title: Variation in electronic prescribing implementation among twelve ambulatory practices.
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.
  
  
  METHODS
  Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: Department of Family Medicine, UMDNJ-New Jersey Medical School, Somerset, NJ 08873, USA. jesse.crosson@umdnj.edu
authors: Jesse C
authors: JC
authors: Crosson
authors: Nicole
authors: N
authors: Isaacson
authors: Debra
authors: D
authors: Lancaster
authors: Emily A
authors: EA
authors: McDonald
authors: Anthony J
authors: AJ
authors: Schueth
authors: Barbara
authors: B
authors: DiCicco-Bloom
authors: Joshua L
authors: JL
authors: Newman
authors: C Jason
authors: CJ
authors: Wang
authors: Douglas S
authors: DS
authors: Bell
mesh_terms: D000555:Ambulatory Care Information Systems; D001292:Attitude to Computers; D004059:Diffusion of Innovation; D011307:Drug Prescriptions; D006123:Group Practice; D006801:Humans; D007348:Insurance, Health; D007407:Interviews as Topic; D050316:Medical Order Entry Systems; D009515:New Jersey; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care