Physician inpatient order writing on microcomputer workstations

Effects on resource utilization

William M. Tierney, Michael E. Miller, J. Marc Overhage, Clement J. McDonald

Research output: Contribution to journalArticle

394 Citations (Scopus)

Abstract

Objective. - To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. Design. - Randomized controlled clinical trial. Setting. - Inpatient internal medicine service of an urban public hospital. Subjects. - A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. Intervention. - Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. Main Outcome Measures. - Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. Results. - Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P=.02). Significant reductions (P<.05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P=.11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P<.0001). Conclusions. - A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Original languageEnglish
Pages (from-to)379-383
Number of pages5
JournalJournal of the American Medical Association
Volume269
Issue number3
StatePublished - Jan 20 1993

Fingerprint

Microcomputers
Inpatients
Physicians
Hospital Costs
Internal Medicine
Patient Acceptance of Health Care
Hospital Medicine
Medical Faculties
Time and Motion Studies
Electronic Health Records
Health Resources
Public Hospitals
Urban Hospitals
Medical Students
Routine Diagnostic Tests
Length of Stay
Randomized Controlled Trials
Observation
Outcome Assessment (Health Care)
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tierney, W. M., Miller, M. E., Overhage, J. M., & McDonald, C. J. (1993). Physician inpatient order writing on microcomputer workstations: Effects on resource utilization. Journal of the American Medical Association, 269(3), 379-383.

Physician inpatient order writing on microcomputer workstations : Effects on resource utilization. / Tierney, William M.; Miller, Michael E.; Overhage, J. Marc; McDonald, Clement J.

In: Journal of the American Medical Association, Vol. 269, No. 3, 20.01.1993, p. 379-383.

Research output: Contribution to journalArticle

Tierney, WM, Miller, ME, Overhage, JM & McDonald, CJ 1993, 'Physician inpatient order writing on microcomputer workstations: Effects on resource utilization', Journal of the American Medical Association, vol. 269, no. 3, pp. 379-383.
Tierney, William M. ; Miller, Michael E. ; Overhage, J. Marc ; McDonald, Clement J. / Physician inpatient order writing on microcomputer workstations : Effects on resource utilization. In: Journal of the American Medical Association. 1993 ; Vol. 269, No. 3. pp. 379-383.
@article{c03c8d3e4035457389a3f3d2611a31c2,
title = "Physician inpatient order writing on microcomputer workstations: Effects on resource utilization",
abstract = "Objective. - To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. Design. - Randomized controlled clinical trial. Setting. - Inpatient internal medicine service of an urban public hospital. Subjects. - A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. Intervention. - Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. Main Outcome Measures. - Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. Results. - Intervention teams generated charges that were $887 (12.7{\%}) lower per admission than did control teams (P=.02). Significant reductions (P<.05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P=.11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P<.0001). Conclusions. - A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.",
author = "Tierney, {William M.} and Miller, {Michael E.} and Overhage, {J. Marc} and McDonald, {Clement J.}",
year = "1993",
month = "1",
day = "20",
language = "English",
volume = "269",
pages = "379--383",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Physician inpatient order writing on microcomputer workstations

T2 - Effects on resource utilization

AU - Tierney, William M.

AU - Miller, Michael E.

AU - Overhage, J. Marc

AU - McDonald, Clement J.

PY - 1993/1/20

Y1 - 1993/1/20

N2 - Objective. - To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. Design. - Randomized controlled clinical trial. Setting. - Inpatient internal medicine service of an urban public hospital. Subjects. - A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. Intervention. - Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. Main Outcome Measures. - Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. Results. - Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P=.02). Significant reductions (P<.05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P=.11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P<.0001). Conclusions. - A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

AB - Objective. - To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. Design. - Randomized controlled clinical trial. Setting. - Inpatient internal medicine service of an urban public hospital. Subjects. - A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. Intervention. - Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. Main Outcome Measures. - Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. Results. - Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P=.02). Significant reductions (P<.05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P=.11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P<.0001). Conclusions. - A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

UR - http://www.scopus.com/inward/record.url?scp=0027531457&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027531457&partnerID=8YFLogxK

M3 - Article

VL - 269

SP - 379

EP - 383

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 3

ER -