformations in the way that work is planned, negotiated and synchronised. These findings are drawn together in a comprehensive organisational communication framework that is highly relevant for developing a contingent and situational understanding of the impact of CPOE on pathology services.

El presente trabajo nos habla acerca de las experiencias vividas y aprendizajes adquiridos a través de 30 casos clínicos llevados a cabo en el Centro de Salud Materno Infantil Manuel Barreto y en el Hospital María Auxiliadora localizados en la ciudad de Lima- Perú. Esto incluirá tanto el diagnóstico como el manejo farmacológico y quirúrgico de las patologías y las complicaciones que puede conllevar esta. Además de las limitaciones presentadas por la coyuntura actual al llevar a cabo los casos y la importancia de realizar una buena historia clínica. Por otro lado, se discutirá acerca de la vida cotidiana de un nuevo internado dentro de una pandemia que no tiene vigencia, el cambio dentro del sistema de salud y las deficiencias que ha presentado incluso antes presentarse la pandemia. La transición de llevar el internado en un hospital a llevarlo en un centro de salud de primer nivel, y como entablar una nueva conexión y realizar trabajo en equipo tanto con tus compañeros internos como con el personal de salud (enfermeras, técnicos y residentes). Las expectativas de cómo desarrollar un nuevo internado y adecuarse a un ambiente laboral totalmente distinto al ya establecido, donde no siempre se cuenta con todos los implementos necesarios para hacer un diagnóstico oportuno. Así mismo, las competencias y actitudes mediante la realización de casos clínicos dentro de los establecimientos de salud. Por último, y lo más importante, la atención al paciente, sus dolencias y como realizar en un futuro el correcto abordaje para poder mejorar la calidad de vida del paciente. / The present paper is based on the experiences and lessons learned through 30 clinical cases carried out at the Manuel Barreto Maternal and Child Health Center and the Maria Auxiliadora Hospital located in the city of Lima-Peru. This will include both the diagnosis and the pharmacological and surgical management of the pathologies and the complications that this can bring. In addition to the limitations presented by the current situation in carrying out the cases and the importance of carrying out a good medical history. On the other hand, the daily life of a new boarding school within an unabated pandemic, the change within the health system and the deficiencies that have arisen even before the pandemic occurs will be discussed. The transition from taking the boarding school in a hospital to taking it to a first-level health center, and how to establish a new connection and engage in teamwork with both your co-interns and health personnel (nurses, technicians, and residents). Expectations of how to develop a new boarding school and adapt to a completely different working environment from the one already established, where not always have all the necessary tools to make a timely diagnosis. Likewise, competencies and attitudes through clinical cases within health facilities. Finally, and most importantly, patient care, their ailments and how to take the right approach in the future to improve the quality of life of the patient. / Trabajo de Suficiencia Profesional