Physicians' Experiences Using Commercial E-Prescribing Systems
Project Details -
Completed
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Contract Number290-05-0007-1
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Funding Mechanism(s)
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AHRQ Funded Amount$128,064
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Principal Investigator(s)
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Organization
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LocationWashingtonDistrict of Columbia
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Project Dates08/22/2005 - 05/30/2007
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Technology
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Care Setting
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Population
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Type of Care
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Health Care Theme
Electronic prescribing (e-prescribing) is one health information technology system that clinicians may use to improve the safety, quality, and efficiency of health care. While e-prescribing has advantages to paper prescriptions, adoption has been slow and implementation has proven to be more difficult than anticipated. Research shows a gap between the vision of advocates and policymakers of this technology and the actual experiences of users. This study investigated the experiences of physician practices using e-prescribing, examining physicians’ perceptions of benefits, and the reasons for the lag between policy goals and actual use.
The main objective of the project was to answer two major research questions:
- To what extent and in what ways are physician practices using electronic prescribing?
- What are the major barriers and facilitators to electronic prescribing adoption and use?
Forty-four discussions in 26 participating organizations were held via telephone between November 2005 and March 2006. The majority of participants were at 15 practices with e-prescribing and included IT or practice administrators, medical directors, physician-users, and other users. Discussions were also held with physicians or administrators at six practices without e-prescribing. Five other participants included health plan, vendor, and pharmacy representatives. Two-thirds of the practices used e-prescribing as part of an electronic medical record; the remaining practices used stand-alone e-prescribing systems. The majority of practices had fully implemented systems, with about half of the practices’ systems in place for more than 2 years.
In general, physicians were positive about their use of e-prescribing, but described major barriers to implementation and use, including maintaining complete patient medication lists, using clinical decision support, obtaining formulary data, and electronically transmitting prescriptions to pharmacies. Three main factors contributed to these barriers: limits of the e-prescribing systems being used, external implementation challenges, and individual clinician preference about using particular features of their system.
Despite challenges, all participants believed that e-prescribing improves prescribing safety and quality while increasing practice efficiency, and preferred these systems to paper. Practices saw improvements in legibility, better documentation, reduced pharmacy “callbacks”, and improved management of renewals.
It was noted that many of the systems being used did not have advanced features needed for additional improvements in safety, efficiency, and quality, such as clinical decision support tools, including alerts and reminders; access to patient-specific formulary data; and capacity for two-way electronic communication between the medical practices and pharmacies and pharmacy benefit managers to send prescriptions, clarifications, and renewal requests. Even when systems did have advanced features, many physicians did not use them because of implementation hurdles, or the perception that these advanced features did not add value.
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