Physicians' attitudes towards ePrescribing – evaluation of a Swedish full-scale implementation

<p>Abstract</p> <p>Background</p> <p>The penetration rate of Electronic Health Record (EHR) systems in health care is increasing. However, many different EHR-systems are used with varying ePrescription designs and functionalities. The aim of the present study was to evaluate experienced ePrescribers' attitudes towards ePrescribing for suggesting improvements.</p> <p>Methods</p> <p>Physicians (n = 431) from seven out of the 21 Swedish health care regions, using one of the six most widely implemented EHR-systems with integrated electronic prescribing modules, were recruited from primary care centers and hospital clinics of internal medicine, orthopaedics and surgery. The physicians received a web survey that comprised eight questions on background data and 19 items covering attitudes towards ePrescribing. Forty-two percent (n = 199) of the physicians answered the questionnaire; 90% (n = 180) of the respondents met the inclusion criteria and were included in the final analysis.</p> <p>Results</p> <p>A majority of the respondents regarded their EHR-system easy to use in general (81%), and for the prescribing of drugs (88%). Most respondents believed they were able to provide the patients better service by ePrescribing (92%), and regarded ePrescriptions to be time saving (91%) and to be safer (83%), compared to handwritten prescriptions. Some of the most frequently reported weaknesses were: not clearly displayed price of drugs (43%), complicated drug choice (21%), and the perception that it was possible to handle more than one patient at a time when ePrescribing (13%). Moreover, 62% reported a lack of receipt from the pharmacy after successful transmission of an ePrescription. Although a majority (73%) of the physicians reported that they were always or often checking the ePrescription a last time before transmitting, 25% declared that they were seldom or never doing a last check. The respondents suggested a number of improvements, among others, to simplify the drug choice and the cancellation of ePrescriptions.</p> <p>Conclusion</p> <p>The Swedish physicians in the group studied were generally satisfied with their specific EHR-system and with ePrescribing as such. However, identified weaknesses warrant improvements of the EHR-systems as well as of their implementation in the individual health care organisation.</p

The Role of E-Prescription in Reducing Medication Error in The Prescribing Stage at The Puskesmas Mojoanyar, East Java

Electronic prescription or e-prescription has been considered as a solution to overcome errors in the early stage of medicines use. However, the electronic prescribing is still not widely implemented in Indonesia. The purpose of this study was to identify the role of electronic prescription in minimizing the incidence of medication errors at the prescribing stage. A cross-sectional study was conducted to compare errors between electronic and hand-written prescriptions in primary health care Mojoanyar. Mojokerto, East Java. Prescriptions were collected retrospectively using purposive and quota sampling based on predetermined criteria. A checklist form was used to collect and review prescriptions during the period February March 2021 (hand-written prescriptions) and December 2022 January 2023 (e-prescriptions). Errors in prescribing were identified in aspects related to the prescription writing process (incompleteness information; illegibility writing) and aspects related to drug selection decisions (drug interaction, drug dosage form, drug dosing and therapeutic duplication). The Chi-square test was used for testing relationships between categorical variables as appropriate. The data were presented in frequency and percentage using descriptive statistics. A total of 2570 prescriptions from 656 patients were reviewed for errors in which 1275 (328 patients) hand-written and 1295 (328 patients) electronic prescriptions. The results showed that incompleteness information was found to be significantly higher in hand-written compared to electronic prescriptions (p < 0.05). Illegible writing was only found in 92 (7.22%) hand-written prescriptions. The risk of drug interactions and other errors in drug selection decisions were not reduced by electronic prescribing. Electronic prescription was able to reduce prescribing errors, especially in the writing process, while for treatment decision it was necessary to add feature to the electronic support system

Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians

Background: One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient’s medication and its usage. E-prescribing has become increasingly applied in recent years as a contributing application to prescribers and patients. The aim of this study was to determine the level of satisfaction of family physicians providing primary care in Turkey regarding the application of e-prescriptions, and reveal the related positive effects and problems encountered in the first months of implementation of e-prescribing. Methods: A questionnaire with eight questions was sent to e-mails of all family physicians working in Turkey in May 2013. A total of 1564 family physicians filled in the questionnaire form and sent it back by e-mail. The responses to openended questions were evaluated by content analysis. Results: It was observed that the most frequently indicated advantages of the application of e-prescriptions were speeding up the prescription process and saving time (36.6%). The most commonly reported problems regarding the application of e-prescriptions were found to be system-induced problems (26.5%) and internet problems (19.9%). In addition, the mean score of satisfaction of the family physicians who did not report problems with the application of e-prescriptions was higher than that of those who reported having problems with it. In the study, 77.8% of the family physicians were satisfied with the application of e-prescriptions. Conclusion: Although some problems were reported regarding the application of e-prescriptions in the first months of the application, family physicians participated in the study were found to be satisfied with the application of e-prescriptions, and identified positive effects on their work and processes

