Introduction of computerized provider order entry (CPOE) and time impact in an inpatient hematology/oncology service: Serial time and motion studies

Abstract

e17507 Background: The impact of CPOE on inpatient hematology/oncology care is not well studied. CPOE has many benefits, but concerns exist about increased time required to enter electronic orders compared to handwritten orders. We hypothesized that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. Methods: Physician assistants (PAs) enter all patient orders (except those for chemotherapy) and are the dedicated and exclusive care providers on this non-house staff service at the main Hospital of the University of Michigan Health System. We chose the PA service for observation as we could eliminate potential biases introduced by rotating house staff we observed in earlier studies. PAs were directly observed at -1, +3 and +8 months post implementation of a CPOE system (Sunrise Clinical Manager, Eclypsis, Atlanta GA). Dedicated observers used a data entry tool with a modified database (available on the Health IT Tools section at healthit.ahrq.gov) on a tablet computer. For analysis, the 60 individual activities were grouped into 6 major categories, as well as an ordering category. We observed the same three PAs for 82.5 hours pre-CPOE, for 75.0 hours at 3 months post and for 70.5 hours 8 months post. Productive time was all non-personal and non-administrative time. The faculty entered chemotherapy orders and supervised the PAs, but were not studied. Results: Overall time for order-related activities was unchanged during the three observation periods, requiring 10.3, 10.6 and 11.4% of productive time, respectively. Time spent on direct patient care (as a percentage of productive time) was also unchanged once CPOE was implemented (50.7% pre vs. 49.8% and 47.8% post). Conclusions: We could not detect differences in order-entry time by well-trained PAs using standardized order sets before and after CPOE implementation on an inpatient hematology/oncology service. The decision to adopt CPOE should not be based on the hypothesis that there will be less (or more) time spent on order entry tasks. No significant financial relationships to disclose.