Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices
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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.
To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.
Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.
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.
Field researchers used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience, and expectations.
Five practices fully implemented e-prescribing, 3 installed but with only some prescribers or staff members using the program, 2 installed and then discontinued use, 2 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.
Practice leaders should plan implementation carefully, ensuring that practice members prepare for the effective integration of this technology into clinical workflow.
- Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64. CrossRef
- Gurwitz JH, Field TS, Harrold L, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16. CrossRef
- Lafata JE, Schultz L, Simpkins J, et al. Potential drug–drug interactions in the outpatient setting. Med Care. 2006;44:534–41. CrossRef
- Schiff GD, Rucker TD. Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA. 1998;279:1024–9. CrossRef
- Kohn LT, Corrigan J, Donaldson MS. To Err is Human: Building A Safer Health System. Washington, D.C.: National Academy Press; 2000.
- Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001.
- Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003;348:2526–34. CrossRef
- White House. Transforming health care: the President’s health information technology plan. Available at: http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html. Accessed April 18, 2007.
- Bell DS, Cretin S, Marken RS, Landman AB. A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc. 2004;11:60–70. CrossRef
- Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2:S3–32. CrossRef
- Rosenfeld S, Bernasek C, Mendelson D. Medicare’s next voyage: encouraging physicians to adopt health information technology. Policymakers seem to agree on the necessity of HIT in Medicare but need to commit the resources needed to effect change. Health Aff (Millwood). 2005;24:1138–46. CrossRef
- Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298:61–9. CrossRef
- Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285:421–9. CrossRef
- DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9. CrossRef
- Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med. 2003;114:397–403. CrossRef
- Corley ST. Electronic prescribing: a review of costs and benefits. Top Health Inf Manag. 2003;24:29–38.
- Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc. 2005;12:505–16. CrossRef
- Schade CP, Sullivan FM, de Lusignan S, Madeley J. e-Prescribing, efficiency, quality: lessons from the computerization of UK family practice. J Am Med Inform Assoc. 2006;13:470–5. CrossRef
- Bell DS, Friedman MA. E-prescribing and the Medicare modernization act of 2003. Health Aff (Millwood). 2005;24:1159–69. CrossRef
- Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006;25:w555–71. CrossRef
- Grossman JM, Gerland A, Reed MC, Fahlman C. Physicians’ experiences using commercial e-prescribing systems. Health Aff (Millwood). 2007;26:w393–404. CrossRef
- Simon S, Kaushal R, Cleary PD, et al. Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inform Assoc. 2007;14:110–7. CrossRef
- Pizzi LT, Suh DC, Barone J, Nash DB. Factors related to physicians’ adoption of electronic prescribing: results from a national survey. Am J Med Qual. 2005;20:22–32. CrossRef
- O’Connor PJ, Crain AL, Rush WA, Sperl-Hillen JM, Gutenkauf JJ, Duncan JE. Impact of an electronic medical record on diabetes quality of care. Ann Fam Med. 2005;3:300–6. CrossRef
- Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144:742–52.
- Crosson JC, Ohman-Strickland PA, Hahn KA, et al. Electronic medical records and diabetes quality of care: results from a sample of family medicine practices. Ann Fam Med. 2007;5:209–15. CrossRef
- Crosson JC, Stroebel C, Scott JG, Stello B, Crabtree BF. Implementing an electronic medical record in a family medicine practice: communication, decision-making, and conflict. Annals of Family Medicine. 2005;3:307–11. CrossRef
- Tamblyn R, Huang A, Kawasumi Y, et al. The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc. 2006;13:148–59. CrossRef
- Bell DS, Schueth AJ, Crosson JC, et al. Pilot testing of electronic prescribing standards. Available at: http://healthit.ahrq.gov/portal/server.pt?open=514&objID=5554&mode=2&holderDisplayURL= http://prodportallb.ahrq.gov:7087/publishedcontent/publish/communities/k_o/knowledge_library/features_archive/features/evaluation_of_ahrq__and_cms_funded_e_prescribing_pilot_projects.html. Accessed April 25, 2007.
- Crabtree BF, Miller WL, Aita VA, Flocke SA, Stange KC. Primary care practice organization and preventive services delivery: a qualitative analysis. J Fam Pract. 1998;46:403–9.
- Crabtree BF, Miller WL, Stange KC. Understanding practice from the ground up. J Fam Pract. 2001;50:881–7.
- Jaen C, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994;38:166–71.
- Stange KC, Miller WL, Crabtree BF, O’Connor PJ, Zyzanski SJ. Multimethod research: approaches for integrating qualitative and quantitative methods. J Gen Intern Med. 1994;9:278–82. CrossRef
- Dicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006;40:314–21. CrossRef
- ATLAS.ti: the knowledge workbench. WIN 5.2.9 ed. Berlin: Scientific Software Development; 2003–2005.
- Crabtree BF, Miller WL. Using codes and code manuals: a template organizing style of interpretation. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research, (2nd ed). Thousand Oaks, CA: Sage Publications; 1999:163–77.
- Landis J, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74. CrossRef
- Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices
Journal of General Internal Medicine
Volume 23, Issue 4 , pp 364-371
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- electronic prescribing
- medical informatics
- qualitative research
- health services research
- Industry Sectors
- Author Affiliations
- 1. Department of Family Medicine, UMDNJ-New Jersey Medical School, Somerset, NJ, USA
- 2. Research Division, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA
- 3. Department of Anthropology, Rutgers University, New Brunswick, NJ, USA
- 4. Point-of-Care Partners, LLC, Coral Springs, FL, USA
- 5. Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA
- 6. RAND Corporation, Santa Monica, CA, USA
- 7. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
- 8. Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA, USA
- 9. Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA