***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Direct physician order entry ( POE ) offers many potential benefits , but evidence suggests that POE requires substantially more time than traditional paper-based ordering methods . The Medical Gopher is a well-accepted system for direct POE that has been in use for more than 15 years . The authors hypothesized that physicians using the Gopher would not spend any more time writing orders than physicians using paper-based methods . DESIGN A r and omized controlled trial of POE using the Medical Gopher system in 11 primary care internal medicine practice s. MEASUREMENTS The authors collected detailed time use data using time motion studies of the physicians and surveyed their opinions about the POE system . RESULTS The authors found that physicians using the Gopher spent 2.2 min more per patient overall , but when duplicative and administrative tasks were taken into account , physicians were found to have spent only 0.43 min more per patient . With experience , the order entry time fell by 3.73 min per patient . The survey revealed that the physicians believed that the system improved their patient care and wanted the Gopher to continue to be available in their practice s. CONCLUSIONS Little extra time , if any , was required for physicians to use the POE system . With experience in its use , physicians may even save time while enjoying the many benefits of POE This paper describes the diffusion of an evidence -based stroke guidance system ( SGS ) in a field setting through participatory research . SGS enables physicians to review relevant evidence -based literature , from which patient orders are generated for managing cerebrovascular accident . The paper focuses on the question ' what are the barriers and enablers to adopting SOS ? ' The research site consisted of eight hospitals within two health regions in Alberta , with 47 physicians as the intended users . The data sources consisted of surveys , education sessions , design feedback , field observations , and usage logs . Preliminary results revealed an initial slow rate of adoption that gradually improved with the influence of clinical champions , more effective communication , sustained education , round-the-clock support and continued system refinement . These initial findings suggest that models of technological diffusion can help us better underst and the complexities of changing physician practice behaviors The impact of a bedside terminal system implemented in a community hospital was evaluated using a one-group before- and -after design . Contrary to predictions , the amount of time registered nurses spent in direct care and the positiveness of registered nurses ' attitudes toward bedside terminal technology decreased after the implementation . Registered nurse overtime decreased in accordance with the prediction and unit medication errors remained unchanged . The internal validity of these results was threatened by organizational changes that directly and indirectly affected the study unit . Recommendations are made for conducting evaluation research in a rapidly changing hospital environment OBJECTIVE To assess the effects on health care re source utilization of a network of microcomputer workstations for writing all inpatient orders . DESIGN R and omized 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 OBJECTIVE A research prototype Physician Workstation ( PWS ) incorporating a graphical user interface and a drug ordering module was compared with the existing hospital information system in an academic Veterans Administration General Medical Clinic . Physicians in the intervention group received recommendations for drug substitutions to reduce costs and were alerted to potential drug interactions . The objective was to evaluate the effect of the PWS on user satisfaction , on health-related outcomes , and on costs . DESIGN A one-year , two-period , r and omized controlled trial with 37 subjects . MEASUREMENTS Differences in the reliance on noncomputer sources of information , in user satisfaction , in the cost of prescribed medications , and in the rate of clinical ly relevant drug interactions were assessed . RESULTS The study subjects logged onto the workstation an average of 6.53 times per provider and used it to generate 2.8 % of prescriptions during the intervention period . On a five-point scale ( 5 = very satisfied , 1 = very dissatisfied ) , user satisfaction declined in the PWS group ( 3.44 to 2.98 p = 0.008 ) , and increased in the control group ( 3.23 to 3.72 , p < 0.0001 ) . CONCLUSION The intervention physicians did not use the PWS frequently enough to influence information-seeking behavior , health outcomes , or cost . The study design did not determine whether the poor usage result ed from satisfaction with the control system , problems using the PWS intervention , or the functions provided by the PWS intervention . Evaluative studies should include provisions to improve the chance of successful implementation as well as to yield maximum information if a negative study occurs A two-month r and omized , controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center , Germany , to investigate the influence of computer-based nursing documentation on time investment for documentation , quality of documentation and user acceptance . Time measurements , question naires , documentation analysis and interviews were used to compare patients documented with the computer-based system ( PIK group ) with the control group ( patients documented with the paper-based system ) .  The results showed the advantages and disadvantages of computer-based nursing documentation .  Time needed for nursing care planning was lower in the PIK group . Some formal aspects of quality were considerably better in the PIK group . On the other h and , time required for documentation of tasks and for report writing was greater in the PIK group . User acceptance increased significantly during the study . The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians Abstract Objective . Nowadays , registration of patient data on paper is gradually being replaced by registration using an intensive care information system ( ICIS ) . The aim of this study was to evaluate the effect of the use of an ICIS on nursing activity . Design . R and omized controlled trial with a crossover design . Setting . An 18-bed medical-surgical ICU in a teaching hospital . Patients , nurses and interventions . During a 6week period 145 consecutive adult patients admitted to the ICU after uncomplicated cardiothoracic surgery were r and omized into two groups : for one group the documentation was carried out using a paper-based registration ( Paper ) , in the second group an ICIS was used for documentation . Measurements and results . The nursing activities for these patients were studied during two separate periods : the admission period and the registration phase ( the period directly following the admission procedure ) . The duration of the admission procedure was