Perceptions of Standards-based Electronic Prescribing Systems as Implemented in Outpatient Primary Care: A Physician Survey

Pediatrics and Public Health Boston University and Boston Medical Center, Boston, MA, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 05/2009; 16(4):493-502. DOI: 10.1197/jamia.M2998
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OBJECTIVE To compare the experiences of e-prescribing users and nonusers regarding prescription safety and workload and to assess the use of information from two e-prescribing standards (for medication history and formulary and benefit information), as they are implemented. DESIGN Cross-sectional survey of physicians who either had installed or were awaiting installation of one of two commercial e-prescribing systems. MEASUREMENTS Perceptions about medication history and formulary and benefit information among all respondents, and among e-prescribing users, experiences with system usability, job performance impact, and amount of e-prescribing. RESULTS Of 395 eligible physicians, 228 (58%) completed the survey. E-prescribers (n = 139) were more likely than non-e-prescribers (n = 89) to perceive that they could identify clinically important drug-drug interactions (83 versus 67%, p = 0.004) but not that they could identify prescriptions from other providers (65 versus 60%, p = 0.49). They also perceived no significant difference in calls about drug coverage problems (76 versus 71% reported getting 10 or fewer such calls per week; p = 0.43). Most e-prescribers reported high satisfaction with their systems, but 17% had stopped using the system and another 46% said they sometimes reverted to handwriting for prescriptions that they could write electronically. The volume of e-prescribing was correlated with perceptions that it enhanced job performance, whereas quitting was associated with perceptions of poor usability. CONCLUSIONS E-prescribing users reported patient safety benefits but they did not perceive the enhanced benefits expected from using standardized medication history or formulary and benefit information. Additional work is needed for these standards to have the desired effects.

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Available from: Jesse Crosson, Oct 06, 2015
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    • "This limits the value of physicians' opinions about the technology. Similarly, among the physicians that Wang et al. [17] consider to be users of the eRx technology, only 37% said that they used it in all their prescribing (an average of 178 eRx/month), while 17% said that they had abandoned the technology. All the studies included in this review are observational, with or without a control group (Level III or Level IV, respectively ). "
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    ABSTRACT: The objective of this study was to identify physicians' and pharmacists' perceptions of the challenges and benefits to implementing a nationwide electronic prescribing network linking medical clinics and community pharmacies in Quebec, Canada. Forty-nine people (12 general practitioners, 2 managers, 33 community pharmacists, and 2 pharmacy staff members) from 40 points of care (10 primary care clinics (42% of all the connected sites) and 30 community pharmacies (44%)) were interviewed in 2013. Verbatim transcripts were analyzed using thematic analysis. A low level of network use was observed. Most pharmacists processed e-prescriptions by manual entry instead of importing electronically. They reported concerns about potential errors generated by importing e-prescriptions, mainly due to the instruction field. Paper prescriptions were still perceived as the best means for safe and effective processing of prescriptions in pharmacies. Speed issues when validating e-prescription messages were seen as an irritant by physicians, and resulted in several of them abandoning transmission. Displaying the medications based on the dispensing data was identified as the main obstacle to meaningful use of medication histories. Numerous challenges impeded realization of the benefits of this network. Standards for e-prescription messages, as well as rules for message validation, need to be improved to increase the potential benefits of e-prescriptions. Standard drug terminology including the concept of clinical medication should be developed, and the implementation of rules in local applications to allow for the classification and reconciliation of medication lists from dispensing data should be made a priority. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:
    Journal of the American Medical Informatics Association 04/2015; 22(4). DOI:10.1093/jamia/ocv026 · 3.50 Impact Factor
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    • "• Cost savings and reduced expenses of health care for patients, health care providers, health programs, and health care insurance organizations throughout the prescription processing system (48-52). "
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    ABSTRACT: The tendency to use advanced technology in healthcare and the governmental policies have put forward electronic prescription. Electronic prescription is considered as the main solution to overcome the major drawbacks of the paper-based medication prescription, such as transcription errors. This study aims to provide practical information concerning electronic prescription system to a variety of stakeholders. In this review study, PubMed, ISI Web of Science, Scopus, EMBASE databases, Iranian National Library Of Medicine (INLM) portal, Google Scholar, Google and Yahoo were searched for relevant English publications concerning the problems of paper-based prescription, and concept, features, levels, benefits, stakeholders and standards of electronic prescription system. There are many problems with the paper prescription system which, according to studies have jeopardized patients' safety and negatively affected the outcomes of medication therapy. All of these problems are remedied through the implementation of e-prescriptions. The sophistication of electronic prescription and integration with EHR will become a reality, if all its stakeholders collaborate in developing fast and secure electronic prescription systems. It is plausible that the required infrastructure should be provided for implementation of the national integrated electronic prescription systems in countries without the system. Given the barriers to the implementation and use, policymakers should consider multiple strategies and offer incentives to encourage e-prescription initiatives. This will result in widespread adoption of the system.
    10/2013; 15(10):e8436. DOI:10.5812/ircmj.8436
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    • "This limits the value of physicians' opinions about the technology. Similarly, among the physicians that Wang et al. [17] consider to be users of the eRx technology, only 37% said that they used it in all their prescribing (an average of 178 eRx/month), while 17% said that they had abandoned the technology. All the studies included in this review are observational, with or without a control group (Level III or Level IV, respectively ). "
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    ABSTRACT: Objective: To describe second-generation electronic prescription (eRx) technologies and identify their impacts on the medication management process in primary care. Second-generation eRx technologies have focused on networking various stakeholders so that they can communicate electronically. Method: Using key words, a search was conducted of the relevant databases up to January 2011. A manual search was conducted of the bibliographies of the studies as well as the prior systematic reviews found. The tables of contents of the major periodicals in the field were also searched. This included studies of the impacts of eRx technologies that allow electronic circulation of information between prescription sites and dispensing sites, independent of the methodology used. A structured form was used to extract the data. The studies' impacts were classified by stage in the medication management process (prescription, transmission of the prescription, execution of the prescription and use of the medication). Results: Nineteen observational studies were included in this review. Most of them (10/19) have evaluated users' perceptions using interviews, focus groups or questionnaires. Two technology models stand out: the push model, under which the prescriber directs the prescription toward a specific pharmacy, and the pull model, under which any authorized pharmacy can download a given prescription into its system. The push model is the most widely used, particularly in the United States. Communication between prescribers and dispensers is usually unidirectional, and communications standards have to be refined. The only demonstrated impacts of second-generation eRx technologies were found at two levels: positive impacts on the quality of the pharmacological profile available to professionals, and negative impacts on the execution of prescriptions in pharmacies. Stakeholders' perceptions were mixed and reflected considerable differences according to context, the type of technology used, the intensity of its use and its maturity. Electronic transmission of prescriptions provides a new way to monitor patient compliance. Conclusion: There is little empirical data demonstrating benefits to second-generation eRx technologies, even if it is a highly promoted model for improving primary care quality. More research is required, with studies that measure the impacts of second-generation technologies using empirical data and conducted in the context of actual use. Future studies should also employ the same terminology and provide full descriptions of context, type of technology and intensity of use.
    International Journal of Medical Informatics 02/2013; 82(6). DOI:10.1016/j.ijmedinf.2013.01.012 · 2.00 Impact Factor
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