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Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching.

TitleComputerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching.
Publication TypeJournal Article
Year of Publication2013
AuthorsHanauer, DA, Zheng, K, Commiskey, EL, Duck, MG, Choi, SW, Blayney, DW
JournalJ Oncol Pract
Volume9
Issue4
Paginatione103-14
Date Published2013 Jul
ISSN1935-469X
KeywordsHematology, Humans, Inpatients, Medical Oncology, Medical Order Entry Systems, Patient Care, Physician Assistants, Task Performance and Analysis, Time Factors, Workflow
Abstract

PURPOSE: Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time.METHODS: We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage.RESULTS: Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study.CONCLUSION: CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.

DOI10.1200/JOP.2012.000655
Alternate JournalJ Oncol Pract
PubMed ID23942926
PubMed Central IDPMC3710176
Grant ListK23 AI091623 / AI / NIAID NIH HHS / United States
P30 CA046592 / CA / NCI NIH HHS / United States
UL1RR024986 / RR / NCRR NIH HHS / United States
People: 
David Hanauer
University of Michigan Comprehensive Cancer Center at North Campus Reserach Complex
1600 Huron Parkway, Bldg 100, Rm 100 
Mailing Address: 2800 Plymouth Rd, NCRC 100-1004
Ann Arbor, MI 48109-2800 
Ph. (734) 764-8848 Fax. (734) 615-0517
Please acknowledge the Cancer Center Support Grant (P30 CA046592) when publishing manuscripts or abstracts that utilized the services of the University of Michigan's Comprehensive Cancer Center's Shared Resource: Cancer Informatics.
Suggested language: "Research reported in this [publication/press release] was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA046592."

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