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E-prescribing will not greatly disrupt workflow in outpatient practices if carefully implemented

A new study may alleviate concerns that electronic prescribing (e-prescribing) systems, which have been shown to reduce medication errors and adverse drug events, will slow workflow at outpatient practices.

The University of Washington researchers concluded that use of desktop or laptop computers for e-prescribing for outpatients would not disrupt prescriber or staff workflow, when carefully implemented. Among 27 prescribers studied, the mean time spent to write an e-prescription was a mere 12 seconds longer than written prescriptions. Since the clinicians ordered an average of nine prescriptions during an observation period of 3.5 hours, this amounted to an additional 3 to 5 minutes of clinicians' time for e-prescribing over written prescribing. This small increment in time can be justified if e-prescribing improves the safety and quality of patient care. For example, e-prescribing that allows computer-faxing directly to the retail pharmacy may minimize transcription errors and improve the transmission process, note the researchers.

They 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 27 prescribers and 42 staff (physicians, nurses, and medical assistants) on tasks performed during the observation period. At the sites with optional e-prescribing, more than 75 percent of prescription-related events were performed electronically.

The authors point out that the e-prescribing systems used in the practices studied had not yet integrated decision support functions such as drug safety alerts and diagnosis-based reminders, which may lead to longer e-prescribing times.

See "The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: A time-motion study," by William Hollingworth, Ph.D., Emily Beth Devine, Pharm.D., M.B.A., Ryan N. Hansen, Pharm.D., and others, in the November/December 2007 Journal of the American Medical Informatics Association 14(6), pp. 722-730.

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