Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment
1 Pharmaceutical Outcomes Research and Policy Program, University of Washington, Box 357630, Seattle, WA 98195-7630, USA
2 Department of Medical Education and Biomedical Informatics, University of Washington, Box 357240, Seattle, WA 98195-7240, USA
3 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA
4 Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195-7660, USA
5 School of Health Information Sciences, University of Texas, Houston, UT-Memorial Hermann Center for Healthcare Quality & Safety, 6410 Fannin Street, Houston, TX 77030, USA
6 Department of Medicine, University of Washington, Box 359968, Seattle, WA 98195-9968, USA
BMC Medical Informatics and Decision Making 2010, 10:72 doi:10.1186/1472-6947-10-72Published: 19 November 2010
The United States (US) Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE) systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system) in the ambulatory setting.
Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17) and staff (n = 53) perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory). Two coders independently coded to theoretical saturation and resolved discrepancies through discussions.
Ten themes emerged that describe perceptions of e-prescribing implementation: 1) improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2) improved documentation resulted in safer care; 3) efficiencies were gained by using fewer paper charts; 4) organizational support facilitated adoption; 5) transition required time; resulted in workload shift to staff; 6) hardware configurations and network stability were important in facilitating workflow; 7) e-prescribing was time-neutral or time-saving; 8) changes in patient interactions enhanced patient care but required education; 9) pharmacy communications were enhanced but required education; 10) positive attitudes facilitated adoption.
Prescribers and staff worked through the transition to successfully adopt e-prescribing, and noted the benefits. Overall impressions were favorable. No one wished to return to paper-based prescribing.