title: Challenges to the implementation of a nationwide electronic prescribing network in primary care: a qualitative study of users' perceptions.
abstract: OBJECTIVE
  The objective of this study was to identify physicians' and pharmacists' perceptions of the challenges and benefits to implementing a nationwide electronic prescribing network linking medical clinics and community pharmacies in Quebec, Canada.
  
  
  METHODS
  Forty-nine people (12 general practitioners, 2 managers, 33 community pharmacists, and 2 pharmacy staff members) from 40 points of care (10 primary care clinics (42% of all the connected sites) and 30 community pharmacies (44%)) were interviewed in 2013. Verbatim transcripts were analyzed using thematic analysis.
  
  
  RESULTS
  A low level of network use was observed. Most pharmacists processed e-prescriptions by manual entry instead of importing electronically. They reported concerns about potential errors generated by importing e-prescriptions, mainly due to the instruction field. Paper prescriptions were still perceived as the best means for safe and effective processing of prescriptions in pharmacies. Speed issues when validating e-prescription messages were seen as an irritant by physicians, and resulted in several of them abandoning transmission. Displaying the medications based on the dispensing data was identified as the main obstacle to meaningful use of medication histories.
  
  
  CONCLUSIONS
  Numerous challenges impeded realization of the benefits of this network. Standards for e-prescription messages, as well as rules for message validation, need to be improved to increase the potential benefits of e-prescriptions. Standard drug terminology including the concept of clinical medication should be developed, and the implementation of rules in local applications to allow for the classification and reconciliation of medication lists from dispensing data should be made a priority.
authors.affiliation: Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada aude.motulsky@mcgill.ca.
authors.forename: Aude
authors.initials: A
authors.lastname: Motulsky
authors.affiliation: Department of Health Management, Université de Montréal, Montreal, Canada.
authors.forename: Claude
authors.initials: C
authors.lastname: Sicotte
authors.affiliation: Faculty of Nursing Sciences, Université Laval, Quebec City, Canada Public Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec City, Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.affiliation: Public Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec City, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Payne-Gagnon
authors.affiliation: Department of Health Management, Université de Montréal, Montreal, Canada.
authors.forename: Julie-Alexandra
authors.initials: JA
authors.lastname: Langué-Dubé
authors.affiliation: Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Rochefort
authors.affiliation: Clinical and Health Informatics Research Group, Faculty of Medicine, McGill University, Montreal, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D003157:Community Pharmacy Services; D055695:Electronic Prescribing; D006801:Humans; D010595:Pharmacists; D010820:Physicians; D011320:Primary Health Care
keywords: community pharmacist; electronic prescription; general practitioner; medication data exchange network; medication histories; primary care