OBJECTIVE To compare the experiences of e-prescribing users and nonusers regarding prescription safety and workload and to assess the use of information from two e-prescribing standards (for medication history and formulary and benefit information), as they are implemented. DESIGN Cross-sectional survey of physicians who either had installed or were awaiting installation of one of two commercial e-prescribing systems. MEASUREMENTS Perceptions about medication history and formulary and benefit information among all respondents, and among e-prescribing users, experiences with system usability, job performance impact, and amount of e-prescribing. RESULTS Of 395 eligible physicians, 228 (58%) completed the survey. E-prescribers (n = 139) were more likely than non-e-prescribers (n = 89) to perceive that they could identify clinically important drug-drug interactions (83 versus 67%, p = 0.004) but not that they could identify prescriptions from other providers (65 versus 60%, p = 0.49). They also perceived no significant difference in calls about drug coverage problems (76 versus 71% reported getting 10 or fewer such calls per week; p = 0.43). Most e-prescribers reported high satisfaction with their systems, but 17% had stopped using the system and another 46% said they sometimes reverted to handwriting for prescriptions that they could write electronically. The volume of e-prescribing was correlated with perceptions that it enhanced job performance, whereas quitting was associated with perceptions of poor usability. CONCLUSIONS E-prescribing users reported patient safety benefits but they did not perceive the enhanced benefits expected from using standardized medication history or formulary and benefit information. Additional work is needed for these standards to have the desired effects.

BACKGROUND: Electronic prescribing has been advocated as an important tool for improving the safety and quality of medication use in ambulatory settings. However, widespread adoption of e-prescribing in ambulatory settings has yet to be realized. The determinants of successful implementation and use in these settings are not well understood. OBJECTIVE:To describe the practice characteristics associated with implementation and use of e-prescribing in ambulatory settings. DESIGN:Multi-method qualitative case study of ambulatory practices before and after e-prescribing implementation.PARTICIPANTS: Sixteen physicians and 31 staff members working in 12 practices scheduled for implementation of an e-prescribing program and purposively sampled to ensure a mix of practice size and physician specialty. MEASUREMENTS:Field researchers used observational and interview techniques to collect data on prescriptionrelated clinical workflow, information technology experience, and expectations. RESULTS:Five practices fully implemented e-prescribing, 3 installed but with only some prescribers or staff members using the program, 2 installed and then discontinued use, 2 failed to install. Compared to practice members in other groups, members of successful practices exhibited greater familiarity with the capabilities of health information technologies and had more modest expectations about the benefits likely to accrue from e-prescribing. Members of unsuccessful practices reported limited understanding of e-prescribing capabilities, expected that the program would increase the speed of clinical care and reported difficulties with technical aspects of the implementation and insufficient technical support. CONCLUSIONS:Practice leaders should plan implementation carefully, ensuring that practice members prepare for the effective integration of this technology into clinical workflow.KEY WORDS: electronic prescribing; medical informatics; qualitative research; health services research.

Introduction: Use of electronic prescribing (e-prescribing) can improve safety and reduce costs of care by alerting prescribers to drug-drug interactions, patient nonadherence to therapies, and insurance coverage information. Deriving these benefits will require clinical decision support based on presentation of accurate and complete formulary and benefit (F&B) and medication history (RxH) data to prescribers, but relatively little is known about how this information is used in primary care.Methods: This is a multimethod comparative case study of 8 practices, which were selected to ensure practice size and physician specialty variation, implementing a stand-alone e-prescribing program. Field researchers observed prescription workflow and interviewed physicians and office staff.Results: Before implementation, few prescribers reported using F&B references when making medication choices; all used paper-based methods for tracking medication history. After implementation, some prescribers reported using F&B data to inform medication choices but missing information reduced confidence in these resources. Low confidence in RxH data led to paper-based workarounds.Conclusions: Challenges experienced with formulary checks and RxH documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. Greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings. (J Am Board Fam Med 2012;25:24 -32.)

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

I n health care, there is a silent and often unrecognized dependency on health information technology (HIT). It underlies every element of managed care pharmacy, from payers managing a pharmacy benefit through the provision of medication therapy management (MTM) and innovative programs that deliver quality pharmaceutical care to providers involved in direct patient care. It is also redefining how key stakeholders in medication management communicate with each other.This commentary describes how managed care pharmacy uses HIT today and how that will evolve in the near future. It examines how information is shared among managed care programs, providers, sponsors, government, and members, facilitating more informed decision making and enhancing productivity and efficiency. It also presents challenges and opportunities for moving forward. These insights were identified by a subset of the Academy of Managed Care Pharmacy (AMCP) Healthcare Information Technology Advisory Council, whose role is to advise AMCP membership on the role of HIT in managed care pharmacy and who believes that for HIT to continue to serve managed care pharmacy, AMCP must be involved in its development. ■■ HIT in Managed Care Pharmacy TodayManaged care pharmacy currently employs many essential HIT tools including pharmacy claims processing, electronic prescribing (e-prescribing), computerized physician order entry (CPOE), and electronic health records (EHRs). SUMMARYUnderstanding the use of health information technology (HIT) and its implications is crucial for the future of managed care pharmacy. Information is the cornerstone of providing and managing care, and the ability to exchange data is easier and more complicated than ever before. In this commentary, a subset of the Academy of Managed Care Pharmacy Healthcare Information Technology Advisory Council addresses how HIT supports managed care today and its anticipated evolution, with a focus on quality, patient safety, communication, and efficiency. Among the tools and functions reviewed are electronic health records, electronic prescribing, health information exchange, electronic prior authorization, pharmacists as care team members, formularies, prescription drug abuse, and policy levers to address these issues.