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Electronic Prescribing at the Point of Care: A Time–Motion Study in the Primary Care Setting

Authors

  • Emily Beth Devine,

    1. Biomedical & Health Informatics, School of Medicine, University of Washington, Seattle, WA
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    • Address correspondence to Emily Beth Devine, Pharm.D., M.B.A., Ph.D., Research Associate Professor, Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195-7630; e-mail: bdevine@u.washington.edu. Emily Beth Devine, Pharm.D., M.B.A., Ph.D., Adjunct Research Associate Professor, is also with the Biomedical & Health Informatics, School of Medicine, University of Washington, Seattle, WA. William Hollingworth, Ph.D., is with the Department of Social Medicine, University of Bristol, Bristol, UK. Ryan N. Hansen, Pharm.D., Senior Fellow, David K. Blough, Ph.D., Research Associate Professor, and Sean D. Sullivan, PhD, Professor & Director, Professor of Health Services and Medicine, are with the Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Seattle, WA. Nathan M. Lawless, Ch.E., R.Ph., Clinical Pharmacist and Jennifer L. Wilson-Norton, R.Ph., M.B.A., Director of Pharmacy, are with the Strategic Health Services, The Everett Clinic, Everett, WA. Diane P. Martin, Ph.D., Professor, is with the Department of Health Services, University of Washington, Seattle, WA.

  • William Hollingworth,

    1. Department of Social Medicine, University of Bristol, Bristol, UK
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  • Ryan N. Hansen,

    1. Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Seattle, WA
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  • Nathan M. Lawless,

    1. Strategic Health Services, The Everett Clinic, Everett, WA
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  • Jennifer L. Wilson-Norton,

    1. Strategic Health Services, The Everett Clinic, Everett, WA
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  • Diane P. Martin,

    1. Department of Health Services, University of Washington, Seattle, WA
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  • David K. Blough,

    1. Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Seattle, WA
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  • Sean D. Sullivan

    1. Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Seattle, WA
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Abstract

Objective. To evaluate the impact of an ambulatory computerized provider order entry (CPOE ) system on the time efficiency of prescribers. Two primary aims were to compare prescribing time between (1) handwritten and electronic (e-) prescriptions and (2) e-prescriptions using differing hardware configurations.

Data Sources/Study Setting. Primary data on prescribers/staff were collected (2005–2007) at three primary care clinics in a community based, multispecialty health system.

Study Design. This was a quasi-experimental, direct observation, time–motion study conducted in two phases. In phase 1 (n=69 subjects), each site used a unique combination of CPOE software/hardware (paper-based, desktops in prescriber offices or hallway workstations, or laptops). In phase 2 (n=77), all sites used CPOE software on desktops in examination rooms (at point of care).

Data Collection Methods. Data were collected using TimerPro software on a Palm device.

Principal Findings. Average time to e-prescribe using CPOE in the examination room was 69 seconds/prescription-event (new/renewed combined)—25 seconds longer than to handwrite (99.5 percent confidence interval [CI] 12.38), and 24 seconds longer than to e-prescribe at offices/workstations (99.5 percent CI 8.39). Each calculates to 20 seconds longer per patient.

Conclusions. E-prescribing takes longer than handwriting. E-prescribing at the point of care takes longer than e-prescribing in offices/workstations. Improvements in safety and quality may be worth the investment of time.

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