title: Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy.
abstract: BACKGROUND
  Electronic prescribing systems have often been promoted as a tool for reducing medication errors and adverse drug events. Recent evidence has revealed that adoption of electronic prescribing systems can lead to unintended consequences such as the introduction of new errors. The purpose of this study is to identify and characterize the unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in an outpatient pharmacy.
  
  
  METHODS
  A multidisciplinary team conducted direct observations of workflow in an independent pharmacy and semi-structured interviews with pharmacy staff members about their perceptions of the unrealized potential and residual consequences of electronic prescribing systems. We used qualitative methods to iteratively analyze text data using a grounded theory approach, and derive a list of major themes and subthemes related to the unrealized potential and residual consequences of electronic prescribing.
  
  
  RESULTS
  We identified the following five themes: Communication, workflow disruption, cost, technology, and opportunity for new errors. These contained 26 unique subthemes representing different facets of our observations and the pharmacy staff's perceptions of the unrealized potential and residual consequences of electronic prescribing.
  
  
  CONCLUSIONS
  We offer targeted solutions to improve electronic prescribing systems by addressing the unrealized potential and residual consequences that we identified. These recommendations may be applied not only to improve staff perceptions of electronic prescribing systems but also to improve the design and/or selection of these systems in order to optimize communication and workflow within pharmacies while minimizing both cost and the potential for the introduction of new errors.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Nanji
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Boehne
authors.forename: Carol A
authors.initials: CA
authors.lastname: Keohane
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
mesh_terms: D055695:Electronic Prescribing / Q000191:economics; D006801:Humans; D008404:Massachusetts; D050316:Medical Order Entry Systems; D008508:Medication Errors; D010594:Pharmacies / Q000191:economics / Q000458:organization & administration*; D057188:Workflow
keywords: Electronic prescribing; Medication errors; Pharmacy care; Unintended consequences