title: Meaningful use of electronic prescribing in 5 exemplar primary care practices.
abstract: OBJECTIVE
  Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques.
  
  
  METHODS
  We conducted a multimethod qualitative case study of 5 ambulatory primary care practices identified as exemplars of effective e-prescribing. The practices were identified by a group of e-prescribing experts. Field researchers conducted in-depth interviews and observed prescription-related workflow in these practices.
  
  
  RESULTS
  In these exemplar practices, successful use of e-prescribing required practice transformation. Practice members reported extensive efforts to redesign work processes to take advantage of e-prescribing capabilities and to create specific e-prescribing protocols to distribute prescription-related work among practice team members. These practices had substantial resources to support e-prescribing use, including local physician champions, ongoing training for practice members, and continuous on-site technical support. Practices faced considerable challenges during use of e-prescribing, however, deriving from problems coordinating new work processes with pharmacies and ineffective health information exchange that required workarounds to ensure the completeness of patient medical records.
  
  
  CONCLUSIONS
  More widespread implementation and effective use of e-prescribing in ambulatory care settings will require practice transformation efforts that focus on work process redesign while being attentive to effects on patient and pharmacy involvement in prescribing. Improved health information exchange is required to fully realize expected quality, safety, and efficiency gains of e-prescribing.
authors.affiliation: Research Division, Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, Somerset, New Jersey 08873, USA. jesse.crosson@umdnj.edu
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Etz
authors.forename: Shinyi
authors.initials: S
authors.lastname: Wu
authors.forename: Susan G
authors.initials: SG
authors.lastname: Straus
authors.forename: David
authors.initials: D
authors.lastname: Eisenman
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Bell
mesh_terms: D000555:Ambulatory Care Information Systems; D011307:Drug Prescriptions; D057286:Electronic Health Records; D055695:Electronic Prescribing; D006801:Humans; D007407:Interviews as Topic; D009817:Office Management / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D018511:Systems Integration; D057188:Workflow