Transition to ePrescribing for systemic anti-cancer therapy – Perceptions of a multidisciplinary haematology/oncology team in a large teaching hospital

Abstract

Introduction A National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems. Methods A mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition. Results Twelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability. Conclusion This study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems’ implementation in haematology/oncology settings.

Influential factors in the adoption of clinical decision support systems in hospital settings: a systematic review and meta-synthesis of qualitative studies

“…At the adoption phase, managers and clinicians are concerned with the integrity of CDSS and the impact that it will have on the workflow of end-users (O’Connor et al. , 2022).…”

“…With respect to study participants, only three studies (Ash et al, 2015;Lee et al, 2016;Mozaffar et al, 2016a) took internal and external (users, managers, IT staff and vendor experts) stakeholders' perceptions into perspective and only one study investigated vendor experts' perception with regard to CDSS adoption (Cresswell et al, 2015). Methodologically, only one study used ethnography (Bailey et al, 2020) and three used combinations of an inductive and deductive approach using a theory-based deductive analytical framework (Cresswell et al, 2017;Mozaffar et al, 2016b;O'Connor et al, 2022). The remaining studies used inductive thematic or grounded theory analysis.…”

“…the longitudinal support and maintenance services provided by vendors (Ash et al, 2012;Cresswell et al, 2015). At the adoption phase, managers and clinicians are concerned with the integrity of CDSS and the impact that it will have on the workflow of end-users (O'Connor et al, 2022). Selection of a suitable CDSS is a challenging task.…”