Crosson JC et al. 2007 "Variation in electronic prescribing implementation among twelve ambulatory practices."
Reference
Crosson JC, Isaacson N, Lancaster D, et al. Variation in electronic prescribing implementation among twelve ambulatory practices. J Gen Intern Med 2007;23(4):364-371.
Abstract
"BACKGROUND: Electronic prescribing has been advocated as an important tool for improving the safety and quality of medication use in ambulatory settings.
However, widespread adoption of e-prescribing in ambulatory settings has yet to be realized. The determinants of successful implementation and use in these settings are not well understood.
OBJECTIVE: To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.
DESIGN: Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.
PARTICIPANTS: Sixteen physicians and 31 staff members working in 12 practices scheduled for implementation of an e-prescribing program and purposively sampled to ensure a mix of practice size and physician specialty.
MEASUREMENTS: Field researchers used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience, and expectations.
RESULTS: Five practices fully implemented e-prescribing. Three installed but with only some prescribers or staff members using the program. Two installed and then discontinued use, and two failed to install. Compared to practice members in other groups, members of successful practices exhibited greater familiarity with the capabilities of health information technologies and had more modest expectations about the benefits likely to accrue from e-prescribing. Members of unsuccessful practices reported limited understanding of e-prescribing capabilities, expected that the program would increase the speed of clinical care and reported difficulties with technical aspects of the implementation and insufficient technical support."
However, widespread adoption of e-prescribing in ambulatory settings has yet to be realized. The determinants of successful implementation and use in these settings are not well understood.
OBJECTIVE: To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.
DESIGN: Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.
PARTICIPANTS: Sixteen physicians and 31 staff members working in 12 practices scheduled for implementation of an e-prescribing program and purposively sampled to ensure a mix of practice size and physician specialty.
MEASUREMENTS: Field researchers used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience, and expectations.
RESULTS: Five practices fully implemented e-prescribing. Three installed but with only some prescribers or staff members using the program. Two installed and then discontinued use, and two failed to install. Compared to practice members in other groups, members of successful practices exhibited greater familiarity with the capabilities of health information technologies and had more modest expectations about the benefits likely to accrue from e-prescribing. Members of unsuccessful practices reported limited understanding of e-prescribing capabilities, expected that the program would increase the speed of clinical care and reported difficulties with technical aspects of the implementation and insufficient technical support."
Objective
To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.
Tools Used
Type Clinic
Primary care
Type Specific
Family practice, internal medicine, OB-GYN, and pediatrics
Size
unknown
Geography
Urban
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
"Both [e-prescribing] programs are designed for the electronic submission of prescriptions to pharmacies during the clinical encounter using a computer interface or personal digital assistant (PDA) and can be used to print paper prescriptions for patients. Prescriptions also can be electronically submitted outside of the clinical encounter."
Context or other IT in place
A computerized practice management system was already in place as well as high-speed Internet access.
Workflow-Related Findings
"A physician in [a practice that installed e-prescribing but did not use it] said that following implementation, 'I realized that it wasn't going to be a time improvement' ... (and) ... struggles with the program led to a decrease in 'face time' with patients and that he chose to maintain patient contact rather than work to solve implementation problems."
"Several doctors [in practices that installed e-prescribing but did not use the system consistently] said that they did not like the priority listing of generic medicines in the program and thought this could undermine their clinical authority as they prefer to write for brand name drugs."
Other doctors [in practices that installed e-prescribing but did not use the system consistently] "complained that the system led to extra work."
A staff member [in a practice that installed e-prescribing but did not use the system consistently] "reported that the program reduced time spent on the phone with pharmacies."
Study Design
Pre-postintervention (no control group)
Study Participants
"Sixteen physicians and 31 staff members working in 12 practices ... [were] purposively sampled to ensure a mix of practice size and physician specialty."