The Impact of Technology Failure on Electronic Prescribing Behavior in Primary Care: A Case Study
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Electronic Prescribing (e-Rx) has significant potential to improve quality of care and reduce medication errors. However, its adoption rate in primary care has been slow for a variety of reasons. We examine the adverse impact of an information technology (IT) failure on the prescribing process as a critical reliability barrier to adoption. Data from Allscripts TouchWorks® database containing prescriptions written by six physicians in two primary care settings were analyzed using a statistical change-point detection algorithm to identify the tipping point in actual usage and subsequent trends in usage behavior. Physicians overwhelmingly switched from electronic transmission of prescriptions to print option in the presence of such a failure. We propose an approach for a control system that will allow for early detection of system failures and rapid process improvement, and discuss implications for handling such failures in the rapidly evolving IT-enabled healthcare delivery context.
KeywordsElectronic prescribing Reliability of information technology Change point detection CUSUM control chart
This research was supported in part by a grant from the University of Pittsburgh Medical Center eRecord program. We thank Dr. C. Shalizi of Carnegie Mellon University and Dr. W. Vogt of University of Georgia for valuable suggestions on the analytical models used in this paper and Allscripts® for providing us with the de-identified prescription data analyzed in this study. We are also grateful to the clinicians and staff of the two medical practices for participating in this study through interviews, feedback, and data.
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