Health Information Technology

Electronic prescribing improves safety, but with a small increase in physician time

The use of electronic prescribing (e-prescribing) has been promoted to reduce medical errors, but a new study suggests that this improvement in patient safety comes with a small increase in physician prescribing time. On average, prescriptions prepared using computerized provider order entry (CPOE) systems in the examination room took 69 seconds. This was 25 seconds longer than if handwritten and 24 seconds longer than if entered at computers in the prescriber's office or a hallway workstation. According to the researchers, this meant that a provider seeing 20 patients per day spent 6 minutes longer if all prescriptions were e-prescribed than if handwritten, an increase of 20 seconds per patient. The observed increase in time when providers changed from e-prescribing in their offices or at hallway workstations to e-prescribing in the examination room was unexpected, the researchers noted.

The study was conducted at a multispecialty health system with 16 ambulatory care sites in Washington State. The system has an internally developed electronic health record that began adding CPOE functions in 2003. Three primary care sites were chosen for a two-phase direct observation time-motion study of prescribing. During phase 1, one site was still using handwritten prescriptions, another had begun e-prescribing 11 months before the study began, and the third site 15 months before the study began. During phase 2, all three sites accessed the CPOE system from desktops in the examination rooms.

Because systematic reviews by others found that CPOE systems can reduce medication errors by 55 to 86 percent and preventable adverse drug events by 17 percent, the researchers suggest that the 20-second-per-patient increase in time spent may be worthwhile in terms of improved safety and quality of patient care. The study was funded in part by the Agency for Healthcare Research and Quality (HS15319 and HS14739).

More details are in "Electronic prescribing at the point of care: A time-motion study in the primary care setting," by Emily Beth Devine, Pharm.D., M.B.A., Ph.D., William Hollingsworth, Ph.D., Ryan N. Hansen, Pharm.D., and others in the February 2010 HSR: Health Services Research 45(1), pp. 152-171.

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