Interoperable Electronic Prescribing In The United States: A Progress Report

Friedman, Maria A.; Schueth, Anthony J.; Bell, Douglas S.

doi:10.1377/hlthaff.28.2.393

Cited by 30 publications

(18 citation statements)

References 7 publications

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“…40 In addition, electronic prescribing can potentially reduce the rate of medical errors during dispensing, and is effective in tracking patient co-payments, and promoting medication adherence. 44 Ideally, HIT resources and tools are centralized and available to all providers across a network.…”

Section: 21mentioning

confidence: 99%

Creation of Safety-Net-Based Provider Networks Under the California Health Care Coverage Initiative: Interim Findings

et al. 2009

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Section: 21mentioning

confidence: 99%

Creation of Safety-Net-Based Provider Networks Under the California Health Care Coverage Initiative: Interim Findings

et al. 2009

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“…Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet certain criteria, including use of e-prescribing 21 .…”

Section: Introductionmentioning

confidence: 99%

“…Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet certain criteria, including use of e-prescribing 21 .…”

mentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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BACKGROUND: Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems. OBJECTIVE: To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety. DESIGN, PARTICIPANTS: Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS. MAIN MEASUREMENTS: Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety. KEY RESULTS: We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2-54.8) and lowest one year postimplementation (12.2 per 100 prescriptions, 95% CI 8.6-17.4) (p<0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5-33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2-18.6) (p =0.337). Survey results complemented quantitative findings. CONCLUSIONS: Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits. INTRODUCTIONImproving healthcare safety is a national priority, and eprescribing is viewed as an important tool in these efforts 1-2 . Research on the ability of e-prescribing to improve safety has predominantly come from the inpatient setting and on locally developed systems created by organizations for their own use 3-5 . Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet c...

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“…[302] MMA intended to foster ePrescribing through creation of standards for exchange and removals of rules that could block the development of ePrescribing. [303] However, the increase in the share of ePrescriptions remained modest.…”

Section: Network Governance In Eprescribingcomparison Us -Swedenmentioning

confidence: 99%

“…[306] Another explanation is the cost for the physicians to invest in ePrescribing. [302] Nelson King [301] describes in their paper how the operating model 147 of ePrescribing in US influences the role of and relationships between actors in the network. Here, an operating model is viewed as a blueprint of actions and exchange between actors in a network to achieve a certain goal, i.e.…”

Section: Network Governance In Eprescribingcomparison Us -Swedenmentioning

confidence: 99%

Interoperability : - capability to interoperate in a shared work practice using information infrastructures

Öhlund¹

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InteroperabilityCapability to interoperate in a shared work practice using information infrastructures -studies in ePrescribing Columbo AbstractThe ability to interoperate between systems, people, and organizations is considered an important issue within eHealth in order to deliver patient centered care. The achieving and improving of interoperability is a complex undertaking involving the evolution of an information infrastructure, sharing of knowledge and resources, governance of the interoperation between organizations, people and work practices, and handling of economic and legal matters. However, there is a weak scientific basis for interoperability, and proposed initiatives to improve interoperability largely lacks empirical evidence of their utility.This thesis contributes with practical knowledge on improving interoperability, based on active participation in and empirical studies of improving interoperability in ePrescribing. A case study is presented that describes and analyzes the evolution of ePrescribing in Sweden since the early pioneering years in 1980s, its growth and consolidation before the reregulation of the pharmacy market in 2009. The case study shows the importance of cooperation between the stakeholders for the growth and consolidation of ePrescribing, and identifies important events in the evolution of an advanced information infrastructure. To better understand the complexity of ePrescribing work practice, a practical theory on ePrescribing was developed. A unique field experimental study measuring improvement of interoperability in ePrescribing, before and after a major intervention to improve the quality of ePrescriptions between 2004 and 2009 is presented. The findings from the field experimental study showed that collective efforts to clarify and align the shared ePrescribing work practice and the ePrescription message contributed to substantially improve interoperability in ePrescribing.Based on the findings and knowledge gathered in the situational inquiry into the evolution of ePrescribing in Sweden, the improvement of interoperability, and the application of theories about information systems actability, communication and organizational theories, a practical theory on interoperation and interoperability aiming both towards the practice and research community is presented. Interoperability is seen as the exercised capability of organizations through their agents to interoperate in a shared work practice in an effective, efficient, and satisfactory manner based on a common ground in a mediated, prescriptive, and nonpersonal communicative setting using an information infrastructure for mediating interoperation. The plausibility that the theory of interoperation and interoperability grounded in ePrescribing is generalizable to eHealth is analyzed. ForewordInformation Systems Development (ISD) is a research discipline within the Faculty of Arts and Sciences at Linköping University (LiU), Linköping Sweden. ISD is a discipline studying human work with developing and changing different...

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Interoperable Electronic Prescribing In The United States: A Progress Report

Cited by 30 publications

References 7 publications

Creation of Safety-Net-Based Provider Networks Under the California Health Care Coverage Initiative: Interim Findings

Creation of Safety-Net-Based Provider Networks Under the California Health Care Coverage Initiative: Interim Findings

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

Interoperability : - capability to interoperate in a shared work practice using information infrastructures

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