Calle Hedberg wrote: Can you provide any direct references (or even better URLs) to such studies?
October 04, 2004 Wayne Wilson wrote: I don't have any URL's or references either. Excerpt of possible reports: Copyright � 2004, American Medical Informatics Association J Am Med Inform Assoc. 2004 March; 11 (2): 100-103 DOI: 10.1197/jamia.M1411 Computerized Physician Order Entry: Helpful or Harmful? Robert G. Berger, MD and J.P. Kichak, BA http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=353014 CPOE systems will prove to be more costly to institutions than just the purchase and maintenance of the hardware and software involved in such a purchase or development. The increased time required by physicians to enter data into CPOE products will result in increased personnel costs for direct patient care. The Leapfrog Group used the results of the first Harvard study as its entire basis for its theoretical calculations of decrease in health care costs as a result of institution of CPOE systems. However, these calculations can show an opposite trend when taking into account the follow-up Harvard study and adding the increased time required by housestaff (the primary users of the system) to enter their daily orders. Although the absolute numbers are small, the installation of CPOE created a 200% increase in actual serious ADEs during the first two years of implementation (from the second Harvard publication discussed previously, which showed an absolute increase from five ADEs to 15 ADEs in the first two years of use of CPOE). Therefore, if the Harvard studies are reflective of the effects of CPOE in general, national health care costs as a result of ADEs will increase transiently to $6 billion per year (using the Leapfrog numbers) during the first two years of CPOE implementation. Because housestaff work hours have recently been limited to 80 hours per week, the additional time required for them to enter data in CPOE will almost certainly result in additional health care personnel costs to hospitals in the form of physician extenders to provide direct patient care. This additional time required to enter computer-based orders has been estimated at 5% of their total workweek hours.20,21 If a large hospital employs 500 housestaff, an additional 25 full-time equivalent physicians or physician extenders would be required for direct patient care, assuming that before the institution of CPOE, a resident's 80-hour week was entirely spent doing direct patient care. This would add approximately $1.6-2 million to individual hospital budgets in addition to the costs of purchase and maintenance of a CPOE system itself. Computerized POE: Changing Roles for the Clinical Pharmacist http://www.aphanet.org/PInfo/JAPhA_Sept-Oct_99_Article.htm Along with the change to POE came a change in the role of pharmacists at our institution. POE automates many aspects of the medication order so pharmacists no longer have to spend so much time checking drug doses, drug allergies, and drug-drug interactions. Thus pharmacists have been freed to spend more time on clinical activities including drug utilization review (DUR) and drug therapy management to improve patient care. Copyright � 2001, American Medical Informatics Association J Am Med Inform Assoc. 2001 July; 8 (4): 361-371 Controlled Trial of Direct Physician Order Entry Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices J. Marc Overhage, MD, PhD, Susan Perkins, PhD, William M. Tierney, MD, and Clement J. McDonald, MD http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=130081 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. Quotations of other reports: (1) Jha AK, Kuperman GJ, Teich JM, Leape L, Shea B, Rittenberg E, Burdick E, Seger DL, Vander Vliet M, and Bates DW, "Identifying Adverse Drug Events: Development of a Computer-Based Monitor and Comparison with Chart Review and Stimulated Voluntary Reporting", Journal of the American Medical Informatics Association, 5(3):305-314 (1998) Teich J, PR M, Schmiz J, Kuperman G, Spurr C, Bates D. Effects of computerized physician order entry on prescribing practices. Archives of Internal Medicine. 2000;160:2741-47. Bates, D. W., Boyle, D. L., and Teich, J. M. "Impact of Computerized Physician Order Entry on Physician Time." Proceedings of the Annual Symposium on Computer Applications in Medical Care, 1994, 11(1), 996. Sincerely yours, Tim Tim Flewelling Information Architect/Architecte de l'informatique Health and Wellness/Sant� et Mieux-�tre Government of New Brunswick/Gouvernement du Nouveau Brunswick Tel (506) 453-2871 Fax (506) 444-5505 [EMAIL PROTECTED] http://app.infoaa.7700.gnb.ca/gnb/pub/DetailPersonEng1.asp?RecordID=17800 Confidentialit�/Confidentiality: Le contenu de cet envoi, privil�gi� et confidentiel, ne s'adresse qu'au(x) destinataire(s) indiqu�(s) ci-dessus. Il est interdit par toute autre personne, de le divulguer, le communiquer ou le reproduire. 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If you have received this message in error, please contact the sender and delete the material from any computer. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Wayne Wilson Sent: Monday, October 04, 2004 12:28 PM To: [EMAIL PROTECTED] Subject: Re: physician prescribing tool development -----BEGIN PGP SIGNED MESSAGE----- Hash: SHA1 Calle Hedberg wrote: | | | That's VERY interesting - I have heard about this before, but I have not | seen any of the actual studies/papers showing 20-30% loss of efficiency. | (It's largely in line with my personal observations, and it largely | explain why EHRs in resource poor settings usually are utter failures - | you just don't have the 20-30% extra time if you are seeing 60-70 | patients per day to begin with). | | Can you provide any direct references (or even better URLs) to such | studies? | I don't have any URL's or references either. I want to comment that it's just not resource poor settings where this efficiency hit leads to failure, it's also true here in the US. That's because the pressure to reduce the average visit time per patient with the physician is an extremely powerful economic force in workflow re-design. I was the introducer at the TEPR 98 session on cost justification. There was only one presentation that addressed the issue of time spent per patient, that was by Dr. Wenner. He made an assertion then about the increased time/cost of EHR's and I challenged where the evidence was. Much to my suprise, the clinical head of a large healthcare software vendor, standing in the back of the room (we were SRO), came to Dr. Wenner's defense, saying that it was the case. Dr. Wenner sells a bit of software called Instant Medical History, used in primary care settings that have patients do a pre-interview on computer, the synopised results of which are available during the physician/patient encounter. This is yet another area where evidence seems lacking and marketing seems predominant. -----BEGIN PGP SIGNATURE----- Version: GnuPG v1.2.4 (GNU/Linux) Comment: Using GnuPG with Thunderbird - http://enigmail.mozdev.org iD8DBQFBYWwCY+HG7UEwVGERAmG5AJ9tpyxjvPauN063Q1fe5P0zsEYp9gCdFaXG 5MFWXf+m4dZllhcfhQZL5M0= =GHE/ -----END PGP SIGNATURE-----
