Evaluating the technical adequacy of electronic prescribing standards: Results of an expert panel process.
To support more informed prescribing decisions, e-prescribing systems need data on patients' medication histories and their drug-specific insurance coverage. We used an expert panel process to evaluate the technical adequacy of two standards for delivering this information, the Medication History function of the NCPDP SCRIPT Standard and the NCPDP Formulary and Benefit Standard.


METHODS
We convened a panel representing 14 organizations that had experience with these standards. Experts within each organization submitted narrative responses and ratings assessing the standards in 6 domains, including data quality,completeness, usability, and interoperability. Areas of disagreement were discussed in recorded teleconferences. Narrative was analyzed using a grounded-theory approach.


RESULTS
Panelists agreed that the structure of the Medication History Standard was adequate for delivering accurate and complete information but implementation problems made the data difficult to use for decision support.The panel also agreed that the Formulary and Benefit Standard was adequate to deliver formulary status lists, but other parts of the standard were not used consistently and group-level variations in coverage were not represented. A common problem for both standards was the lack of unambiguous drug identifiers; panelists agreed that RxNorm deserves further evaluation as a solution to this problem.


CONCLUSIONS
A panel of industry experts found the basic structure of these two standards to be technically adequate, but to enable benefits for patient care, improvements are needed in the standards' implementation.
Bell
Douglas S
DS
RAND Corporation, Santa Monica; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA.
Schueth
Anthony J
AJ
Guinan
John Paul
JP
Wu
Shinyi
S
Crosson
Jesse C
JC
D055695:Electronic Prescribing / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards*; D014481:United States