Technologies de prescription informatisée et transformation du rôle des pharmaciens communautaires

L’amélioration de la qualité de l’utilisation des médicaments dans les soins primaires est devenue un enjeu crucial. Les pharmaciens communautaires se présentent comme des acteurs centraux dans l’atteinte de cet objectif, en réclamant une extension de leur rôle. L’objectif principal de cette thèse est de mieux comprendre comment les technologies de prescription informatisée (eRx) influencent la transformation du rôle des pharmaciens communautaires. Le premier article présente les résultats d’une étude de cas qui aborde la transformation du rôle des pharmaciens communautaires à partir du concept de professionnalisation. Elle propose un modèle logique des influences d’une technologie de eRx sur cette professionnalisation, élaboré à partir de la typologie de Davenport. Ce modèle logique a été validé en interviewant douze pharmaciens communautaires participant à un projet pilote typique de technologie de eRx. A partir des perceptions des pharmaciens communautaires, nous avons établi que la technologie était susceptible de soutenir la professionnalisation des pharmaciens en passant par cinq mécanismes : la capacité analytique, l’élimination des intermédiaires, l’intégration, l’automatisation et la diffusion des connaissances. Le deuxième article analyse les perturbations induites par les différentes fonctions des technologies de eRx sur la stabilité de la juridiction des pharmaciens communautaires, en se basant sur un cadre de référence adapté d’Abbott. À partir de trente-trois entrevues, avec des praticiens (médecins et pharmaciens) et des élites, cette étude de cas a permis de décrire en détail les influences des différentes fonctions sur les modalités d’action des professionnels, ainsi que les enjeux soulevés par ces possibilités. La perturbation principale est liée aux changements dans la distribution des informations, ce qui influence les activités de diagnostic et d’inférence des professionnels. La technologie peut redistribuer les informations relatives à la gestion des médicaments autant au bénéfice des médecins qu’au bénéfice des pharmaciens, ce qui suscite des tensions entre les médecins et les pharmaciens, mais aussi parmi les pharmaciens. Le troisième article présente une revue systématique visant à faire une synthèse des études ayant évalué les effets des technologies de eRx de deuxième génération sur la gestion des médicaments dans les soins primaires. Cette revue regroupe dix-neuf études menées avec des méthodes observationnelles. Les résultats rapportés révèlent que les technologies sont très hétérogènes, le plus souvent immatures, et que les effets ont été peu étudiés au-delà des perceptions des utilisateurs, qui sont mitigées. Le seul effet positif démontré est une amélioration de la qualité du profil pharmacologique accessible aux professionnels, alors que des effets négatifs ont été démontrés au niveau de l’exécution des prescriptions, tels que l’augmentation du nombre d’appels de clarification du pharmacien au prescripteur. Il semble donc que l’on en connaisse peu sur les effets des technologies de eRx de deuxième génération. Ces trois études permettent de constater que les nouvelles technologies de eRx peuvent effectivement influencer la transformation du rôle du pharmacien communautaire en perturbant les caractéristiques des prescriptions, et surtout, l’information et sa distribution. Ces perturbations génèrent des possibilités pour une extension du rôle des pharmaciens communautaires, tout en soulignant les défis intra et interprofessionnels associés à l’actualisation de ces possibilités. Dans l’ensemble, nos résultats soulignent que les perturbations associées aux technologies de eRx dépassent les éléments techniques du travail des utilisateurs, pour englober de multiples perturbations quant à la nature même du travail et du rôle des professionnels. Les décideurs et acteurs impliqués dans le déploiement des technologies de eRx auraient avantage à prendre en compte l’ensemble de ces considérations pour rapprocher les effets observés des bénéfices promis de ces technologies.The quality of medication use in primary care needs to improve: this has become a crucial issue. Community pharmacists want to play a key role in meeting this objective and are calling for an expanded role. The main objective of this thesis is to better understand how electronic prescription (eRx) technologies are influencing the transformation of the role played by community pharmacists. The first article presents results from a case study on the transformation of the community pharmacists’ role, based on the concept of professionalization. It proposes a logical model of how an eRx technology influences this professionalization, developed from the Davenport typology. The logical model was validated by interviewing twelve community pharmacists participating in a typical pilot project involving an eRx technology. Based on the perceptions of community pharmacists, we have determined that there are five mechanisms by which the technology is likely to support the professionalization of pharmacists: analytic capacity, the elimination of intermediaries, integration, automation and the dissemination of knowledge. The second article analyzes the disturbances produced by the various functions of eRx technologies on the jurisdiction of community pharmacists, based on an adaptation of Abbott’s model. Using data from 33 interviews with practitioners, physicians and pharmacists, as well as elite members of these two professions, this case study provides a detailed description of how different functions influence professionals’ modalities of action, as well as the issues raised by these possibilities. The primary disturbance is associated with changes in the distribution of information, which can influence the diagnostic and inference activities of professionals. The technology may redistribute information on the management of medication to the benefit of both physicians and pharmacists, and this creates tensions, not only between physicians and pharmacists but also among pharmacists. The third article presents a systematic review that synthesized studies assessing the impacts of second-generation eRx technologies on the management of medication in primary care. It examined 19 studies that applied observational methods. The findings reveal that the technologies are very heterogeneous and often far from mature, and that their effects received little attention beyond the perceptions of users, which were mixed. The only positive impact shown is an improvement to the quality of the pharmacological profile available to professionals. Negative impacts touched on the execution of prescriptions, such as a greater number of calls from pharmacists to prescribers to clarify information. It would therefore appear that little is known about the impacts of second-generation eRx technologies. These three studies allow us to conclude that new eRx technologies may well influence how the role of the community pharmacist is being transformed, specifically by disturbing the characteristics of prescriptions and, above all, information and its distribution. These disturbances generate opportunities for extending the role of community pharmacists, while underscoring the intra and interprofessional challenges associated with their realization. Overall, our results suggest that the disturbances associated with eRx technologies go beyond technical aspects of users’ work, to include multiple disturbances of the very nature of the professionals’ work and role. The decision makers and actors involved in deploying eRx technologies would be well advised to take all these considerations into account to bring the observed effects of these technologies more in line with their promised benefits