measured by time-motion analysis and the nursing activities in the registration phase were studied by work sampling methodology . All nursing activities during the registration phase were grouped in four main categories : patient care , documentation , unit-related and personal time . The duration of the admission procedure was longer in the ICIS group ( 18.1±4.1 versus 16.8±3.1 min , p<0.05 ) . In the registration phase , a 30 % reduction in documentation time ( Paper 20.5 % of total nursing time versus ICIS 14.4 % , p<0.001 ) , corresponding to 29 min ( per 8h nursing shift ) was achieved . This time was completely re-allocated to patient care . Conclusions . The use of the present ICIS in patients after cardiothoracic surgery alters nursing activity ; it reduces the time for documentation and increases the time devoted to patient care . Electronic Supplementary Material is available if you access this article at http://dx.org/10.1007/s00134-002-1542-9 . On that page ( frame on the left side ) , a link takes you directly to the supplementary material Objective To determine the percentage of time that intensive care unit ( ICU ) nurses spend on documentation and other nursing activities before and after installation of a third-generation ICU information system . Design Prospect i ve data collection using real-time time-motion analysis , before and after installation of the ICU information system . Setting A ten-bed surgical ICU at a Veterans Affairs medical center . SubjectsICU nurses . Interventions Installation of a third-generation ICU information system . Measurements and Main Results Ten ICU nurses were studied before and after installation of the ICU information system . Each ICU nurse ’s activities and tasks , during 4-hr observation periods , were categorized in real-time by a nurse observer and recorded in a laptop computer . Each recorded task was automatically time-stamped and logged into a data file . The percentage of time spent on documentation decreased from 35.1 ± 8.3 % to 24.2 ± 7.6 % ( p = .025 ) after the ICU information system was installed . The percentage of time providing direct patient care increased from 31.3 ± 9.2 % to 40.1 ± 11.7 % ( p = .085 ) . The percentage of time doing patient assessment , a direct patient care task , increased from 4.0 ± 4.7 % to 9.4 ± 4.4 % ( p = .001 ) . Conclusions Installation of a third-generation ICU information system decreased the percentage of time  ICU nurses spent on documentation by > 30 % . Almost half of the time saved on documentation was spent on patient assessment , a direct patient care task Computerized  physician order entry ( CPOE )  has been shown to improve quality , and to reduce re source utilization , but most available data suggest that it takes longer to enter orders using CPOE . We had previously implemented a CPOE system , and elected to evaluate its impact on physician time in the new setting . To do this , we performed a prospect i ve study using r and om reminder methodology . Key findings were that interns spent 9.0 % of their time ordering with CPOE , compared to 2.1 % before , although CPOE saved them an additional 2 % of time , so that the net difference was 5 % of their total time . However , this is counterbalanced by decreased time for other personnel such as nursing and pharmacy , and by the quality and efficiency changes . We conclude that while CPOE has many benefits , it represents a major process change , and organizations must factor this in when they implement it OBJECTIVE The aim of this paper is twofold . First , we describe two important dimensions of  patient care information systems ( PCIS ) evaluation :  the domain of evaluation and the different phases of the PCIS implementation . Second , we cl aim that , though R and omized Controlled Trials ( RCTs ) are often still seen as the st and ard approach , this type of design hardly generates relevant information for the organizational decision maker . METHOD Interpretive study of evaluation literature . RESULTS AND CONCLUSIONS The field of evaluation is scattered and the types of questions that can be asked and methods that can be used seem infinite and badly demarcated . Different stakeholders , moreover , often have different priorities in evaluating ICT . The most important reason for the lack of relevance of RCTs is that they are ill suited for investigating why and how a PCIS is being used , or not , and what the ( often unplanned ) effects and consequences are . Subsequently , our aim is to contribute to the discussion about the viability of qualitative versus quantitative methods in PCIS evaluation , by arguing for a specific integration of quantitative and qualitative research methods . The joint utilization of these methods , we cl aim , yields the richest results Abstract Objective : To test the hypotheses that : ( 1 ) integrating information processing tasks using an electronic clinical information system ( ECIS ) decreases time to complete these tasks by h and ; and ( 2 ) structured data entry encourages generation of more detailed records and capture of specific data elements even when entry is voluntary . Design : Prospect i ve observational time analysis during medical documentation tasks . Retrospective analysis of clinical documentation completed by h and or electronically . Setting : Eleven bed pediatric intensive care unit within an academic medical center . Participants : Five pediatric intensive care medicine attending physicians . Measurements : Compared h and written and electronic documentation to determine : ( 1 ) time spent entering data or composing notes ; ( 2 ) number of descriptors documenting patients ' physical exams ; ( 3 ) users ' preferences for structured or unstructured data entry ; ( 4 ) frequency of documenting specific data elements related to nutritional support . Results : Documentation time varied by user but not charting method : it took 13 % less time to document using the ECIS but this was not significant . Electronic documents were more detailed than h and written containing 50 % more descriptors ( 17.8±1.4 vs 11.6±1.4 ) overall and some data elements that were not h and written : information related to nutritional supplementation was recorded in 13 % of electronic documents but in none of 89 h and written documents . Conclusions : Electronic and h and written documentation consumed equal amounts of time . Structured entry , compared to h and writing , may encourage recording of specific or otherwise unincorporated data elements result ing in a more detailed record . This suggests that user interfaces and decision support components may influence both the types and complexity of clinical data recorded by caregivers This article describes a comparative study that examined the frequencies of nursing activities , when using a clin 
    Output:
    
Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process .
This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized .
It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups , physicians and nurses