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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Table 1

Characteristics of Exemplar Electronic Prescribing Practices

Practice No. and Structure	Type	Records	Nature of eRx	No. of eRx Users	Source of IT Support	No. of Rx/Month^a	No. of Visits/Year^a
1. Part of an IPA	Internal medicine, pediatrics	Paper	Stand-alone	4 at site/1 CMA responsible	IPA (through contractor)	1,600	12,000
2. Part of medical group	Multiple-specialty practice	EHR	Integrated	25 at site/2 RNs responsible	Internal department	9,839	112,000
3. Associated with hospital	Pediatrics	Hybrid paper and EHR	Integrated	8 at site/4 RNs responsible	Hospital	1,176	22,468
4. Associated with hospital	Internal and family medicine	EHR	Stand-alone	10 at site/3 RNs responsible	Hospital	8,000	25,000
5. Part of medical group	Multiple-specialty practice	EHR	Integrated	60 at site/5 pharmacy technicians dedicated	Internal department	–	–

CMA=certified medical assistant; EHR = electronic health record; eRx = electronic prescribing; IPA = independent physicians association; IT=information technology; RN=registered nurse; Rx=prescription.
Note: Prescribers are physicians, physician assistants, or nurse practitioners. Sources were advance questionnaires, and interviews conducted by and observations made by coauthors.
↵a Estimates provided by practice leaders; leaders of practice 5 did not provide estimates.

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Table 2

Best Practices at Each Phase of Electronic Prescribing Adoption

Phase	Best Practices
Planning	Identify organizational champion and/or supportive leader Examine existing work processes to determine how these might be affected by implementation Plan workflow and work process changes, standardize data entry processes, and develop protocols Introduce pharmacists and patients to new processes
Implementation	Provide comprehensive, on-site training program focused on communicating benefits of e-prescribing to practice members, test runs with software, and introduction to new work processes, standards, and protocols Identify and train super users Ensure availability of ongoing technical support
Use	Assess accuracy of formulary information (through communication with pharmacies) Monitor pharmacy and patient compliance with new work processes Ensure completeness of medication history information in the medical record through workarounds for paper prescriptions Analyze and modify work processes as needed Ensure availability of ongoing technical support

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Supplemental Appendix, Table, & Figure

Supplemental Appendix. Advance Questionnaire for Site Visits; Supplemental Table 1. Expert Advisory Committee; Supplemental Figure 1. Prescription-sized handout explaining electronic prescribing to patients and pharmacists.

Files in this Data Supplement:

Supplemental data: Appendix - PDF file, 1 page, 111 KB
Supplemental data: Table - PDF file, 1 page, 131 KB
Supplemental data: Figure - PDF file, 1 page, 233 KB
The Article in Brief

Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

Jesse C. Crosson , and colleagues

Background In the United States, many physicians have adopted e-prescribing but do not regularly use it to write prescriptions. In addition, new approaches to adopting e-prescribing are needed to meet federal policy goals. This study identifies key lessons from 5 primary care practices that effectively e-prescribe.

What This Study Found Successful use of e-prescribing requires substantial investments of planning time and ongoing transformation of work processes. Practices that successfully incorporate e-prescribing have substantial resources to support e-prescribing use, including local physician champions, ongoing training for practice members, and continuous on-site technical support. Even these practices, however, face considerable challenges in e-prescribing, including problems coordinating new work processes with pharmacies and ineffective health information exchange that requires workarounds to ensure the completeness of patient records.

Implications

Although e-prescribing is among the technologies expected to transform health care in the near future, successful and widespread implementation will require a longer-term commitment to supporting practice transformation, resources to aid in making these changes, and improvements to the infrastructure for health information exchange.