Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching.
OBJECTIVE
Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time.


METHODS
We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage.


RESULTS
Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study.


CONCLUSIONS
CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.
University of Michigan, Ann Arbor, MI; and Stanford University, Stanford, CA.
David A
DA
Hanauer
Kai
K
Zheng
Elaine L
EL
Commiskey
Mary G
MG
Duck
Sung W
SW
Choi
Douglas W
DW
Blayney
D006405:Hematology / Q000458:organization & administration; D006801:Humans; D007297:Inpatients; D008495:Medical Oncology / Q000458:organization & administration; D050316:Medical Order Entry Systems; D005791:Patient Care / Q000592:standards*; D010823:Physician Assistants; D013647:Task Performance and Analysis; D013997:Time Factors; D057188:Workflow