Impact of Office-Based E-Prescribing on Prescribing Processes and Outcomes

Under current systems of care delivery, sub-optimal prescribing practices in outpatient settings can result in preventable and costly errors. Electronic-prescribing (e-prescribing), a technology that allows prescribers to write prescriptions electronically has been shown to create safer, more efficient prescribing practices. In order for the positive effects of e-prescribing to occur, e-prescribing systems must have utility for prescribers and must be integrated into the workflow of routine medical practice. For e-prescribing to improve quality and safety, it must have valid and usable decision-support capabilities that are available at the point of care.

The primary aim of this study was to evaluate the implementation of an e-prescribing system in ambulatory settings. ZixCorp’s PocketScript system was one of the most widely used outpatient e-prescribing systems during the period of this study. It included functions that addressed multiple clinical safety and efficiency issues, including safety alerts, formulary decision support, and drug history.

This study evaluated how this e-prescribing system affected the processes of prescribing for physicians in order to assess characteristics of successful and productive adoption. It also evaluated how physicians used the functionality of the e-prescribing system and how the functionalities used affected the medications used by patients. The specific aims of the study were to:

• Measure physician use of two safety-related e-prescribing functions: safety alerts and dispensed drug history.
• Measure the effect of e-prescribing on processes of prescribing for physicians to assess characteristics of successful and productive adoption.
• Extend and expand ongoing research to assess whether the adoption of e-prescribing is associated with improved clinical outcomes for patients.

Focus groups, direct observation, and semi-structured interviews were conducted with physicians, practice managers, nurses, and other medical staff. Following several iterations of focus group data, hypotheses regarding clinician perception of e-prescribing were revised as more data were collected and interpretations were formulated. A large-sample survey was mailed to physicians using e-prescribing systems. Survey results evaluated the relationship between measures of e-prescribing system use and the types of e-prescribing systems used, as well as physician and patient characteristics. E-prescribing records were evaluated to identify patterns of how physicians used the features of the system and how these correlated with medications used by patients.

Qualitative analyses identified seven hypotheses regarding clinician perception of e-prescribing, ranging from positive to neutral to negative, that affect how physicians adopt new technologies. Survey results found that physicians using e-prescribing systems that were part of an integrated electronic health record were more likely to use advanced e-prescribing features than were physicians using stand-alone e-prescribing systems. Quantitative analyses showed that over time physicians used e-prescribing systems more frequently and used more of the features. Overall results indicate that, as more physicians use health information systems, attention to integration and design will be important to ensure robust uptake and appropriate use by clinicians.