Functional characteristics of commercial ambulatory electronic prescribing systems: a field study.
OBJECTIVE
To compare the functional capabilities being offered by commercial ambulatory electronic prescribing systems with a set of expert panel recommendations.


METHODS
A descriptive field study of ten commercially available ambulatory electronic prescribing systems, each of which had established a significant market presence. Data were collected from vendors by telephone interview and at sites where the systems were functioning through direct observation of the systems and through personal interviews with prescribers and technical staff.


METHODS
The capabilities of electronic prescribing systems were compared with 60 expert panel recommendations for capabilities that would improve patient safety, health outcomes, or patients' costs. Each recommended capability was judged as having been implemented fully, partially, or not at all by each system to which the recommendation applied. Vendors' claims about capabilities were compared with the capabilities found in the site visits.


RESULTS
On average, the systems fully implemented 50% of the recommended capabilities, with individual systems ranging from 26% to 64% implementation. Only 15% of the recommended capabilities were not implemented by any system. Prescribing systems that were part of electronic health records (EHRs) tended to implement more recommendations. Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site visit findings were considered the gold standard.


CONCLUSIONS
The commercial electronic prescribing marketplace may not be selecting for capabilities that would most benefit patients. Electronic prescribing standards should include minimal functional capabilities, and certification of adherence to standards may need to take place where systems are installed and operating.
Wang
C Jason
CJ
UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Room 314, Los Angeles, CA 90095-1736, USA.
Marken
Richard S
RS
Meili
Robin C
RC
Straus
Julie B
JB
Landman
Adam B
AB
Bell
Douglas S
DS
D000555:Ambulatory Care Information Systems / Q000592:standards*; D016303:Clinical Pharmacy Information Systems / Q000592:standards*; D016494:Computer Security / Q000592:standards; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted / Q000592:standards; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D010593:Pharmaceutical Services / Q000458:organization & administration