Early Adopters of Electronic Prescribing Struggle to Make Meaningful Use of Formulary Checks and Medication History Documentation

Published in: Journal of the American Board of Family Medicine, vol. 25, no. 1, Jan.-Feb. 2012, p. 24-32

Posted on RAND.org on January 01, 2012

by Jesse C. Crosson, Anthony J. Schueth, Nicole Isaacson, Douglas S. Bell

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Research Question

  1. Do primary care physicians who use electronic prescribing systems (e-prescribing) use information about formularies and the patient's medication history?

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.

Key Findings

Formulary and benefit (F&B) information is being used...

  • In primary care offices where e-prescribing was implemented, prescribers did use information about formularies and benefits.

...but confidence in F&B info and medication history is low.

  • Missing and inaccurate information reduced confidence in these resources and led to paper-based workarounds.

Recommendation

  • The data in e-prescribing systems needs to be more accurate and complete if it is to further improve the efficiency and safety of prescribing in primary care.

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