Factors supporting the intention to use e-prescribing systems: health professionals' use of technology in a voluntary setting

Illegible written prescriptions and “Doctor’s handwriting” may have been synonymous, but this stereotype has begun to change with the gradual uptake of e-prescriptions. These eprescriptions are electronically captured and delivered prescriptions, and are touted as the solution to the many medical risks caused by written prescriptions. Whilst there is published support for the benefits of e-prescriptions, the uptake of e-prescribing has been too gradual for all patients to enjoy these benefits. The inadequate research into physicians’ adoption of e-prescribing systems presents a need for further study in this area, in an effort to improve the general use of these systems. Based on a review of literature, this study proposes six factors which may explain physicians’ intentions to use e-prescribing systems. These factors are based upon the Unified Theory of Acceptance and Use of Technology (UTAUT). This model is extended in this study by Social Dominance Theory, Commitment-Trust Theory and the Product Evaluation Model. Quantitative data was collected to test the proposed hypotheses. This data was gathered from physicians who have had some exposure to an e-prescription system. 72 usable responses were obtained for this study. The results of the study suggest that Performance Expectancy and Price Value have the highest influence on Behavioural Intention. Effort Expectancy and Social Influence had no direct influence on Behavioural Intention when in the presence of other variables, but they, along with Trust, had an indirect effect on Behavioural Intention through Performance Expectancy. Surprisingly, Social Dominance Orientation was not found to have an influence on Behavioural Intention. Implications, contributions and further research are discussed

Elektronisk «Legemidler i bruk» - et blikk inn i fremtiden Evaluering av pilotprosjektet «Legemidler i bruk» i «Reseptformidleren», inkludert elektronisk multidose i e-resept

