Table 2. Adoption factors and selected quotes from respondents classified by CAF themes
Related ThemeQuotea
System quality
StandardisationIt does not work. First, the e-prescribing network is not in my EMR. It’s a different screen. So when I have 22 pills [the respondent names a few commercial ones], and here it is named [name other pills, generic ones this time], and then you have a cream I didn’t prescribe. So, to go from one to another, to compare, it just doesn’t work. They are not in the same order. I’m unable to say if the dosage of Lasix 20 is the same as the diuretic 20mg. The terms are not the same. It requires a lot of energy. (Physician)
InteroperabilitySince the e-prescribing network is extern to the EMR, you always have to go out of the EMR and go in another application. It is tiring; to open it and then you need a password. It is never-ending. (Physician)
Working functionsThe aspects of visualization, user-friendliness and screen consultation [of the medication history] are all going well. No complaints. It goes well with what you use on an everyday basis. (Pharmacist)
Implementation planningFor sure, the implementation planning was not the best. They should have implemented it with an eye towards the north, Toward the surrounding regions. I have a lot of clients of a [neighbour region] physician. I asked them, ‘What is the logic behind doing only our region, but not the others?’ It made no sense whatsoever. (Pharmacist)
Education and trainingThere was a training session. I don’t remember how many hours, an afternoon I believe. Either I did not understand or the explanation was poor, but I didn’t understand what the goal of the e-prescribing network really was. There was no relaunch or follow-up, at least not for me. (Physician)
ComputerisationThe pharmacy began its computerizing process almost 30 years ago if I remember correctly. It has been a long time. I never learned the old method. The physicians are beginning that process. But we have always known how to handle that. (Pharmacist)
Technical support Waiting on the phone [for technical support] was very long and sometimes the line would be busy. I was there two times it happened, so the second I knew what to do. I just deactivated the link to the network. I asked them why I had to do that. And they said ‘It’s a mystery’. They also said that they would call us back to reactivate it and they never did. It’s me, at the end of the day that tried it to know if it functioned, and it did. (Pharmacy technician)
Involvement of cliniciansWe took the decision to use more and more the EMR, and it also implies the e-prescribing network. Everyone is okay with the idea. Does everyone adapt to the EMR and the network at the same time? Definitely not. But there is a strong trend in the clinic. We even fixed a date later this year where everyone needs to have entered their notes electronically in their EMR. (Physician)
On-site championWhat you need is a champion per clinic. If a clinic does not have a computer champion, they need a volunteer that will be trained. And this person need to be available and interested to help their colleagues, at any time. You need to be ready to say to your patient: ‘Wait for me, I will go help a colleague with an issue. I will come back’. (Physician)
Openness to changeThe owners did it out of curiosity. To be at the forefront also. It’s a new thing and we wanted to test its potential. […] We gave a lot of comments to the company on how it was working. This is why we brought the e-prescribing network. We were eager to see what it was and to use it. (Pharmacist)
Perception of benefitsIt is good as long as the data are there and reliable. If you have unreliable or obsolete data, or you don’t have any data at all, then the e-prescribing network is not worth a thing. There’s nothing in it for you. (Physician)
Funding and incentive
Financial incentivesThere is an incentive. You know there is a program in Quebec for EMR adoption that provides financial incentives for physicians for familiarization with all of that. There is a part that is provided initially, and the other part is given only if you use six of the twelve functionalities of the EMR. And one of these functionalities is to use the e-prescribing network. So there is a motivation there. If physicians want their money by using the network in their EMR. (Physician)
Legislation, policy and governance
Paper prescriptionAnyway, even electronic [prescription], is not legal. We need the paper. I cannot just go and retrieve the prescription through the e-prescribing network. (Pharmacist)
  • a All the quotes were translated from French