Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices

TLDR

Direct physician order entry (POE) promises many benefits, yet evidence indicates it may require substantially more time than paper-based methods, and the Medical Gopher system has been widely used for over 15 years. The study hypothesized that physicians using the Gopher would not spend more time writing orders than those using paper-based methods. The authors conducted a randomized controlled trial across 11 primary care internal medicine practices, collecting detailed time‑motion data and surveying physicians about the Gopher system. Physicians using the Gopher spent 2.2 minutes more per patient overall, but after removing duplicative and administrative tasks the excess was only 0.43 minutes; with experience the entry time fell by 3.73 minutes per patient, and physicians reported improved patient care and a desire to continue using the system, indicating that little or no extra time is required and time may even be saved with experience.

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.