Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices

Overhage, J. Marc; Perkins, Susan M.; Tierney, William M.; McDonald, Clement J.

doi:10.1136/jamia.2001.0080361

Cited by 176 publications

(124 citation statements)

References 28 publications

Supporting

Mentioning

118

Contrasting

Order By: Relevance

“…18,23 Computerization of ordering can dramatically affect the care delivery process, as patterns of communication, cooperation, and collaborative work must shift to accommodate the technology. It is not surprising that the National Health Policy forum reported that clinician productivity can drop approximately 20% within the first three months of CPOE implementation, 6 though other studies 29,30 have indicated that productivity often improves over time as users gain proficiency with the system. CPOE can be improved through development of interoperability with and access to other clinical information systems and research about how users circumvent the system to get their work done.…”

Section: Cpoe Changes Work Pace Sequence and Dynamicsmentioning

confidence: 99%

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

et al. 2008

View full text Add to dashboard Cite

OBJECTIVE: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems. METHODS:We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow.RESULTS: CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure. CONCLUSIONS:As CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved. INTRODUCTIONHealth care providers use computerized provider order entry (CPOE) systems to place orders for medications, laboratory tests and other ancillary services. 1 CPOE has been shown to decrease medication ordering errors and redundant test ordering, promote practice standardization, and reduce overall healthcare costs. 2-4 Despite these benefits, CPOE systems have yet to be widely adopted for several reasons, including the high cost of implementation, clinician resistance to technology, worry regarding practice disruption and loss of productivity, fear of technology failure, and the inability of some CPOE implementations to integrate with existing healthcare systems. [5][6][7] Furthermore, there is evidence that unintended adverse consequences can surround the implementation and ongoing maintenance of these systems. [8][9][10] Recent, conflicting reports about the role of CPOE in the reduction of medication errors and associated costs have cast some doubt on the actual scale of improvements to be gained as CPOE systems have generated new kinds of medical errors, negatively affected patient outcomes, and resulted in higher overall medical costs for those institutions implementing them. 9,11-13 Thus, there remains a need for ongoing analysis of CPOE to understand the causes of these issues and help find solutions.A growing body of research explores the impact of integrating clinical information systems, including CPOE, within healthcare. 1,[14][15][16][17] Regardless of the study focus, one theme consistently emerges: embedding CPOE in healthcare fundamentally changes the way clinicians coordinate their work activities and collaborate to deliver care. [18][19][20][21] Indeed, in our prior work we identified nine broad categories of unintended adverse consequences related to CPOE, negative impact on workflow emerged as the most frequently occurring theme. 18,22 The purpo...

show abstract

Section: Cpoe Changes Work Pace Sequence and Dynamicsmentioning

confidence: 99%

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Time and motion studies have found that documentation and indirect patient care activities take a significant percentage of provider time [14,15]. As we seek to optimize and gain more value from electronic documentation, Schiff and Bates suggest that we need to re-engineer documentation "with the goal of building a more distributed, reliable, and content-rich yet succinct and efficient system" [16]. Understanding the way ED physicians use electronic documentation is a first step in designing this next generation documentation system.…”

mentioning

confidence: 99%

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Neri¹,

Redden²,

Poole³

et al. 2015

Appl Clin Inform

View full text Add to dashboard Cite

SummaryObjective: To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods: We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results: Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion: We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. Research Article P.M. Neri et al.: Physicians' Perceptions of Electronic Documentation and WorkflowFor personal or educational use only. No other uses without permission. All rights reserved. BackgroundElectronic clinical documentation serves multiple purposes including communication, billing, maintenance of a legal record, and serves as a tool for synthesis and medical decision making. Electronic Health Record (EHR) incentive programs in the United States designed to stimulate health information technology (HIT) adoption require hospitals and providers to show they use the EHR "meaningfully" and meet certain objectives in order to receive incentive payments. The second stage of the meaningful use program recognizes the importance of electronic documentation by including it as a menu objective to fulfill program requirements [1]. In response to these policies and incentives, emergency departments (EDs)...

show abstract

“…[20][21][22][23] Additionally, there is limited data on how EHR-related work burdens are distributed among the various members of the healthcare team within these practices, with most studies focusing exclusively on the work of either physicians 12,15,24 or nurses. 25,26 One systematic review found EHR use to be more efficient for documentation by nurses than by physicians, but did not distinguish between types of clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Howard¹,

Clark²,

Friedman³

et al. 2012

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND:The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. OBJECTIVE: To study the impact of EHR use on clinician and staff work burden in small, communitybased primary care practices. DESIGN: We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. PARTICIPANTS: All practice members and selected patients in seven community-based primary care practices in the Northeastern US. KEY RESULTS: The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHRrelated work burden for clinicians, as well as facilitate population-based care. CONCLUSIONS: The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.KEY WORDS: electronic health records; primary care; work burden; qualitative research.

show abstract

Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices

Abstract: Little extra time, if any, was required for physicians to use the POE system. With experience in its use, physicians may even save time while enjoying the many benefits of POE.

Cited by 176 publications

References 28 publications

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

Contact Info

Product

Resources

About