The application of computing to health care changes how, when, and where clinicians collect and retrieve patient information. Measuring the impacts of technology on clinical tasks often involves performing a time and motion study. In a time and motion study, observers follow clinicians and record how long specific tasks, such as signing a medication prescription or listening to a patient describe her symptoms, take to complete. Researchers and practice managers use time and motion study data to evaluate whether and to what extent health information technology applications, including computerized provider order entry, electronic prescribing, and electronic health records, increase efficiency - for example, by helping clinicians perform routine tasks faster.
Resources for Time and Motion Studies
Researchers at Partners Healthcare have created a tool to help others accurately capture time and motion study data. The tool - a Microsoft Access database - allows observers to record time and motion data and store them for analysis. In addition, Partners has created a user's guide for this new tool and published a journal article that provides a case example of how the tool can be used to evaluate the effectiveness of a health information technology. Together, the tool, the user's guide, and the journal article can help you measure the impact of technology on clinical workflow.
Time and Motion Database (MDB, 464 KB)
Time and Motion Database User's Guide (PDF, 456 KB)
How AHRQ Grantees Are Using Time and Motion Studies to Measure Health IT Impacts
Grant: R01 HS015430
Project Title: Health Information Technology in the Nursing Home
Principal Investigator: Jerry Gurwitz, MD
This grant is examining the extent to which adding clinical decision support (CDS) to a computerized provider order entry (CPOE) system will improve quality and reduce costs associated with medication ordering and administration for residents in long-term care facilities. A major component of the grant involves analyzing the CDS' impact on staff time, including the time of physicians entering medication orders, the time of pharmacists and pharmacy technicians filling medication orders, and the time of nurses administering medications to residents. Overall, the grant will explore whether improved prescribing practices reduce costs associated with filling and administering medications. In addition to the time-motion data, the project investigators will track medication prescribing and administration to estimate the cost of care delivery to residents.
In this project, observers are using personal digital assistants (PDAs) running PocketTimer from Stevens Creek Software, Inc. to track times manually. To capture data related to the steps in the medication handling activities performed by nurses, pharmacists, and physicians, the project investigators developed categories of tasks for each profession, using an approach similar to that used in a previous time-motion study (Overhage, et al). Final results and outcomes are expected in late 2007, and the project researchers plan to publish their findings in academic journals, as well as on the AHRQ Web site.
Grant: UC1 HS015319
Project Title: Evaluating the Impact of an ACPOE/CDS System on Outcomes
Principal Investigator: Sean D. Sullivan, PhD, RPh
This grant is examining the impact of electronic prescribing (e-prescribing) on medication errors at The Everett Clinic, an integrated ambulatory health system. Many experts believe that e-prescribing, a function of an ambulatory computerized provider order entry (ACPOE) system, reduces the incidence of medication errors by ensuring legibility and completeness of the prescription, and by alerting physicians to potential drug interactions and patient allergies. Some physicians, clinic administrators, and researchers are concerned that ACPOE systems may negatively affect clinical workflow -- the tasks and processes performed by nurses and physicians -- by increasing the time it takes nurses and physicians to do their job. Researchers at the University of Washington and The Everett Clinic designed a time-motion study to evaluate the impact of e-prescribing on physician and staff time spent on prescribing-related activities. Hopefully, the time-motion study will reveal that e-prescribing has only a small impact on physician and staff time, and that the safety benefits of e-prescribing will outweigh this potentially minor impact on clinical workflow.
The time-motion component of the grant involves observing physicians and clinic staff to capture all their activities, including those that are prescribing-related. Observers use personal digital assistants (PDAs) running TimerPro software by Applied Computer Services, Inc., to record clinic activities. The software running on the PDAs was customized to reflect the categories and tasks of interest to the investigators and the clinic staff, and was based in part on a previous study (Overhage, et al). As of September 2006, the investigators had completed a preliminary manuscript for submission to an academic journal. Final results and outcomes are expected in 2007, and the researchers intend to publish them in an academic journal, as well as on the AHRQ Web site.