The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time-Motion Study
William Hollingworth, PhD, Emily Beth Devine, PharmD, MBA, Ryan N. Hansen, PharmD, Nathan M. Lawless, CE, RPh, Bryan A. Comstock, MSc, Jennifer L. Wilson-Norton, RPh, MBA, Kathleen L. Tharp, Sean D. Sullivan, PhD.
J Am Med InformAssoc. 2007;14:722-730.
Does e-prescribing pose a potential detrimental impact on physician and staff workflow?
Setting: Multi-specialty integrated health-system with 14 locations in Pacific Northwest. Outpatient ambulatory care providers and staff at 3 locations were asked to allow an observer to record time-motion data for 4 hours. One location was not using e-prescribing, one used optional e-prescribing on desktop PCs located in physician offices and nursing stations, and one used optional e-prescribing on wireless laptops in the exam rooms and nursing stations. The e-prescribing software was a basic implementation at the time of the study without such enhancements as drug-drug interactions or clinical decision support for medication monitoring. 27 of 33 (82%) providers and 42 of 59 (71%) of staff members agreed to participate. Results:
Participants were observed for an average of 3.6 hours. 52% of provider time was spent on direct patient care, with 24% of staff time spent on direct patient care. With optional e-prescribing greater than 75% of prescriptions were electronic.
Providers using e-prescribing spent 3 minutes less time per hour writing and 3.9 minutes more time per hour on computer tasks than providers using paper. Overall, e-prescribing took on average 12.0 seconds longer than handwriting prescriptions. New prescriptions took 15.4 seconds longer and refill prescriptions took 4.0 seconds longer. These results were not significantly different.
There was no significant difference in staff time spent on prescribing between the sites using paper and the sites using e-prescribing.
There was no significant increase in the time taken to accomplish e-prescribing compared to handwritten prescriptions.
CPOE and e-prescribing are thought to be integral components to decreasing medication errors and adverse drug events. A potential barrier to their adoption is physician resistance to these systems, often due to worries that they will increase the time needed to perform routine tasks like prescribing. Hollingworth points out that in 2004 64% of ambulatory visits included an order for medication, and that at the average visit 1.7 medications were ordered. It is reassuring that there is no significant time difference between handwriting and e-prescribing. Even with the large average numbers of prescriptions the daily time burden for physicians should be relatively small. If e-prescribing reduces errors significantly the small time burden is well worth it. One limitation of this study is that decision support was not active. If it was active it may have adversely affected the time burden of e-prescribing.
Sengstack(1) writes that physician buy-in is a key element to the success of an EHR and CPOE implementation. This study is useful in giving a realistic view of the time e-prescribing takes. It has at times been oversold as saving time, leading to physician frustration when the promise doesn’t live up to the reality. This study helps to reassure physicians that they are not facing an inordinate time burden with the adoption of e-prescribing.
1 Sengstack PP, Gugerty B. CPOE Systems: Success Factors and Implementation Issues. Journal of Healthcare Information Management. 2004;18(1):36-45.