A Multicentre Evaluation of the Impact of Computerised Physician Order Entry on Medication Documentation Workflow, Time, and Quality

Multicentre evaluations are key to provide generalisable results on medication safety interventions. Yet, for computerised physician order entry (CPOE) assessment, evaluations are mostly singe-centred and poorly comparable.We performed a multicentre simulation-based lab study at three independent study sites implementing varying CPOE systems with the aim to compare the effects of CPOE implementation on workflow changes, time requirement, and quality of medication documentation.At each study site, medication documentation processes with and without CPOE usage were analysed. Based on patient case scenarios, a simulation-based lab study was performed where the time required to document medication according to the analysed processes was measured. Additionally, the quality of medication documentation with and without CPOE usage was evaluated. Results were compared between the three study sites.At two hospitals, CPOE implementation led to a streamlining of the medication documentation process with less documentation systems and professional groups involved and an elimination of double documentation. However, at one hospital multiple documentation of medication orders persisted even after CPOE implementation. In total, the time required to document medication according to the case scenarios was faster without than with a CPOE system (median time without CPOE = 13:56 minutes [range = 07:29-32:17], median time with CPOE = 16:51 minutes [09:18-33:41], <i>p</i> = 0.047, +20.8%). One hospital was taking considerably longer for medication documentation than the two others, both with and without CPOE usage. Medication documentation quality rose significantly and to a median of 100.0% at each study site with CPOE usage.This study showed that a simulation-based lab study methodology is suitable for comparing CPOE effects across study sites. Furthermore, it provides evidence on the changes in medication documentation workflow, time requirement, and quality that occur with a CPOE implementation.