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Clinical Trial
. 2001 Jul-Aug;8(4):361-71.
doi: 10.1136/jamia.2001.0080361.

Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices

J M Overhage  1 , S Perkins, W M Tierney, C J McDonald
Affiliations
Clinical Trial

Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices

J M Overhage et al. J Am Med Inform Assoc. 2001 Jul-Aug.

Abstract

Objective: Direct physician order entry (POE) offers many potential benefits, but evidence suggests that POE requires substantially more time than traditional paper-based ordering methods. The Medical Gopher is a well-accepted system for direct POE that has been in use for more than 15 years. The authors hypothesized that physicians using the Gopher would not spend any more time writing orders than physicians using paper-based methods.

Design: A randomized controlled trial of POE using the Medical Gopher system in 11 primary care internal medicine practices.

Measurements: The authors collected detailed time use data using time motion studies of the physicians and surveyed their opinions about the POE system.

Results: The authors found that physicians using the Gopher spent 2.2 min more per patient overall, but when duplicative and administrative tasks were taken into account, physicians were found to have spent only 0.43 min more per patient. With experience, the order entry time fell by 3.73 min per patient. The survey revealed that the physicians believed that the system improved their patient care and wanted the Gopher to continue to be available in their practices.

Conclusions: Little extra time, if any, was required for physicians to use the POE system. With experience in its use, physicians may even save time while enjoying the many benefits of POE.

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Figures

Figure 1
Figure 1
Representative form for ordering a chest radiograph, from the Gopher clinical workstation.
Figure 2
Figure 2
Screen from the palm computer used to record data during the time motion study, which shows the major category list (partially obscured) and a fully expanded subcategory list.
Figure 3
Figure 3
Time expended per patient by internists using traditional paper-based methods (control, gray) and the Gopher system (intervention, black). The differences were not statistically significant. The means were adjusted for the distribution of providers in the two location types.
See this image and copyright information in PMC

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