Rivkin S 1997 "Opportunities and challenges of electronic physician prescribing technology."

Reference
Rivkin S. Opportunities and challenges of electronic physician prescribing technology. Med Interface 1997;10(8):77.
Abstract
"The results of a six-month pilot with electronic prescribing used by 17 Health Alliance Plan (HAP) physicians are reported. All 17 practice in an IPA setting in southeastern Michigan. This critical evaluation reveals the many opportunities and various challenges that this new technology brings to the managed health care environment."
Objective

"To investigate the advantages and disadvantages of electronic prescribing computer programs in five IPA physicians' offices."

Tools Used
Type Clinic
Primary care
Type Specific
Family practice, internal medicine, and pediatrics
Size
Small and/or medium
Other Information
Five practices participated with a total of 17 providers. There are more than 522,000 members part of the Henry Ford Health System mixed-model health maintenance organization.
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
"The product operated on a stand-alone PC [personal computer] in the physician's office. Data from the physician's practice management system was downloaded to the physician's prescribing system. The system presented a series of screens onto which the practitioner would enter prescription and patient information. Prior to final approval for faxing, the prescription information was transmitted electronically to the company's server in their home office and a series of system edits was performed. Were any problem detected, pharmacy personnel were required to review the information and send back a message suggesting needed changes. Should the physician desire to override the plan's formulary recommendation, the physician would then be required to enter a code that would allow the prescription to proceed. More often than not, physicians designated key personnel (nurses or medical assistants) to enter the prescription information."
Context or other IT in place
Practice management system
Workflow-Related Findings
"Sometimes prescriptions were not filled immediately [in the pharmacy] because pharmacy staff were not in the habit of using this new procedure. Other times, patients were not in the pharmacy computer system because identification of the correct patient could not be ensured."
"Should the physician desire to override the plan's formulary recommendation, the physician would then be required to enter a code that would allow the prescription to proceed."
"The system was a stand-alone system and required a tremendous amount of labor in wiring the offices for the workstation. Other unforeseen difficulties included connection problems with the company sponsoring the technology, operational issues with prescription transfers, and problematic prescriptions requiring review."
"Rate of generic use at the start of this pilot averaged 85 percent. By the end it was 99 percent. At baseline, HAP formulary compliance -- which included prescribing generics, formulary and preferred agents -- averaged 83 percent. By the end of the data-recording period, formulary compliance reached 95 percent."
"Some offices were able to enter prescriptions through this system only when fully staffed. Many blamed the system's cumbersome nature for this. According to physician staff members, the system needed multiple screens to enter prescription information since it was a stand-alone product, independent of the office management tool already in place and patient demographics needed to be entered on separate screens."
"In many offices, this tool was reportedly used for those patients who called the physician's office and requested prescriptions (whether new or refills) rather than for those who were seen in the office ... [One] office said this tool was used only when patients had multiple prescriptions."
"However, many physician offices continued to phone in prescriptions or write them out by hand since this particular system was seen as cumbersome and the traditional process for distributing the written prescription seemed faster."
"Even though the product itself was seen as particularly cumbersome, some redeeming characteristics were identified. Once the patient's data were loaded into the system, it was relatively simple to display the prescription record - merely by entering the patient's name."
"Some offices reported perceived time savings, noted by decreases in necessary phone calls from the pharmacy to the physician's office, as some problems with prescriptions were flagged by the electronic prescribing technology in the physician's office."
"Patients avoided two trips to the pharmacy since they had only to retrieve the medication, not deliver the prescription note."
"If a prescription was being transferred to a nearby pharmacy or possibly even one located within the same building as the physician's office, the patient could expect the prescription to take a while [to arrive, approximately 15 to 20 minutes]."
"Unfortunately, this system also lacked a feedback mechanism that would confirm the prescription's transmission. Office staff often assumed (understandably) that the prescription arrived at the designated location and would be filled. There were two problems with this assumption: First, the transaction was not instant; and second, the pharmacy might not immediately fill the prescription. In fact, prescriptions would often sit on the fax machine until the patient arrived ... Unconfirmed prescription transmissions frustrated both users (office staff) and beneficiaries (patients)."
"Support staff will not embrace this technology unless physicians first demonstrate their commitment to using it."
"Initially, difficulties were encountered with the electronic transfer of prescriptions from the physicians' offices to the designated pharmacy. In particular, the prescriptions would be delayed when drug-utilization flags were raised."
Study Design
Only postintervention (no control group)
Study Participants
"Whereas the goal was 10 office sites, only five practices - a total of 17 physicians - received this program. The initial goal was to expand this pilot to all 10, but this was impossible since the system took four months to install. All practitioners were primary care physicians...Provider Enrollment: Feedback was elicited from HAP executives to identify potential candidates for this pilot. Though rather informal, this process initially sought to identify HAP providers who were interested in computerized technologies and who provided care for large numbers of HAP members."