Ermete: A Decision Support System for an Innovative Management of Knowledge and Prescription in Laboratory Medicine: A Trial of Two Italian Local Health Authorities

Laboratory tests play an important role in the diagnostic process. Unfortunately, their utility is at present affected by a significant rate of inappropriate prescriptions. The current strategies to solve the problem are not adequate. The aim of this study is to propose a structural solution through the Health Information Technology. Between the years 2008 and 2010, a methodology to prescribe laboratory tests with the aid of a Decision Support System (DSS), denomened Ermete, has been tested in collaboration with General Practitioners of Local Health Authorities of Rovigo and Mirano. The DSS, during the process of prescription, showed indications of appropriateness in real time and the general practitioner might or might not accept the indication. The number of prescriptions processed with DSS was compared with the number of prescriptions issued by the same physicians, in the same period of the previous year, without the assistance of the DSS. Results showed a decrease of the total number of prescriptions when the DSS was used. The reduction rate was 37.2% in Rovigo and 26.1% in Mirano. The achieved results showed that it is possible to perform the governance of prescriptions without political and administrative actions. The DSS was effective in reducing inappropriateness and in managing knowledge.