The Workflow of Computerized Medication Ordering in Primary Care is Not Prescriptive

Abstract

While the potential benefits of computerized provider order entry (CPOE) are well recognized, little is known about how prescribers have integrated electronic medication ordering into other aspects of patient care. As part of a larger investigation of computerized medication alerts, we observed and opportunistically interviewed 20 primary care prescribers at a major Veterans Affairs Medical Center (VAMC). Participants were recruited from each of the VAMC's 5 primary care clinics and included physicians, nurse practitioners, and clinical pharmacists. Prescribers were observed as they ordered mediations via the CPOE system during routine patient care. In total, observations included 91 routine patient encounters across 66.5 hrs of observation. This paper provides illustrative case examples of how prescribers have integrated CPOE into medication decision-making processes and other patient care tasks. Results demonstrate that CPOE workflow varies widely among prescribers. In addition, results indicate that there are trade-offs associated with using CPOE with the patient in the exam room versus outside of the exam room. Findings may have implications for provider-patient relationships, workflow efficiency, and medication safety, and may ultimately enhance the effectiveness of CPOE in primary care.

Human Factors Research and Design Trends for the Modern Exam and Hospital Room

“…Dr. Russ' research has identified at least three major workflows for medication ordering in the outpatient setting (Russ A.L., Saleem J.J., McManus M.S., Frankel R.M., & Zillich, 2010). These workflows can be described as a 'discrete' approach, where a prescriber completes CPOE tasks after the patient encounter, and in a separate room; 'task switching' approach, where a prescriber shuttles back and forth repeatedly between a computing room and the patient's exam room to complete medication ordering; and 'integrated' approach, where a prescriber completes CPOE work as part of the patient encounter in the exam room.…”