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Physician inpatient order writing on microcomputer workstations. Effects on resource utilization

Authors

Tierney WM, Miller ME, Overhage JM, McDonald CJ

Journal

JAMA

Publication Date

1993 Jan 20

Volume

269

Issue

Pages

379-83

HIT Description: Electronic Health Record (EHR) used for inpatient computerized physician order entry More info...
Purpose of Study: Measure the effects on resource utilization when physician enter inpatient orders on computerized workstations.
Years of study: 1990-1991
Study Design: Randomized controlled trial
Outcomes: Total charges per hospital visit, length of stay and hospital costs.

Summary:

Settings: Six internal medicine wards within a public academic hospital, with all patients cared for by housestaff, fellows and faculty attendings.
Intervention: Implementation of computerization
Evaluation Method: Electronic data extracted from a set of networked microcomputers on which inpatient ordering occurred, the EHR documentation system, and financial/billing system. Also some data presented were collected from a time-motion study and a user survey.
HIT System: Regenstrief Medical Record System, an in-house developed EHR system, which supports writing of orders into computerized system.
Healthcare Utilization: 12.7% reduction in total charges per admission for patients in the intervention group, with similar reduction in bed charges, test charges and medication charges. On average, the intervention group had a 0.89 per day reduction in length-of-stay versus the control group.
Changes in efficiency and productivity: Intern physicians in the intervention group spent an average of 33 minutes/day longer writing orders (avg. 5.5 minutes/patient/day)� � Medications were filled sooner for both admitting orders (63 minutes) and daily drug orders (34 minutes) than for patients in the control group.� � Survey of the intervention group revealed than most felt that the accuracy of orders was improved (75%). Less felt that their work was made faster (44%), but about half (52%) said that their work was made easier.
Time needed to accrue benefit: Benefits demonstrated prospectively during 17-month study period.�

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