Overhage JM et al. 2001 "Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices."

Overhage JM, Perkins S, Tierney WM, et al. Controlled trial of direct physician order entry: effects on physicians' time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc 2001;8(4):361-369.
"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. [We examined] a well-accepted system for direct POE that has been in use for more than 15 years. The authors hypothesized that physicians using the [system] would not spend any more time writing orders than physicians using paper-based methods.
Design: A randomized controlled trial of POE using the ... 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 [system] 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 [system] 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."
To determine whether "physicians using [computerized provider order entry] would not spend any more time writing orders than physicians using paper-based methods."
Type Clinic
Primary care
Type Specific
Internal medicine
Small, medium and large
Other Information
Practices selected for the study were part of the Indiana University Medical Group - Primary Care.
Type of Health IT
Computerized provider order entry (CPOE)
Type of Health IT Functions
"The [system] provides order entry, clinical documentation, diagnostic result review, access to clinical knowledge bases, and links to billing functions. After leaving the examination room, the provider enters these data on workstations in a shared workroom or in the provider's office, using a series of forms...There were no computers in the examination rooms. For each encounter, the provider records billing diagnoses, medications prescribed, changes in allergies, test orders, referrals, nursing intervention orders and, optionally, notes. The system stores this information in a clinical data repository...from which providers can view the information as coded data or as a note with a more traditional appearance. The [system] then uses the data to create billing documents (superbill), requisitions, consult requests, prescriptions, and patient education materials. When entering orders, including prescriptions, physicians can create instructions by typing them in free text, choosing fill-in-the-blank templates, or using their previous instructions for an order. They commonly use the last method when refilling medications."
Context or other IT in place
Participating practices had in place an electronic health record system (EHR), specifically the Regenstrief Medical Record System (RMRS).
Workflow-Related Findings
"Overall, physicians randomized to use the [CPOE system] spent 2.12 minutes (6.2 percent) longer per patient writing orders than did control physicians who used paper-based methods. Unfortunately, physicians in the intervention group continued to perform certain tasks using paper-based methods even though the computer was automatically performing those tasks for them ... The time wasted on these unnecessary or duplicative
tasks was more than a minute per patient. If we could eliminate this wasted time through further training and process improvement, we estimate the net time cost of [C]POE system use would be only 0.92 minutes per patient. Furthermore, [our data] include the time for users early in their experience with the computer as well as later. We found that the time costs declined with experience, so the time costs for using the [C]POE system could be very small."
"Intervention physicians ... responding on a five-point Likert scale [1=strongly agree and 5=strongly disagree] agreed that their work was done faster (1.92 ± 0.90), easier (1.58 ± 0.67), that the quality of documentation improved (1.42 ± 0.67), workflow was improved (1.75 ± 0.62) and quality of care improved (1.83 ± 0.71). When asked if we should remove the [system] from their practice, they strongly disagreed (3.82 ± 0.40)."
When using the CPOE system, "[a]ncillary personal did not have to complete requisitions."
When using the CPOE system, "records were legible and always available, [and] physicians wrote consequent orders more often."
Study Design
Randomized controlled trial (RCT)
Study Participants
Study participants included 34 internists: 14 were in the intervention group and 20 were in the control group. Residents and fellows were not included in the study. The 34 participants were observed across 11 practices.