A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England

Johanna I. Westbrook, Ling Li, Sonal Shah, Elin C. Lehnbom, Mirela Prgomet, Behnaz Schofield, Kathrin Cresswell, Ann Slee, Jamie J. Coleman, Lucy McCloughan, Aziz Sheikh

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Qualitative studies have provided important insights into how hospital pharmacists’ work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals’ work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists’ work pre- and post-EMM implementation in two countries. Methods: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. Results: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%–27.5%; England 27.1%–33.8%) and history-taking (Australia 7.6%–13.3%; England 19.5%–28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%–27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. Conclusions: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists’ work in both countries. Anticipated reductions in medication review and history taking were not observed.

LanguageEnglish
Pages253-259
Number of pages7
JournalInternational Journal of Medical Informatics
Volume129
DOIs
Publication statusPublished - 1 Sep 2019

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Medication Systems
Time and Motion Studies
Pharmacists
England
Time Management
Software
History

Keywords

  • Computerised provider order entry system
  • Electronic health records
  • Electronic prescribing
  • Observation
  • Time and motion

Cite this

Westbrook, Johanna I. ; Li, Ling ; Shah, Sonal ; Lehnbom, Elin C. ; Prgomet, Mirela ; Schofield, Behnaz ; Cresswell, Kathrin ; Slee, Ann ; Coleman, Jamie J. ; McCloughan, Lucy ; Sheikh, Aziz. / A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. In: International Journal of Medical Informatics. 2019 ; Vol. 129. pp. 253-259.
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title = "A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England",
abstract = "Background: Qualitative studies have provided important insights into how hospital pharmacists’ work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals’ work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists’ work pre- and post-EMM implementation in two countries. Methods: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. Results: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6{\%}–27.5{\%}; England 27.1{\%}–33.8{\%}) and history-taking (Australia 7.6{\%}–13.3{\%}; England 19.5{\%}–28.9{\%}) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9{\%} to 10.8{\%}; p = 0.01). The Australian rate did not change (18.0{\%}–27.2{\%}; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4{\%} of time working alone, compared to 92.0{\%} for English pharmacists. Conclusions: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists’ work in both countries. Anticipated reductions in medication review and history taking were not observed.",
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author = "Westbrook, {Johanna I.} and Ling Li and Sonal Shah and Lehnbom, {Elin C.} and Mirela Prgomet and Behnaz Schofield and Kathrin Cresswell and Ann Slee and Coleman, {Jamie J.} and Lucy McCloughan and Aziz Sheikh",
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A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. / Westbrook, Johanna I.; Li, Ling; Shah, Sonal; Lehnbom, Elin C.; Prgomet, Mirela; Schofield, Behnaz; Cresswell, Kathrin; Slee, Ann; Coleman, Jamie J.; McCloughan, Lucy; Sheikh, Aziz.

In: International Journal of Medical Informatics, Vol. 129, 01.09.2019, p. 253-259.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England

AU - Westbrook,Johanna I.

AU - Li,Ling

AU - Shah,Sonal

AU - Lehnbom,Elin C.

AU - Prgomet,Mirela

AU - Schofield,Behnaz

AU - Cresswell,Kathrin

AU - Slee,Ann

AU - Coleman,Jamie J.

AU - McCloughan,Lucy

AU - Sheikh,Aziz

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: Qualitative studies have provided important insights into how hospital pharmacists’ work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals’ work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists’ work pre- and post-EMM implementation in two countries. Methods: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. Results: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%–27.5%; England 27.1%–33.8%) and history-taking (Australia 7.6%–13.3%; England 19.5%–28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%–27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. Conclusions: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists’ work in both countries. Anticipated reductions in medication review and history taking were not observed.

AB - Background: Qualitative studies have provided important insights into how hospital pharmacists’ work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals’ work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists’ work pre- and post-EMM implementation in two countries. Methods: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. Results: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%–27.5%; England 27.1%–33.8%) and history-taking (Australia 7.6%–13.3%; England 19.5%–28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%–27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. Conclusions: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists’ work in both countries. Anticipated reductions in medication review and history taking were not observed.

KW - Computerised provider order entry system

KW - Electronic health records

KW - Electronic prescribing

KW - Observation

KW - Time and motion

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UR - http://purl.org/au-research/grants/nhmrc/1054146

U2 - 10.1016/j.ijmedinf.2019.06.011

DO - 10.1016/j.ijmedinf.2019.06.011

M3 - Article

VL - 129

SP - 253

EP - 259

JO - International Journal of Medical Informatics

T2 - International Journal of Medical Informatics

JF - International Journal of Medical Informatics

SN - 1386-5056

ER -