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Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

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.

Objective

To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings.

Design

Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.

Participants

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.

Measurements

Field researchers used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience, and expectations.

Results

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.

Conclusions

Practice leaders should plan implementation carefully, ensuring that practice members prepare for the effective integration of this technology into clinical workflow.

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Acknowledgments

This research was supported through funding provided by the U.S. Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, 1 U18 HS016391-01. We acknowledge the participation of Horizon Blue Cross and Blue Shield of New Jersey, Caremark and Allscripts in this research project.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Family Medicine, UMDNJ-New Jersey Medical School, Somerset, NJ, USA

    Jesse C. Crosson PhD

  2. Research Division, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA

    Jesse C. Crosson PhD, Nicole Isaacson MSS, PhD, Debra Lancaster MLIR & Barbara DiCicco-Bloom RN, PhD

  3. Department of Anthropology, Rutgers University, New Brunswick, NJ, USA

    Emily A. McDonald

  4. Point-of-Care Partners, LLC, Coral Springs, FL, USA

    Anthony J. Schueth MS

  5. Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA

    Joshua L. Newman MD

  6. RAND Corporation, Santa Monica, CA, USA

    Joshua L. Newman MD, C. Jason Wang MD, PhD & Douglas S. Bell MD, PhD

  7. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    C. Jason Wang MD, PhD

  8. Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA, USA

    C. Jason Wang MD, PhD

  9. Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Douglas S. Bell MD, PhD

Authors
  1. Jesse C. Crosson PhD
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  2. Nicole Isaacson MSS, PhD
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  3. Debra Lancaster MLIR
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  4. Emily A. McDonald
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  5. Anthony J. Schueth MS
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  6. Barbara DiCicco-Bloom RN, PhD
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  7. Joshua L. Newman MD
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  8. C. Jason Wang MD, PhD
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  9. Douglas S. Bell MD, PhD
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Corresponding author

Correspondence to Jesse C. Crosson PhD.

Appendix

Appendix

Table 2 Baseline Interview Questions—Prescribers and Office Staff
Full size table
Table 3 Office Manager Interview Questions—Baseline and Follow-up
Full size table
Table 4 Follow up Interview Questions—Prescribers and Office Staff
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Crosson, J.C., Isaacson, N., Lancaster, D. et al. Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices. J GEN INTERN MED 23, 364–371 (2008). https://doi.org/10.1007/s11606-007-0494-8

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  • DOI: https://doi.org/10.1007/s11606-007-0494-8

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