title: Electronic prescribing at the point of care: a time-motion study in the primary care setting.
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.
  
  
  METHODS
  Primary data on prescribers/staff were collected (2005-2007) at three primary care clinics in a community based, multispecialty health system.
  
  
  METHODS
  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).
  
  
  METHODS
  Data were collected using TimerPro software on a Palm device.
  
  
  RESULTS
  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.
authors.affiliation: Biomedical & Health Informatics, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Emily Beth
authors.initials: EB
authors.lastname: Devine
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Lawless
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson-Norton
authors.forename: Diane P
authors.initials: DP
authors.lastname: Martin
authors.forename: David K
authors.initials: DK
authors.lastname: Blough
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D003153:Community Health Services; D017598:Efficiency, Organizational; D055695:Electronic Prescribing; D017050:Episode of Care; D006801:Humans; D050316:Medical Order Entry Systems; D019370:Observation; D011320:Primary Health Care; D013996:Time and Motion Studies; D014584:User-Computer Interface; D014861:Washington; D014956:Writing