title: Qualitative evaluation of an electronic prescribing and administration system.
abstract: OBJECTIVE
  To provide a formative socio-technical evaluation of a pilot implementation of an integrated electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on one ward.
  
  
  METHODS
  A qualitative observational approach using discourse analysis within a socio-technical evaluation framework addressing systems functions, human perspectives and organisational context.
  
  
  METHODS
  Surgical ward in a teaching hospital.
  
  
  METHODS
  Staff on study ward and in pharmacy.
  
  
  METHODS
  Implementation over time of an integrated electronic prescribing, automated dispensing, barcode patient identification and EMAR system.
  
  
  METHODS
  Assessment of technical performance, developed attitudes to the new system, changes to delivery of care and work practices.
  
  
  RESULTS
  The system was successfully implemented on the ward, and remained in operation for over 2 years. Many of the technical components of the system initially showed problems, but the system evolved, with increased functionality and improved performance. Attitudes to the system in the early stages were mixed. Over time, and with experience of making the system work for them, staff attitudes changed to become more balanced and the potential benefits of the system became clearer to most. The system structured the work of staff, sometimes unexpectedly.
  
  
  CONCLUSIONS
  Electronic prescribing systems need to be seen as occasions for change and learning rather than as black-boxed technical solutions to identified problems. The evaluation framework allows understanding as well as hypothesis testing, and is recommended for future evaluations of electronic prescribing systems.
authors: The School of Pharmacy, BMA House, Tavistock Square, London, UK. n.barber@pharmacy.ac.uk
authors: Nick
authors: N
authors: Barber
authors: Tony
authors: T
authors: Cornford
authors: Ela
authors: E
authors: Klecun
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D016303:Clinical Pharmacy Information Systems / Q000592:standards*; D006757:Hospital Units / Q000458:organization & administration*; D006784:Hospitals, Teaching; D006801:Humans; D007858:Learning; D008131:London; D050316:Medical Order Entry Systems / Q000592:standards*; D009936:Organizational Innovation; D010355:Patient Identification Systems; D010865:Pilot Projects; D019095:Point-of-Care Systems; D018511:Systems Integration
references: Milbank Q. 2005;83(4):691-729
references: 16279964
references: N Engl J Med. 2003 Jun 19;348(25):2526-34
references: 12815139
references: J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
references: 10428004
references: JAMA. 2005 Mar 9;293(10):1197-203
references: 15755942
references: Qual Saf Health Care. 2007 Aug;16(4):279-84
references: 17693676
references: BMJ. 2004 May 15;328(7449):1197-9
references: 15142933
references: Arch Intern Med. 2005 May 23;165(10):1111-6
references: 15911723
references: Methods Inf Med. 2004;43(3):215-31
references: 15227551
references: Int J Med Inform. 2001 Nov;64(1):39-56
references: 11673101
references: Int J Med Inform. 1999 Aug;55(2):87-101
references: 10530825
references: BMJ. 2000 Mar 18;320(7237):750-3
references: 10720357