Hollingworth W et al. 2007 "The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time-motion study."
Reference
Hollingworth W, Devine EB, Hansen RN, et al. The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time-motion study. J Am Med Inform Assoc 2007;14(6):722-730.
Abstract
"Electronic prescribing has improved the quality and safety of care. One barrier preventing widespread adoption is the potential detrimental impact on workflow. We used time-motion techniques to compare prescribing times at three ambulatory care sites that used paper-based prescribing, desktop, or laptop e-prescribing. An observer timed all prescriber (n = 27) and staff (n = 42) tasks performed during a 4-hour period. At the sites with optional e-prescribing >75% of prescription-related events were performed electronically. Prescribers at e-prescribing sites spent less time writing, but time-savings were offset by increased computer tasks. After adjusting for site, prescriber and prescription type, e-prescribing tasks took marginally longer than hand written prescriptions (12.0 seconds; -1.6, 25.6 CI). Nursing staff at the e-prescribing sites spent longer on computer tasks (5.4 minutes/hour; 0.0, 10.7 CI). E-prescribing was not associated with an increase in combined computer and writing time for prescribers. If it is carefully implemented, e-prescribing will not greatly disrupt workflow."
Objective
"To compare the time-efficiency of paper-based versus e-prescribing for physicians, and staff in ambulatory clinics."
Tools Used
Type Clinic
Primary care
Type Specific
Family practice, pediatrics, and internal medicine
Size
Small and/or medium
Geography
Suburban
Other Information
In the multispecialty health system located north of Seattle, approximately 2.5 million prescriptions are written per year. Three of 14 clinics were studied, with between eight and 15 prescribers and 13-25 staff.
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
"Internally-developed e-prescribing capabilities have been rolled out to each of the fourteen ... locations since 2003. The e-prescribing system uses point-and-click functionality and allows physicians to generate new or renewed prescriptions for their patients... The e-prescribing system uses [a commercial] drug database ... for medication and strength selection. Providers have the option of using pre-specified medication directions or writing free-text directions. The system obliges the prescriber to complete all prescription details before being able to sign it. These prescriptions can be printed out for the patient or e-faxed directly to any one of over 200 pharmacies. Prescriptions are automatically added to the patient's EHR medication list. Discontinued medications, and reason for discontinuation, are also available for review. The e-prescribing system optimizes medication selection by providing an automatically generated list of physician-specific favorites, based on the [clinic] formulary, and by calculating appropriate weight based, pediatric dosing. Clinic staff can use the system to initiate a prescription by filling in the pertinent information and sending the prescription to the provider for review and authorization."
Context or other IT in place
The clinic health system "first implemented an internally developed [electronic health record] EHR system in 1995; adding modules and enhancements over time. At the time of study initiation, the system included chart notes, laboratory tests and imaging re
Workflow-Related Findings
"At all three sites combined, nurses spent only a small proportion of their time (1.1 minutes per hour) on prescription or formulary related facsimiles or phone calls, there was no significant difference in this proportion between e-prescribing and paper-based sites (weighted mean difference, -0.2 minutes; -1.3, 1.0 (CI))."
"Medical assistants at the e-prescribing sites ... spent significantly more time examining charts and paperwork (5.3 minutes, 0.6, 9.9 (CI)).... There was no significant difference between e-prescribing and paper-based sites in the proportion of time that medical assistants spent on prescription or formulary related facsimiles or phone calls (0.6 minutes; -0.4, 1.5 (CI))."
"The results of our study revealed that e-prescribing did not greatly disrupt prescriber or staff workflow."
"On average, prescribers at the two e-prescribing sites spent significantly less time ... per hour (-3.0 minutes; -5.6, -0.2 CI) on writing tasks than prescribers at the paper-based site ... Conversely, prescribers at the e-prescribing sites spent more time per hour on computer-based tasks (3.9 minutes; 0.3, 7.5 CI). These changes offset each other, there was no significant increase in the total amount of time spent on handwritten and computing tasks, combined, at the e-prescribing sites (1.0 minutes; -3.4, 5.3)."
"Prescribers at the paper-based site spent a higher proportion of their time examining patients and relatively less time talking with colleagues."
"After adjustment for site, prescriber and type of prescription (new/renew) handwritten prescription[s] took fractionally less time than e-prescription[s] events (adjusted mean difference: 12.0 seconds; -1.6, 25.6 CI)."
"Nurses at the e-prescribing sites spent approximately five minutes more per hour on the computer than their counterparts at the paper-based site (5.4 minutes; 0.0, 10.7 (CI)). Although nurses spent slightly less time on writing tasks (-0.9 minutes; -2.5, 0.7 (CI)) at the e-prescribing sites, this was not statistically significant and did not offset additional computing time."
"Nurses at the paper-based site spent more time on other miscellaneous tasks, most frequently, restocking examination rooms, examining patients, looking for charts, or unoccupied."
Study Design
Only postintervention with intervention and control groups
Study Participants
Twenty-seven out of 33 prescribers (physicians, physician assistants, and advanced registered nurse practitioners) agreed to participate.