Electronic Prescribing and Its Implementation in the United States

Introduction: Electronic prescribing (e-prescribing) is an important part of the nation’s push to create an electronically accessible national health system. E-prescribing allows providers to send prescriptions electronically to the pharmacy and can be stand-alone systems or part of an integrated electronic health record system. Methodology: The methodology for this study was a literature review. Electronic databases accessed include EBSCOhost, PubMED, and Google Scholar. Additionally, government websites and a semi-structured interview were used. A total of 39 sources were referenced for the review. Results: The results of the literature review demonstrated that e-prescribing reduces prescribing errors, increases efficiency, and helps save on healthcare costs. However, there are still significant barriers to implementation. Discussion: The benefits that come with using e-prescribing are numerous. While there are still barriers that prevent many prescribers from implementing e-prescribing systems, incentives and improved patient safety will help increase its utilization. Conclusion: E-prescribing has the potential to increase patient safety and efficiency of care. This supports our hypothesis that e-prescribing has led to improved patient care through meaningful use. More than just a convenient way to send prescriptions, e-prescribing allows prescribers to prescribe safely and cost effectively, and is likely to continue to grow in the future

e-Prescribing and Patient Safety: Results From a Mixed Method Study

Objective: To describe the perspectives of ambulatory care clinicians on the effect of electronic prescribing (e-prescribing) systems on patient safety outcomes. Study Design: Mixed method study of clinicians and staff in 64 practices using 1 of 6 e-prescribing technologies in 6 US states. Methods: We used clinician surveys (Web-based and paper) and focus groups to obtain the perspectives of clinicians on e-prescribing and patient safety. Results: Providers highly valued having medications prescribed by other providers on the medication list and the ability to access patient medication lists remotely. Providers thought that there will always be prescription or medication errors and that the implementation of e-prescribing software changes rather than eliminates prescription or medication errors. New errors related to the dosing or scheduling of a medication, accidentally prescribing the wrong drug, or duplicate prescriptions. Conclusions: Lessons from the ambulatory care trenches must be considered as technology moves forward so that the hypothesized patient safety gains will be realized

Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting

Electronic prescribing (e-prescribing) is an important part of the nation\u27s push to enhance the safety and quality of the prescribing process. E-prescribing allows providers in the ambulatory care setting to send prescriptions electronically to the pharmacy and can be a stand-alone system or part of an integrated electronic health record system. The methodology for this study followed the basic principles of a systematic review. A total of 47 sources were referenced. Results of this research study suggest that e-prescribing reduces prescribing errors, increases efficiency, and helps to save on healthcare costs. Medication errors have been reduced to as little as a seventh of their previous level, and cost savings due to improved patient outcomes and decreased patient visits are estimated to be between $140 billion and$240 billion over 10 years for practices that implement e-prescribing. However, there have been significant barriers to implementation including cost, lack of provider support, patient privacy, system errors, and legal issues

Diffusion of Electronic Health Records in Rural Primary Care Clinics

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants\u27 experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved

Planned implementation of an integrated Cardiovascular Information System in an Acute Hospital Group

Computer based patient records have been highlighted as a requirement in modern healthcare. Evidence around their contribution to quality of care is mixed and is more reliant on how well they are implemented, with there being a bedding in period of up to one year before seeing benefits. Successful implementation leads to efficiencies, cost savings and a return on the significant financial outlay. The need for funding can be a major barrier, as are changes in work practices and people issues such as resistance. Sites with great implementation have high levels of clinician involvement, leadership with vision, resilience, flexibility and collaboration. This project outlines the plan to deliver a CVIS which will integrate across a hospital group. It has identified triggers for change and forces that might prevent it, has developed a communication plan based on a stakeholder analysis. It has created a collaborative working group, involving key stakeholders who have agreed the key priorities and essential features of the system. Important milestones are highlighted, such as addressing the funding, putting governance in place, selecting the correct vendor, having sufficient hardware, software and training in place. The project will be evaluated throughout its life cycle using a novel WHO-HOT-Fit framework. The project is an academically robust, strategic plan to implement a CVIS which will require leadership that is collaborative, honest and seeks out, and identifies people with talent and tacit knowledge who can contribute to the process

Exploring the facilitators and barriers towards implementation of electronic prescribing, dispensing, and administration of medicines in hospitals in Ireland.

Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. The aim of this doctoral research was to explore this under-researched area in three phases. Phase one: - Phase one focused on critically appraising and synthesising the available evidence on healthcare professionals perceptions, attitudes, and views of the facilitators and barriers to implementing electronic prescribing, electronic dispensing, and/or electronic administration of medicines in the hospital setting. The review protocol was registered with the Centre for Reviews and Dissemination and conducted according to best practice. Key facilitators included systems improved patient safety and provided better access to patients drug records and that team leadership and hardware/software availability and reliability were essential for successful implementation. Key barriers consisted of hardware and network problems, altered work practices, and weakened interpersonal communication between healthcare professionals and with patients. Phase two: - This phase employed a qualitative phenomenological design to gain original insight into the perceptions of local key stakeholders towards the facilitators and barriers to implementing prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospitals in Ireland using Normalization Process Theory as a theoretical framework. Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two hospital Information Technology managers. Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multidisciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Phase three: - A similar qualitative methodology was employed in phase three of this research in order to explore the perceptions of national key stakeholders and eHealth leads towards the facilitators and barriers to system implementation. Sixteen consenting invitees participated: eight hospital leads, four government leads, two regulatory leads, and two academics. Key facilitators included enhanced patient safety, workflow efficiencies, improvements in governance, and financial gains. Perceived barriers included the introduction of new drug errors, loss of patient contact, initial time inefficiencies, and issues with the complexity of integration and standardisation of work processes. Overall, adequate technology, stakeholder involvement, and organisational leadership and support are required at a national and local level to drive the eHealth agenda forward. Testing at scale, contingency plans, and ongoing evaluations will assist in determining success or otherwise of system implementation. This research has generated novel findings with many potentially transferable themes identified which extend the evidence base. This will assist organisations to better plan for implementation of medication-related eHealth systems

Physicians and Technology: A Collective Case Study of Physicians and Use of Health

The purpose of this collective case study was to understand and describe the experience of physicians who use health information technology in medical practice. There are numerous factors applying pressure to the practice of medicine with limited support to physicians practicing medicine. With recent health insurers and both state and federal governments mandating health information technology, physicians are required to implement an electronic health record (EHR) with measurable outcomes and benefits to the delivery of healthcare. This study is significant in that it offers a view into the experience of physicians who use health information technology in medical practice. To gain insight into the experience of physicians and their use of health information technology, I interviewed four physicians practicing in a medical clinic setting. Analysis of the interview transcripts revealed four themes: (a) the change process within the work was the challenge with the EHR implementation; (b) physicians learn best from other physicians; (c) implementation of the EHR impacted the entire team of care providers, not just the physicians; and (d) EHR optimization was reinforced with follow- up training after implementation

Monarch HealthCare: Leveraging Experience in Population Health Management to Attain Accountable Care

Examines the progress of a physician-led independent practice association in forming an accountable care organization by working with Anthem as part of the Brookings-Dartmouth ACO Pilot Program, including creating the infrastructure for accountable care