J Am Med Inform Assoc 14:722-730 doi:10.1197/jamia.M2377
  • The Practice of Informatics
  • Technology Evaluation

The Impact of e-Prescribing on Prescriber and Staff Time in Ambulatory Care Clinics: A Time–Motion Study

  1. William Hollingworth,
  2. Emily Beth Devine,
  3. Ryan N Hansen,
  4. Nathan M Lawless,
  5. Bryan A Comstock,
  6. Jennifer L Wilson-Norton,
  7. Kathleen L Tharp,
  8. Sean D Sullivan
  1. Affiliations of the authors: Pharmaceutical Outcomes Research and Policy Program (WH, EBD, RNH, KLT, SDS), Department of Radiology (WH), University of Washington, Seattle, WA; The Everett Clinic (NML, JLW-N), Everett WA; Department of Medicine (BAC, SDS), Department of Health Services (SDS), University of Washington, Seattle, WA
  1. Correspondence: Will Hollingworth, PhD, Research Assistant Professor, Department of Radiology, University of Washington, Box 359960, 325 Ninth Avenue, Seattle, WA 98104-2499; e-mail:<willh{at}>
  • Received 12 January 2007
  • Accepted 7 August 2007


Electronic prescribing has improved the quality and safety of care. One barrier preventing widespread adoption is the potential detrimental impact on workflow. We 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 all prescriber (n = 27) and staff (n = 42) tasks performed during a 4-hour period. At the sites with optional e-prescribing >75% of prescription-related events were performed electronically. Prescribers at e-prescribing sites spent less time writing, but time-savings were offset by increased computer tasks. After adjusting for site, prescriber and prescription type, e-prescribing tasks took marginally longer than hand written prescriptions (12.0 seconds; −1.6, 25.6 CI). Nursing staff at the e-prescribing sites spent longer on computer tasks (5.4 minutes/hour; 0.0, 10.7 CI). E-prescribing was not associated with an increase in combined computer and writing time for prescribers. If carefully implemented, e-prescribing will not greatly disrupt workflow.


  • Funding for this research was provided by the Agency for Healthcare Research and Quality (AHRQ Grant number: 5UC1HS015319). The authors are grateful to Dr Al Fisk for his help in the design and implementation of the study at the Everett Clinic. Marie Bach and Julie Jaeger provided valuable assistance in collecting time-motion data. We also thank the physicians, clinic staff, and patients of the Everett Clinic for allowing us to collect the time and motion data on clinical activity. Preliminary data from this paper were presented at the AHRQ Patient Safety and Health IT Conference (Washington DC, June 4-7th 2006). The views expressed in this paper are solely those of the authors.

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