Schade CP et al. 2006 "e-Prescribing, efficiency, quality: Lessons from the computerization of UK family practice."

Schade CP, Sullivan FM, Lusignan S, et al. e-Prescribing, efficiency, quality: lessons from the computerization of UK family practice. J Am Med Inform Assoc 2006;13(5):470-475.
"Nearly all general practice physicians (GPs) in the United Kingdom (UK) have electronic health record (EHR) systems in their practices compared with perhaps 15% of primary care physicians in the United States (U.S.). Based on interviews of 13 general GPs and review of current literature, the authors argue that the historical experience of widespread electronic health record uptake in the UK provides insight into features that might motivate broad adoption in the United States. These features include electronic prescribing, improved quality and consistency of care, practice efficiencies that have both timesaving and revenue generating effects, and potential shielding from malpractice claims."

To discuss the benefits of and barriers to implementation of electronic health record (EHR) systems in U.S. ambulatory primary care practices based on experience in the UK.

Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Small and/or medium
Urban and rural
Other Information
Study practices were "varied in location (urban vs. rural), number of physicians (solo to small group), degree of practitioner involvement with electronic record keeping, and duration of EHR use."
Type of Health IT
Electronic health records (EHR)
Electronic prescribing (e-Rx)
Type of Health IT Functions
Functions included coding/billing and documentation.
Workflow-Related Findings
"The UK physicians uniformly stated that EHRs had improved efficiency, by which they meant both improved practice operations and better use of time. They did not all agree that EHRs actually saved physician time."
"One physician attributed a reduction in acute myocardial infarction incidence to better lipid management because of attention to the Quality Outcome Framework (UK pay for performance) goals. Another noted reduced variation in chronic disease care because 'the system does not miss patients.'"
"Record legibility and good documentation were popular reasons for adopting EHRs among UK physicians; one physician's intention to adopt crystallized after he was cross-examined in court and was unable to read his own writing. Another said he had a quality of care complaint dismissed because he produced the patient's thoroughly documented electronic file. Not only was the complaint dismissed, the physician received compliments for his documentation."
"The UK physicians we visited noted improved legibility as a positive feature of electronic prescribing."
"The UK physicians we visited...rarely paid much attention to the warnings generated by their [e-prescribing] systems because of their frequency and lack of relevance."
"Even [EHRs] that merely replace handwritten prescriptions with computer printed ones, achieve [substantial savings in physician and office staff time], according to the UK physicians we visited."
Study Design
Only postintervention (no control group)
Study Participants
The study participants included 13 general practitioners working in solo or small group practices in Britain.