Masteroppgave helse- og sosialinformatikk- Universitetet i Agder, 2015Utvidelsen av elektronisk forskrivning øker raskt og nye eRx-løsninger innføres fortløpende i den norske primær helsetjenesten. Den aktuelle oppgaven hadde som målsetning å belyse hvordan legene ved kommunalhelsetjenesten vurderte LIB i RF, inkludert elektronisk multidose i e-resept. Det er en ny funksjonalitet i e-resept innført i regi av Helsedirektortoratets pilotprosjekt med samme tittel. Det var 58 leger som deltok i LIB i RF-pilotprosjektet fra fem kommuner. Pilotlegene ble invitert til å delta i en elektronisk survey. Spørreskjemaundersøkelsen inneholdt 42 spørsmål, operasjonalisert i forhold til DeLone & McLean Information System Success model og Unified Theori of Acceptance and Use of Technology. Totalt 36 (62%) leger besvarte det elektroniske spørreskjemaet. Resultatene viste at LIB i RF inkludert elektronisk multidose - løsningen ble angitt en høyere grad av pasientsikkerhet i forhold til reduksjon av uønskede hendelser. Løsningen ble vurdert som et nyttig kvalitetsforbedringsverktøy og mer effektivt enn papirbasert ordinasjonskort. Et positivt sosial aspekt ble ytret og løsningen kunne av de fleste anbefales til andre leger. Problemene relatert til lavere systemkvalitet inkluderte ytelsesproblemer med flere programfeil, opplevd ved vanlig og etablert drift. I forbindelse med dette, påpekte legene viktigheten med lokal brukerstøtte i startfasen. Oppsummert ble legene generelt sett fornøyde med løsningen for LIB i RF, inkludert elektronisk multidose i e-resept. Samtidig ble det belyst retninger til forbedringer i forhold til brukernes perspektiv både på lokalt nivå og for nasjonal utbredelse

Perceptions of nurses with regard to the use of computer information technology at primary health care clinics in the eastern part of Ekurhuleni

M.Cur. (Nursing Management)Information technology is the management of a computer-based information system, particularly software applications and computer hardware, which are used to handle all aspects of information storage, retrieval, transmittal, protection, and processing information securely. The lack of reliable health information is one of the major obstacles to the effective planning of the health services in South Africa. The existing information systems are fragmented and incompatible; most systems are manually driven with minimal computerisation which results in inadequate analysis, interpretation and the use of data at PHC level. The use of computer information technology in the health facilities will improve service delivery; reduce the cost of providing health care; and enhance the management and control of service. Yet, it seems that nurses are insufficiently using computer information technology at the PHC clinics in the eastern part of Ekurhuleni. It has been observed that nurses do not use Computer Information Technology (CIT) to the benefit of the clients. It was unclear what the perceptions of PHC professional nurses about CIT were. The purpose of this study was to explore and describe the perceptions of primary health care nurses with regard to the use of Computer Information Technology (CIT) with the purpose of recommending the actions to be taken by the nurse manager about computer information technology. In this study a quantitative, exploratory and descriptive design was used in order to obtain factual reasoning and information from professional nurses working at five (5) primary health clinics in the eastern part of Ekurhuleni. The total sample of professional nurses was n = 150. The method of data collection was a self-administered and structured survey- questionnaire that took 30 minutes to complete. Descriptive statistics were compiled by using the Statistical Package of the Social Sciences (SPSS) Version 20 software program. Validity and reliability were ensured by the judgments of the researcher and experts about whether the research instrument had covered the comprehensive set of facets that encompassed the concepts (the use of information technology at primary health care clinics). It also included pre-testing of the instrument to establish the consistency with which participants understood, interpreted and responded to all the carefully formulated questions in the survey-questionnaire. Ethical principles and standards for nurse researchers were adhere to. The findings indicated that there were aspects that need to be addressed in respect of the use of information technology in primary health care clinics. Limitations of study and the recommendations for nursing practice, management and research were discussed. This study determined the perceptions of nurses with regard to the use of computer information technology at the PHC clinics that lead to recommendations on the actions to be taken by the nurse managers about the use of computer information technology at PHC clinics

The challenges of using information communication technologies in the healthcare systems in Ethiopia from provider's perspectives

The adoption of eHealth is very slow despite evidences showing its benefits. This research examines the individual, clinical, technical and organizational challenges for eHealth adoption from healthcare provider‟s perspectives. A cross-sectional study design with a quantitative paradigm was used. The study was conducted on 312 doctors and nurses randomly selected from ten hospitals in Addis Ababa, Ethiopia. Most respondents viewed eHealth positively with no significant differences in terms of profession or gender. Computer skill, workload, patient interaction, management support, cost and infrastructure were the main concerns. Privacy and security were not the main concerns. Knowledge of eHealth applications and utilization was low, even for evidence-based medicine and online databases. Specialists and males were better aware of eHealth applications. The study showed that eHealth acceptance was good. Increasing eHealth literacy was recommended as a cost effective means for improving access to updated information to improve the quality of healthcare.Health StudiesM.A. (Public Health (Medical Informatics)