Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

Jesse C. Crosson; Rebecca S. Etz; Shinyi Wu; Susan G. Straus; David Eisenman; Douglas S. Bell

doi:10.1370/afm.1261

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Tools for implementing and using e-prescribing
Jesse C. Crosson

Published on: 23 May 2012
Current Difficulties with Health Information Exchange
Joshua M. Pevnick

Published on: 03 October 2011
E-prescribing-Worth the Work
John A Zweifler

Published on: 19 September 2011

Published on: (23 May 2012)
Page navigation anchor for Tools for implementing and using e-prescribing
Tools for implementing and using e-prescribing
Jesse C. Crosson, Researcher
In our article we highlighted some of the best practices for meaningfully using e-prescribing in primary care practice. This research was conducted as part of efforts, funded by the Agency for Healthcare Research and Quality (AHRQ), to inform the development of a toolset for use by primary care practices seeking to implement this technology.1 This toolset is now available from AHRQ and includes detailed background infor...
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In our article we highlighted some of the best practices for meaningfully using e-prescribing in primary care practice. This research was conducted as part of efforts, funded by the Agency for Healthcare Research and Quality (AHRQ), to inform the development of a toolset for use by primary care practices seeking to implement this technology.1 This toolset is now available from AHRQ and includes detailed background information on e-prescribing along with tools for: setting goals, assessing readiness, choosing between an integrated and a stand-alone system, planning work process changes, selecting a system and comparing vendors, planning for setup and launch of the system, configuration, user training, ongoing use, and monitoring results to make ongoing improvements to use.2
Recent research has found that physicians who have adopted e- prescribing are not using these systems to their fullest extent with many not making work process changes needed to realize promised safety and efficiency gains.3 Thus, the tools developed as part of this research can be of use not only to those who are planning implementation of e- prescribing functions but also to longer-term users.
As both Pevnick and Zweifler point out, more work needs to be done to improve and standardize the electronic exchange of key data. Making these improvements will be essential for ensuring that primary care teams have up to date and usable medication history and formulary coverage for all patients.4
1. Crosson JC, Straus SG, Wu S, et al. Building Implementation Toolsets for E-Prescribing: Final Report. (Prepared by RAND Corporation under Contract No. HHSA 290-2006-00017I, TO #4). AHRQ Publication No. 12- 0015-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2011
2. Bell, DS, Straus, SG, Belson, D, et al. A Toolset for E- Prescribing Implementation in Physician Offices (Prepared by RAND Corporation under Contract No. HHSA 290-2006-00017, TO #4). AHRQ Publication No. 11-0102-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011
3. DesRoches CM, Agarwal R, Angst CM, Fischer MA. Differences between integrated and stand-alone e-prescribing systems have implications for future use. Health affairs (Project Hope). 2010;29(12):2268-77
4. Crosson JC, Schueth AJ, Isaacson N, Bell DS. Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation. J Am Board Fam Med. 2012;25(1):24-32
Competing interests: None declared
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Competing Interests: None declared.
Published on: (3 October 2011)
Page navigation anchor for Current Difficulties with Health Information Exchange
Current Difficulties with Health Information Exchange
Joshua M. Pevnick, Los Angeles
Crosson et al tease out the prerequisite factors for successful implementation of e-prescribing. Although it reinforces existing perceptions, the article makes a significant contribution by using rigorous qualitative analysis to confirm the importance of workflow analysis and redesign, and technical and “superuser” support. More surprising are the challenges still present even in these five exemplar practices. In pa...
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Crosson et al tease out the prerequisite factors for successful implementation of e-prescribing. Although it reinforces existing perceptions, the article makes a significant contribution by using rigorous qualitative analysis to confirm the importance of workflow analysis and redesign, and technical and “superuser” support. More surprising are the challenges still present even in these five exemplar practices. In particular, Crossen et al highlight the current difficulties associated with health information exchange, which are often otherwise underestimated. Exchange of much health data is predicated on the exchange of patient identification and insurance data that was noted to be difficult in this analysis. More attention should be directed to improving the electronic exchange of these critical basic elements that will be necessary for exchange of more complex health data.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (19 September 2011)
Page navigation anchor for E-prescribing-Worth the Work
E-prescribing-Worth the Work
John A Zweifler, Fresno, California. USA
E-prescribing is low hanging fruit on the electronic medical record tree. Crosson et al focus our attention on how challenging it will be to fully savor this morsel.1 Just think how many opportunities e-prescribing offers to improve quality, efficiency, and patient and provider satisfaction: automatically taking into account allergies, drug interactions, dosing, eliminating repetitive documentation- in the progress...
Show More

E-prescribing is low hanging fruit on the electronic medical record tree. Crosson et al focus our attention on how challenging it will be to fully savor this morsel.1 Just think how many opportunities e-prescribing offers to improve quality, efficiency, and patient and provider satisfaction: automatically taking into account allergies, drug interactions, dosing, eliminating repetitive documentation- in the progress note, on the medication list, on the prescription, on the order sheet, on the instruction for the patient, creating a clean and up to date medication list, automating refills, patient education materials, formulary selections, lowest cost pharmaceuticals, and oh yes legibility…hallelujah! But as Crosson et al found, it is not easy to get from here to there. Their qualitative analysis of five exemplary practices also illustrates an effective strategy for illuminating real world issues facing primary care practices today. This translational effort helps put the meat of scientific evidence on the bones of perceptions from the field. Their research also points out how helpful it is to have champions who can pave the way for their colleagues. This concept has obvious implications beyond e-prescribing for family medicine group practices balancing the comprehensive demands of primary care with the need for expertise in specific patient care domains. Crosson et al highlight the role of support staff in addressing e-prescribing challenges. Well trained office personnel can be the eyes, ears, and voices for family physicians to make every encounter with our patients more meaningful, and at a fraction of the cost of another physician.2 Creating an integrated e-prescribing system is well worth the effort- for patients, providers, insurers, and our health care delivery system as a whole. The work by Crosson et al informs us how to best reach our goal.
1. Crosson JC, Etz RS, Wu S, Strauss SG, Eisenman D, Bell DS. Meaningful use of electronic prescribing in 5 exemplar primary care practices. Ann Fam Med. 2011;9(5):392-397
2.Zweifler J. The Missing Link: Improving Quality with a Chronic Disease Management Intervention for the Primary Care Office. Ann Fam Med 2007;5:453-456
Competing interests: None declared
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Competing Interests: None declared.