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

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.