Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation.
BACKGROUND
Use of electronic prescribing (e-prescribing) can improve safety and reduce costs of care by alerting prescribers to drug-drug interactions, patient nonadherence to therapies, and insurance coverage information. Deriving these benefits will require clinical decision support based on presentation of accurate and complete formulary and benefit (F&B) and medication history (RxH) data to prescribers, but relatively little is known about how this information is used in primary care.


METHODS
This is a multimethod comparative case study of 8 practices, which were selected to ensure practice size and physician specialty variation, implementing a stand-alone e-prescribing program. Field researchers observed prescription workflow and interviewed physicians and office staff.


RESULTS
Before implementation, few prescribers reported using F&B references when making medication choices; all used paper-based methods for tracking medication history. After implementation, some prescribers reported using F&B data to inform medication choices but missing information reduced confidence in these resources. Low confidence in RxH data led to paper-based workarounds.


CONCLUSIONS
Challenges experienced with formulary checks and RxH documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. Greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings.
Research Division, Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, Somerset, NJ, USA. jesse.crosson@umdnj.edu
Jesse C
JC
Crosson
Anthony J
AJ
Schueth
Nicole
N
Isaacson
Douglas S
DS
Bell
D000554:Ambulatory Care Facilities; D003363:Cost Control; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055695:Electronic Prescribing; D005569:Formularies as Topic; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008487:Medical History Taking; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D019982:Organizational Case Studies; D011320:Primary Health Care; D017751:Safety Management