BloodLink / BloedLink- OpenClinical demonstrator applications

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The applications accessible from this site are for demonstration purposes only. They have not been validated for clinical use and must not be used for real patient encounters.

Demonstrations of clinical applications

BloodLink

Decision support application for blood test ordering in General Practice

developed by

clinical domains

keywords

Institute of Medical Informatics, Erasmus University, Rotterdam

Blood tests, primary care

Decision support

status

access demonstrator

Advanced prototype, in clinical practice

[Self-extracting zip file. English language demonstrator version of Bloodlink developed for OpenClinical by Mees Mosseveld.]

description

Bloodlink is a system designed to provide GPs with decision support in the use of clinical laboratory diagnostic blood tests. The system is based on guidelines produced by Dutch College of General Practitioners which involve the use of diagnostic blood tests. A controlled randomised clinical trial was carried out in 1996-7 to evaluate the impact of the system on test ordering. Use of the guideline-based Bloodlink system was compared with use of a simpler system based on the notion of a restricted test order form. Use of Bloodlink resulted in a significant change in clinical behaviour: the average number of tests requested by general practitioners using Bloodlink dropped by over 20%. The system was also found to bring about an improvement in the quality of test ordering.

Bloodlink is [2002] being used by some 40 GPs in the Delft region of the Netherlands. A second intervention trial, focused on monitoring indications for test ordering before and after an intervention will be carried out in 2002. This will allow the influence of BloodLink on indication-oriented test ordering to be assessed. For the study, which will involve 230 Dutch general practitioners, the Windows version of BloodLink has been integrated with the Dutch MicroHis GP system.

BloodLink wasintegated with the Electronic Prescription System (EVS) developed by the Dutch Association of General Practitioners (Landelijke Huisartsen Vereniging) and the Dutch College of General Practitioners (Nederlands Huisartsen Genootschap). The current EVS is a stand alone module that comprises decision support for test ordering based on BloodLink, a electronic prescription module and patient information letters.

BloodLink guidelines

Liver disorders

Hepatitis B

Part of BloodLink recommendations screen

references

van Wijk MA, van der Lei J, Mosseveld M, Bohnen AM, van Bemmel JH. Compliance of general practitioners with a guideline-based decision support system for ordering blood tests. Clin Chem. 2002 Jan;48(1):55-60.

[PubMed] [clinchem.org]

" BACKGROUND: Guidelines are viewed as a mechanism for disseminating a rapidly increasing body of knowledge. We determined the compliance of Dutch general practitioners with the recommendations for blood test ordering as defined in the guidelines of the Dutch College of General Practitioners. METHODS: We performed an audit of guideline compliance over a 12-month period (March 1996 through February 1997). In an observational study, a guideline-based decision support system for blood test ordering, BloodLink, was integrated with the electronic patient records of 31 general practitioners practicing in 23 practices (16 solo). BloodLink followed the guidelines of the Dutch College of General Practitioners. We determined compliance by comparing the recommendations for test ordering with the test(s) actually ordered. Compliance was expressed as the percentage of order forms that followed the recommendations for test ordering. RESULTS: Of 12 668 orders generated, 9091 (71%) used the decision-support software rather than the paper order forms. Twelve indications accounted for>80% of the 7346 order forms that selected a testing indication in BloodLink. The most frequently used indication for test ordering was "vague complaints" (2209 order forms; 30.1%). Of the 7346 order forms, 39% were compliant. The most frequent type of noncompliance was the addition of tests. Six of the 12 tests most frequently added to the order forms were supported by revisions of guidelines that occurred within 3 years after the intervention period. CONCLUSIONS: In general practice, noncompliance with guidelines is predominantly caused by adding tests. We conclude that noncompliance with a guideline seems to be partly caused by practitioners applying new medical insight before it is incorporated in a revision of that guideline. "

van Wijk MA, van der Lei J, Mosseveld M, Bohnen AM, van Bemmel JH. Assessment of decision support for blood test ordering in primary care. a randomized trial. Ann Intern Med. 2001 Feb 20;134(4):274-81.

[PubMed] []

" "

van Wijk MA, Bohnen AM, van der Lei J. Analysis of the practice guidelines of the Dutch College of General Practitioners with respect to the use of blood tests. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):322-31.

[PubMed] []

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van Wijk M, Mosseveld M, van der Lei J. Design of a decision support system for test ordering in general practice: choices and decisions to make. Methods Inf Med. 1999 Dec;38(4-5):355-61.

[PubMed] []

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The impact of guideline-based decision support on general practitioners' test ordering. Powerpoint presentation by Marc van Wijk for the AACC Anual Symposium in Chicago, July 2001.

[OpenClinical]

N/A

contact

links

Dr. Marc van Wijk
Institute of Medical Informatics
Erasmus University
Rotterdam.

Institute of Medical Informatics, Erasmus University, Rotterdam

acknowledgements

Marc van Wijk, Mees Mosseveld, Johan van der Lei, Erasmus University, Rotterdam

Entry on OpenClinical: 12 November 2001
Last main update: 12 November 2001

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