The Impact of Computerized Provider Order Entry (CPOE) on Medication Order Processing and Workflow Efficiency by Pharmacists: A Time and Motion Study

Introduction: Recently, there has been a tremendous increase in the preparation on the part of US hospitals to implement CPOE. Employer groups, the federal government, and others have been advocating its implementation since the early 2000s, yet the number of hospitals which have met meaningful use criteria for CPOE is still less than 15%. This number is projected to increase exponentially in a very short time, spurred by incentives from the Centers for Medicare and Medicaid (CMS). With such a large amount of hospitals preparing for CPOE implementation, there is still much to learn about the impact of these systems. The objective of this study is to quantify the change in pharmacist workflow after CPOE is implemented. Methods: An experimental, enhanced pretest-posttest, prospective, time and motion study was conducted in four inpatient pharmacies within the same hospital system. Order entry pharmacists were observed for two separate time periods. The intervention pharmacy was observed first as a non-CPOE pharmacy and then later, after CPOE had been implemented. There was a control pharmacy which was non-CPOE for both time periods. There were two treatment control pharmacies, both of which had CPOE for both time periods. A database instrument recorded 37 different pharmacist tasks, which were grouped into four activities: clinical, distributive, administrative, and miscellaneous. Comparisons of the amount of time spent by the order entry pharmacist in each of the four different activities were conducted. SAS® version 9.3 was used to analyze the data, with statistical significance set at 0.05. Results: A total of 114 hours at the non-CPOE site and 197 hours at the CPOE site met the inclusion criteria. Non-parametric linear regressions were modeled and the predicted values were analyzed. The predicted mean number of minutes for each recorded hour were, by activity (predicted mean ± SD for non-CPOE versus CPOE, p-value): clinical (5.10 ± 2.24 versus 3.83 ± 1.34, p<0.05); distributive (44.55 ± 1.07 versus 47.61 ± 1.43, p<0.05); administrative (7.25 ± 2.34 versus 6.67 ± 1.28, p<0.05); and miscellaneous (3.11 ± 0.77 versus 1.89 ± 0.68, p<0.05). Conclusions: Less time was spent in the clinical, administrative, and miscellaneous activities, while more time was spent in the distributive activity after CPOE implementation. These findings were statistically significant.