Crosson JC, Etz RS, Wu S, et al. "Meaningful use of electronic prescribing in 5 exemplar primary care practices."

Crosson JC, Etz RS, Wu S, et al. Meaningful use of electronic prescribing in 5 exemplar primary care practices. Ann Fam Med 2011 Sep-Oct;9(5):392-7.
PURPOSE Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques. METHODS We conducted a multimethod qualitative case study of 5 ambulatory primary care practices identified as exemplars of effective e-prescribing. The practices were identified by a group of e-prescribing experts. Field researchers conducted in-depth interviews and observed prescription-related workflow in these practices. RESULTS In these exemplar practices, successful use of e-prescribing required practice transformation. Practice members reported extensive efforts to redesign work processes to take advantage of e-prescribing capabilities and to create specific e-prescribing protocols to distribute prescription-related work among practice team members. These practices had substantial resources to support e-prescribing use, including local physician champions, ongoing training for practice members, and continuous on-site technical support. Practices faced considerable challenges during use of e-prescribing, however, deriving from problems coordinating new work processes with pharmacies and ineffective health information exchange that required workarounds to ensure the completeness of patient medical records. CONCLUSIONS More widespread implementation and effective use of e-prescribing in ambulatory care settings will require practice transformation efforts that focus on work process redesign while being attentive to effects on patient and pharmacy involvement in prescribing. Improved health information exchange is required to fully realize expected quality, safety, and efficiency gains of e-prescribing.

The objective of the study was to identify successful implementation and use techniques of e-prescribing. Best practices of e-prescribing implementation are described with workflow redesign integrated early in the implementation process.

Tools Used
Type Clinic
Primary care
Type Specific
Family practice, internal medicine, and pediatrics
not applicable
Other Information
5 exemplar sites of varying sizes and affiliations were selected in collaboration with an Expert Advisory Committee. Purposive sampling to include safety net settings, and e-prescribing as part of EHR and those who had stand alone systems.
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
Functions of the e-prescribing systems were not specified.
Context or other IT in place
Three sites used an e-prescribing system integrated with an EHR, while the other 2 sites used e-prescribing as stand alone systems. All sites had substantial on site IT.
Workflow-Related Findings
In the planning stage of e-prescribing adoption, best practices included having technical support and planning teams working with sites to understand existing work processes and how they could be affected by e-prescribing. Workflow redesign among exemplar sites included standardizing previously idiosyncratic documentation patterns. Planning teams developed protocols that allowed for standardized handling of prescription renewals by nonphysician practice members. Such protocols served as a basis for a care management system focused on ensuring reliable follow-up for patients with chronic conditions.
Study Design
Only postintervention (no control group)
Study Participants
Practice members of exemplar sites were interviewed.