Article

Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies

Center for Studying Health System Change, Washington, DC 20002-4221, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 11/2011; 19(3):353-9. DOI: 10.1136/amiajnl-2011-000515
Source: PubMed

ABSTRACT A core feature of e-prescribing is the electronic exchange of prescription data between physician practices and pharmacies, which can potentially improve the efficiency of the prescribing process and reduce medication errors. Barriers to implementing this feature exist, but they are not well understood. This study's objectives were to explore recent physician practice and pharmacy experiences with electronic transmission of new prescriptions and renewals, and identify facilitators of and barriers to effective electronic transmission and pharmacy e-prescription processing.
Qualitative analysis of 114 telephone interviews conducted with representatives from 97 organizations between February and September 2010, including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions via Surescripts.
Practices and pharmacies generally were satisfied with electronic transmission of new prescriptions but reported that the electronic renewal process was used inconsistently, resulting in inefficient workarounds for both parties. Practice communications with mail-order pharmacies were less likely to be electronic than with community pharmacies because of underlying transmission network and computer system limitations. While e-prescribing reduced manual prescription entry, pharmacy staff frequently had to complete or edit certain fields, particularly drug name and patient instructions.
Electronic transmission of new prescriptions has matured. Changes in technical standards and system design and more targeted physician and pharmacy training may be needed to address barriers to e-renewals, mail-order pharmacy connectivity, and pharmacy processing of e-prescriptions.

Download full-text

Full-text

Available from: Genna R Cohen, Mar 26, 2015
0 Followers
 · 
131 Views
  • Source
    • "Studies show barriers towards electronic prescribing including interruption in work processes and security concerns. Therefore, practice and pharmacy transformation and redesign of work processes are required [24,25]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Primary health care in industrialized countries faces major challenges due to demographic changes, an increasing prevalence of chronic diseases and a shortage of primary care physicians. One approach to counteract these developments might be to reduce primary care physicians’ workload supported by the use of health information technology (HIT) and non-physician practice staff. In 2009, the U.S. Commonwealth Fund (CWF) conducted an international survey of primary care physicians which the present secondary descriptive analysis is based on. The aim of this analysis was twofold: First, to explore to what extend German primary care physicians already get support by HIT and non-physician practice staff, and second, to show possible future perspectives. Methods The CWF questionnaire was sent to a representative random sample of 1,500 primary care physicians all over Germany. The data was descriptively analyzed. Group comparisons regarding differences in gender and age groups were made by means of Chi Square Tests for categorical variables. An alpha-level of p < 0.05 was used for statistical significance. Results Altogether 715 primary care physicians answered the questionnaire (response rate 49%). Seventy percent of the physicians use electronic medical records. Technical features such as electronic ordering and access to laboratory parameters are mainly used. However, the majority does not routinely use technical functions for drug prescribing, reminder-systems for guideline-based interventions or recall of patients. Six percent of surveyed physicians are able to transfer prescriptions electronically to a pharmacy, 1% use email communication with patients regularly. Seventy-two percent of primary care physicians get support by non-physician practice staff in patient care, mostly in administrative tasks or routine preventive services. One fourth of physicians is supported in telephone calls to the patient or in patient education and counseling. Conclusion Within this sample the majority of primary care physicians get support by HIT and non-physician practice staff in their daily work. However, the potential has not yet been fully used. Supportive technical functions like electronic alarm functions for medication or electronic prescribing should be improved technically and more adapted to physicians’ needs. To warrant pro-active health care, recall and reminder systems should get refined to encourage their use. Adequately qualified non-physician practice staff could play a more active role in patient care. Reimbursement should not only be linked to doctors’, but also to non-physician practice staff services.
    BMC Medical Informatics and Decision Making 08/2012; 12(1):81. DOI:10.1186/1472-6947-12-81 · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medical practice is more and more based on electronic healthcare records. Big data and great amount of information drive medical staff to use decision support software to support their activities. The paper presents a software solution in this area, collecting a set of successful treatments from diverse medical software, based on tested treatments related to illness that makes suggestions to other physicians in likewise cases. The suggested treatments is verified with the characteristics of the patient if is compatible. Based on this application the physicians may use tested treatments that have good results. In order to collect a great diversity of cases and situations from as many applications as possible the technological solution is based on Cloud Computing. We expect physicians to be more confident and to relate better to the application because the suggested treatments are given mainly by physicians and are not a result of an algorithm.
    E-Health and Bioengineering Conference (EHB), 2013; 01/2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Electronic health record (EHR) use in ambulatory care can improve safety and quality; however, problems with design, implementation, and poor interface with other systems lead users to develop 'workarounds', or behaviors users adopt to overcome perceived limitations in a technical system. We documented workarounds used in independent, community-based primary care practices, and developed a typology of their key features. Comparative case study of EHR use in seven independent primary care practices. Field researchers spent approximately 1 month in each practice to observe EHR use, conduct patient pathways, and interview clinicians and staff. We observed workarounds addressing a wide range of EHR-related problems, including: user interface issues (eg, insufficient data fields, limited templates), barriers to electronic health information exchange with external organizations, and struggles incorporating new technologies into existing office space. We analyzed the observed workarounds inductively to develop a typology that cuts across specific clinical or administrative processes to highlight the following key formal features of workarounds in general: temporary/routinized, which captures whether the workaround is taken for granted as part of daily workflow or is understood as a short-term solution; avoidable/unavoidable, referring to the extent to which the workaround is within the practice's power to eliminate; and deliberately chosen/unplanned, which differentiates strategically chosen adaptations from less thoughtful workarounds. This workaround typology provides a framework for EHR users to identify and address workarounds in their own practices, and for researchers to examine the effect of different types of EHR workarounds on patient safety, care quality, and efficiency.
    Journal of the American Medical Informatics Association 07/2013; 21(E1). DOI:10.1136/amiajnl-2013-001686 · 3.93 Impact Factor
Show more