The fungibility of time in claims of efficiency: The case of making transmission of prescriptions electronic in English general practice

Abstract

Objectives: This paper presents a study of the effects of the implementation of the NHS Electronic Prescription Service (EPS) on time spent on repeat prescribing in English general practice. EPS is a new network service for the electronic transmission of primary care prescriptions, principally between GP practices and community pharmacies. This service is promoted on the basis of the importance of safe and timely supply of medicines, and the level of medicines use by many patients with treatable chronic conditions. The service is also based on presumptions of significant timesavings and efficiency gains for general practices and GPs. Our objective was to assess the time-related changes (including time savings) conditioned by digital transmission of prescriptions, specifically for repeat prescribing activity in primary care practices.Methods: As part of the official evaluation of EPS in the English NHS we undertook a qualitative research design with field studies in four of the first GP practices adopting EPS. This research was based on interviews with clinical and administrative staff, and non-participant observation of repeat prescribing related activities. Results:We found that the use of EPS reduced turnaround time and conditioned changes in the workflow, with time-savings found mainly in relation to administrative tasks. But the use of this technology also created additional tasks and shifted existing tasks and responsibilities. Thus elimination of tasks did not automatically correspond to potential staff savings or cost savings. Tasks that were eliminated and new tasks that were created were not equivalent in terms of time spent, quality of attention required, and roles involved. Conclusions:The wider claim that healthcare information technology saves time and increases efficiency is often based on assumptions of the fungibility of time and people 3 -i.e. that units of time added or saved on different steps of the workflow can be summed up as if they were all of the same kind, and thus reveal any net efficiency gain.But workflow time savings involve changes in the quality of tasks, redistribution of work and responsibility that mean that time can hardly be added or subtracted to obtain 'efficiency totals'.

England’s Electronic Prescription Service

“…This chapter draws from work conducted as part of the Evaluation of the Electronic Prescription Service in Primary Care, a project which ran from 2008 to 2013 and was funded by the Connecting for Health Evaluation Programme (Cornford et al 2014;Hibberd et al 2012;Petrakaki et al 2012;Lichtner et al 2012). In writing this chapter we identified from the project data key exemplars of where the installed base, which can be thought of as a multi-layered set of socio-technical systems, based on Cornford et al (1994), constrained or influenced the development of the service.…”

Healthcare IT Value Hierarchy Framework for the Small Physician Practices Context

“…Ward, Froehle, Hart, Collins, and Lindsell (2014) used case study to understand the EHR impact on a hospital's performance. Lichtner, Venters, Hibberd, Cornford, and Barber (2013) also used this method to understand the impact of e-prescribing systems on office efficiencies. Lahiri and Seidmann (2012) used case study methodology to understand the impact of Radiology Information Systems (RIS) on an office's workflow.…”

Spatial analysis and prediction of the flow of patients to public health centres in a middle-sized Spanish city

“…In order to avoid the potential source of error connected with the difficulty obtaining accurate population data, particularly with reference to the age ranges, from the databases at each health centre, we obtained the census tracts from the National Statistics Institute (INE, 2014). Once all this information had been collected and stored, the number of health centre clients for each health centre was obtained by carrying out specific, spatial queries through the GIS.…”

“…This leads to delays and slipups, e.g., patients cannot get their appointments as scheduled, doctors' agendas collapse and emergencies are more difficult to handle then otherwise. Research, such as that by Lichtner et al (2013), highlights the importance and necessity of efficient planning, competent management and expert use of resources in health services. Indeed, adequate resources management in primary health care leads to higher score for patient satisfaction and reduces health care costs and drug prescriptions (Starfield, 1992).…”