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First published August 21, 2007 as JAMIA PrePrint; doi:10.1197/jamia.M2377
Journal of the American Medical Informatics Association 2007;14(6):722-730
© 2007 American Medical Informatics Association


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Submitted on January 12, 2007
Accepted on August 7, 2007

The Impact of e-prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time- Motion Study

William Hollingworth PhD1*, Emily Beth Devine PharmD, MBA2, Ryan N. Hansen PharmD2, Nathan M. Lawless CE, RPh3, Bryan A. Comstock MSc4, Jennifer L. Wilson-Norton RPh, MBA3, Kathleen L. Tharp2, and Sean D. Sullivan PhD5

Affiliation of the authors: 1 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA ; 2 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA ; 3 The Everett Clinic, Everett WA; 4 Department of Medicine, University of Washington, Seattle, WA; 5 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA

* To whom correspondence should be addressed.

Electronic prescribing has improved the quality and safety of care. One barrier preventing widespread adoption is the potential detrimental impact on workflow. We used time-motion techniques to compare prescribing times at three ambulatory care sites that used paper-based prescribing, desktop, or laptop e-prescribing. An observer timed all prescriber (n=27) and staff (n=42) tasks performed during a 4-hour period. At the sites with optional e-prescribing >75% of prescription-related events were performed electronically. Prescribers at e-prescribing sites spent less time writing, but time-savings were offset by increased computer tasks. After adjusting for site, prescriber and prescription type, e-prescribing tasks took marginally longer than hand written prescriptions (12.0 seconds; -1.6, 25.6 CI). Nursing staff at the e-prescribing sites spent longer on computer tasks (5.4 minutes/hour; 0.0, 10.7 CI). E-prescribing was not associated with an increase in combined computer and writing time for prescribers. If carefully implemented, e-prescribing will not greatly disrupt workflow.







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