Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary.
BACKGROUND
Free and charitable clinics are a critical part of America's healthcare safety net. Although informatics tools have the potential to mitigate many of the organizational and service-related challenges facing these clinics, little research attention has been paid to the workflows and potential impact of electronic systems in these settings. In previous work, we performed a qualitative investigation at a free clinic dispensary to identify workflow challenges that may be alleviated through introduction of informatics interventions. However, this earlier study did not quantify the magnitude of these challenges. Time-motion studies offer a precise standard in quantifying healthcare workers' time expenditures on clinical activities, and can provide valuable insight into system specifications. These data, informed by a lean healthcare perspective, provide a quality improvement framework intended to maximize value and eliminate waste in inefficient workflow processes.


METHODS
We performed a continuous observation time-motion study in the Birmingham Free Clinic dispensary. Two researchers followed pharmacists over the course of three general clinic sessions and recorded the duration of specific tasks. Pharmacists were then asked to identify tasks as value-added or non-value-added to facilitate calculation of the value quotient, a metric used to determine a workflow's level of efficiency.


RESULTS
Four high-level workflow categories occupied almost 95 % of pharmacist time: prescription (Rx) preparation (39.8 %), clinician interaction (21.5 %), EMR operations (14.8 %), and patient interaction (18.7 %). Pharmacists invested the largest portion of time in prescription preparation, with 21.8 % of pharmacist time spent handwriting medication labels. Based on value categorizations made by the pharmacists, the average value quotient was found to be 40.3 %, indicating that pharmacists spend more than half of their time completing tasks they consider to be non-value-added.


CONCLUSIONS
Our results show that pharmacists spend a large portion of their time preparing prescriptions, primarily the handwritten labeling of medication bottles and documentation tasks, which is not an optimal utilization of pharmacist expertise. The value quotient further supports that there are many wasteful tasks that may benefit from workflow redesign and health information technology, which could result in efficiency improvements for pharmacists.
Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. arf56@pitt.edu.
Arielle M
AM
Fisher
Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Michael Q
MQ
Ding
Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA.
Harry
H
Hochheiser
Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Gerald P
GP
Douglas
Clinical pharmacy information system; Electronic health records; Lean healthcare; Medical informatics applications; Time and motion studies; Vulnerable populations; Workflow
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