Int J Med Inform - The fungibility of time in claims of efficiency: the case of making transmission of prescriptions electronic in English general practice.

Tópicos

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Resumo

JECTIVES: This paper presents a study of the effects of the implementation of the NHS Electronic Prescription Service (EPS) on time spent on repeat prescribing in English general practice. EPS is a new network service for the electronic transmission of primary care prescriptions, principally between GP practices and community pharmacies. This service is promoted on the basis of the importance of safe and timely supply of medicines, and the level of medicines use by many patients with treatable chronic conditions. The service is also based on presumptions of significant time-savings and efficiency gains for general practices and GPs. Our objective was to assess the time-related changes (including time savings) conditioned by digital transmission of prescriptions, specifically for repeat prescribing activity in primary care practices.METHODS: As part of the official evaluation of EPS in the English NHS we undertook a qualitative research design with field studies in four of the first GP practices adopting EPS. This research was based on interviews with clinical and administrative staff, and non-participant observation of repeat prescribing related activities.RESULTS: We found that the use of EPS reduced turnaround time and conditioned changes in the workflow, with time-savings found mainly in relation to administrative tasks. But the use of this technology also created additional tasks and shifted existing tasks and responsibilities. Thus elimination of tasks did not automatically correspond to potential staff savings or cost savings. Tasks that were eliminated and new tasks that were created were not equivalent in terms of time spent, quality of attention required, and roles involved.CONCLUSIONS: The wider claim that healthcare information technology saves time and increases efficiency is often based on assumptions of the fungibility of time and people - i.e. that units of time added or saved on different steps of the workflow can be summed up as if they were all of the same kind, and thus reveal any net efficiency gain. But workflow time savings involve changes in the quality of tasks, redistribution of work and responsibility that mean that time can hardly be added or subtracted to obtain 'efficiency totals'.

Resumo Limpo

jectiv paper present studi effect implement nhs electron prescript servic ep time spent repeat prescrib english general practic ep new network servic electron transmiss primari care prescript princip gp practic communiti pharmaci servic promot basi import safe time suppli medicin level medicin use mani patient treatabl chronic condit servic also base presumpt signific timesav effici gain general practic gps object assess timerel chang includ time save condit digit transmiss prescript specif repeat prescrib activ primari care practicesmethod part offici evalu ep english nhs undertook qualit research design field studi four first gp practic adopt ep research base interview clinic administr staff nonparticip observ repeat prescrib relat activitiesresult found use ep reduc turnaround time condit chang workflow timesav found main relat administr task use technolog also creat addit task shift exist task respons thus elimin task automat correspond potenti staff save cost save task elimin new task creat equival term time spent qualiti attent requir role involvedconclus wider claim healthcar inform technolog save time increas effici often base assumpt fungibl time peopl ie unit time ad save differ step workflow can sum kind thus reveal net effici gain workflow time save involv chang qualiti task redistribut work respons mean time can hard ad subtract obtain effici total

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