Schectman JM et al. 2005 "Determinants of physician use of an ambulatory prescription expert system."

Schectman JM, Schorling JB, Nadkarni MM, et al. Determinants of physician use of an ambulatory prescription expert system. Int J Med Inf 2005;74(9):711-717.
"Purpose: To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system.
Methods: A prescription expert system was implemented in an academic internal medicine residency training clinic and physician utilization was tracked electronically. A physician attitude and behavior survey (response rate = 89%) was conducted six months after implementation.
Results: There was wide variability in system adoption and degree of usage, though 72% of physicians reported predominant usage (>50% of prescriptions) of the expert system six months after implementation. Self-reported and measured technology usage were strongly correlated (r = 0.70, p < 0.0001). Variation in use was strongly associated with physician attitude toward issues of system efficiency and effect on quality, but not with prior computer experience, level of training, or satisfaction with their primary care practice. Non-adopters felt that electronic prescribing was more time consuming and also more likely to believe that their patients preferred hand-written prescriptions.
Conclusion: A voluntary electronic prescription system was readily adopted by a majority of physicians who believed it would have a positive impact on the quality and efficiency of care. However, dissatisfaction with system capabilities among both adopters and non-adopters suggests the importance of user education and expectation management following system selection."
"To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system" at an academic primary care program.
Tools Used
Type Clinic
Primary care
Type Specific
Internal medicine
Other Information
The study took place at a 94 physician practice serving a largely indigent population in central Virginia.
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
"The prescription expert system ... was implemented in September 2003 and enabled electronic maintenance of a medication list, printing and renewing prescriptions, and checking of drug-drug and drug-allergy interactions. The system did not have a medication knowledge base other than that pertaining to interactions. Use of the system was voluntary though strongly encouraged."
Workflow-Related Findings
Forty-four percent of physicians reported using the system regularly "when it was introduced," 23 percent started using it "after others had been using it for a month or two," 19 percent "have just started using it in past month or two," and 14 percent "haven't yet started using it regularly." "There was a strong association between self-reported rate of recent system use and the actual number of prescriptions written in the two months prior to the survey based on electronic utilization data (r = 0.70, p < 0.0001)."
"There was no overall association between the mean score on the scale of attitudes toward computers' effect (beneficial versus detrimental) on the practice of medicine and utilization of the expert system (p = 0.18). However, there was an association between electronic prescription writing and the specific beliefs that computers enhanced the enjoyment of the practice of medicine (p = 0.04) and the quality of health care (p = 0.004)."
"In the system implementation described in our report, 86% of the physicians were actively utilizing the prescription expert system by the end of the six month observation period. The early adopters were in the minority and included those self-described as involved in the system implementation and oversight process as well as other technophiles...Subsequent utilizers bought into the system's impact on quality, felt that it did not impede efficiency, and generally thought it had a favorable impact on patient rapport. Interestingly, system utilizers were not more likely to feel it had all the capabilities they desired (in fact, they tended to be more critical of system capabilities than non-utilizers) and were not significantly more satisfied with its ease of use."
Forty-three percent of physicians felt using the e-Rx was faster than handwriting prescriptions.
Eighty-eight percent of physicians felt the e-Rx system would take less time than handwriting once after the patient medication list is entered.
Eighty-seven percent of physicians felt the system is helpful for organizing/updating the medication list.
Twenty-four percent of physicians would prefer to continue with handwritten prescriptions.
Seventy-nine percent of physicians felt comfortable using the system.
Forty-four percent of physicians felt the system had the expected capabilities.
Fifty-four percent of physicians were satisfied overall with the system's ease of use.
Study Design
Only postintervention (no control group)
Study Participants
Seventy-four internal medicine residents and 10 attending physicians responded to the survey. Data for all 94 physicians was extracted from the e-prescribing system.