The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time-Motion Study

Department of Radiology, University of Washington, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 08/2007; 14(6):722-30. DOI: 10.1197/jamia.M2377
Source: PubMed


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 carefully implemented, e-prescribing will not greatly disrupt workflow.

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    • "Although eRx resulted in more time spent on the computer, less time was spent writing. Workflow was not disrupted and eRx was used over 75% of the time (Hollingworth et al., 2007). Bramble et al. (2013) "
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    ABSTRACT: PurposeThe purpose of this study was to review legislation, barriers and challenges, and current state of e-prescribing (eRx) in the United States.Data sourcesLiterature search of CINAHL, MEDLINE, PubMed, and Google Scholar was performed.Conclusions Challenges to eRx implementation and effective use include transcription, workflow issues, alert fatigue, educational and tangible reminders, and eRx of controlled substances.Implications for practiceFurther research could be best focused on user-friendly and interactive software improvements for both patient and provider use, bidirectional communication, and workflow studies to improve efficiency of eRx.
    Journal of the American Association of Nurse Practitioners 04/2015; DOI:10.1002/2327-6924.12263
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    • "psychological) [12,26,42,43], consult room layout [42] and patients' ability to schedule appointments [27,33]. For net benefits, care quality factors covered patient safety [38], care effectiveness [40], quality improvement [45] and guideline compliance [32,57,60,61]. Productivity factors covered care efficiency [13,27,38,42,56], coordination [24,58] and net cost including billing, staffing and maintenance costs [25,45,46,52]. "
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    ABSTRACT: Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned. For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process. Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
    BMC Medical Informatics and Decision Making 02/2012; 12(10):10. DOI:10.1186/1472-6947-12-10 · 1.83 Impact Factor
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    • "Most asthmatic patients were unable to use their inhaler correctly. Education on inhalation technique and using inhaler by a spacer equally enhanced the efficacy of inhaler drugs.31 Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of the best practice.32 "
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    ABSTRACT: Objective The objective of this study is to assess the performance of community pharmacist towards antidiabetic and antiasthma prescriptions, and also to assess the lack of information provided by community pharmacists regarding patient counseling and missing data, using a simulated patient technique. Methods A prescription including antidiabetic and antiasthma drugs was used by simulated patient to assess community pharmacist’s performance in 194 pharmacies. A performance assessment sheet was used to measure the patient counseling process. A quantitative descriptive and comparative analysis was done for the collected data. Pearson chi-square test (crosstabs) was used with a level of significance 95%). Results The analysis of the 194 pharmacies visited revealed that most of the pharmacists were male (61%), Arabs (35%) and Indians (55%) with some other nationalities. The dispensing time in the pharmacy ranged between 2 to 10 minutes. Spending time with patients was not affected by gender (p-value 0.087), slightly affected by nationality (p-value 0.04), and highly affected by age (p-value 0.002) leaning towards older pharmacists who spent more time with patients than younger pharmacists. Most pharmacists (90%) started preparing the prescription once they received the prescription with no actual prescription screening. fifty five percent of the pharmacists asked about the duration of the treatment after preparing the prescription. ninety six percent did not counsel patients about diet, exercise and lifestyle changes. Less than 40% asked if the prescription was intended to be used for the same patient. Conclusion This study recommends that health authorities consider follow up plans in order to ensure the best pharmaceutical care is provided by community pharmacies.
    Pharmacy Practice 03/2011; 9(1):37-43. DOI:10.4321/S1886-36552011000100006
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