In the University of Michigan Hospital, we went live with the Eclipsys CPOE system in April 2008. My medical informatician colleague, David Hanauer, along with some industrial engineering colleagues, studied the time taken to enter orders before, shortly after, and longer after introduction of CPOE.
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.
By way of background, Physician Assistants (PAs) enter all patient orders (except those for chemotherapy) and are the dedicated and exclusive care providers on a 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.
The PAs were directly observed one month before CPOE implementation, and then 3 months and again 8 months after implementation of our CPOE system. We used dedicated observers using 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.
We found that 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).
We plan to analyze this further, to see if work patterns changed, during the observation periods.