Journal of General Internal Medicine

, Volume 23, Issue 4, pp 364–371

Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices

  • Jesse C. Crosson
  • Nicole Isaacson
  • Debra Lancaster
  • Emily A. McDonald
  • Anthony J. Schueth
  • Barbara DiCicco-Bloom
  • Joshua L. Newman
  • C. Jason Wang
  • Douglas S. Bell



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.


electronic prescribing medical informatics qualitative research health services research 


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Jesse C. Crosson
    • 1
    • 2
  • Nicole Isaacson
    • 2
  • Debra Lancaster
    • 2
  • Emily A. McDonald
    • 3
  • Anthony J. Schueth
    • 4
  • Barbara DiCicco-Bloom
    • 2
  • Joshua L. Newman
    • 5
    • 6
  • C. Jason Wang
    • 6
    • 7
    • 8
  • Douglas S. Bell
    • 6
    • 9
  1. 1.Department of Family MedicineUMDNJ-New Jersey Medical SchoolSomersetUSA
  2. 2.Research Division, Department of Family MedicineUMDNJ-Robert Wood Johnson Medical SchoolSomersetUSA
  3. 3.Department of AnthropologyRutgers UniversityNew BrunswickUSA
  4. 4.Point-of-Care Partners, LLCCoral SpringsUSA
  5. 5.Robert Wood Johnson Clinical Scholars Program, UCLALos AngelesUSA
  6. 6.RAND CorporationSanta MonicaUSA
  7. 7.Department of PediatricsBoston University School of MedicineBostonUSA
  8. 8.Department of Maternal and Child HealthBoston University School of Public HealthBostonUSA
  9. 9.Division of General Internal Medicine and Health Services Research, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA

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