Building an Implementation Toolset for E-Prescribing

This project, one of the Agency for Healthcare Research and Quality's Accelerating Change and Transformation in Organizations and Networks (ACTION) projects, developed two e-Prescribing implementation toolsets, one for independent pharmacies, and the other for health care provider organizations. For the purpose of this study, 'health care provider organizations' included small independent offices, larger medical groups, and safety net clinics. Development was informed by an environmental scan, input from an advisory committee, and observation of sites that implemented e-Prescribing successfully. The toolsets provide comprehensive guidance on technology requirements, workflow analysis tools, and activities that contribute to successful implementation. During the project each toolset was evaluated and refined according to feedback from sites that used them during implementation.

The main objectives of the project were to:

• Catalogue publicly-announced ongoing e-Prescribing initiatives.
• Assess contributors to successful implementation of e-Prescribing initiatives.
• Create two draft e-Prescribing implementation toolsets.
• Evaluate the draft toolset's usability and usefulness in helping provider organizations implement e-Prescribing.
• Create a final e-Prescribing implementation toolset based on findings from the pilot evaluation.

While all pilot test sites used at least one of the tools in the toolset, overall usage was significantly less than anticipated. A main reason for this was that it was difficult to identify practices that were both at an early stage in planning for implementation and committed to enrolling in the site visit protocol. Those practices that were committed and ready to move forward typically already had an implementation plan, either from their vendor or support organization, and did not feel the need for additional tools from the toolset. Additionally, the team received feedback that the toolsets contained a daunting overall volume of information, making resources somewhat difficult to locate. In response, the project developed a one-page quick start guide to make navigation easier.

The team noted several key factors that led to successful implementation of e-Prescribing. Examples of these factors included meaningful pre-implementation steps such as conducting a workflow analysis; having physician champions; providing adequate training; having sufficient support; using a staged approach for pharmacy implementation; and using effective communication strategies.

The project team concluded that the adoption of e-Prescribing will likely continue to be a challenge. Larger up-front investment of time and intensity of training may ease the process. This should include training support staff, working with members of practices and making sure that trainers themselves have learned to use the toolsets. Additionally, shorter versions of the toolsets which contain links to more detailed information could help users navigate the toolsets.