Evaluating the Technical Adequacy of Electronic Prescribing Standards

Results of an Expert Panel Process

Published in: AMIA, American Medical Informatics Association 2008, p. 46-60

Posted on RAND.org on January 01, 2008

by Douglas S. Bell, Anthony J. Schueth, John Paul Guinan, Shin-Yi Wu, Jesse C. Crosson

To support more informed prescribing decisions, e-prescribing systems need data on patients' medication histories and their drug-specific insurance coverage. The authors used an expert panel process to evaluate the technical adequacy of two standards for delivering this information, the Medication History function of the NCPDP SCRIPT Standard and the NCPDP Formulary and Benefit STANDARD.METHODS: The authors convened a panel representing 14 organizations that had experience with these standards. Experts within each organization submitted narrative responses and ratings assessing the standards in 6 domains, including data quality, completeness, usability, and interoperability. Areas of disagreement were discussed in recorded teleconferences. Narrative was analyzed using a grounded-theory approach. RESULTS: Panelists agreed that the structure of the Medication History Standard was adequate for delivering accurate and complete information but implementation problems made the data difficult to use for decision support. The panel also agreed that the Formulary and Benefit Standard was adequate to deliver formulary status lists, but other parts of the standard were not used consistently and group-level variations in coverage were not represented. A common problem for both standards was the lack of unambiguous drug identifiers; panelists agreed that RxNorm deserves further evaluation as a solution to this problem. CONCLUSIONS: A panel of industry experts found the basic structure of these two standards to be technically adequate, but to enable benefits for patient care, improvements are needed in the standards' implementation.

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