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

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.


  • 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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