Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation

J Am Board Fam Med. 2012 Jan-Feb;25(1):24-32. doi: 10.3122/jabfm.2012.01.100297.


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.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care Facilities
  • Cost Control
  • Diffusion of Innovation*
  • Electronic Health Records / statistics & numerical data*
  • Electronic Prescribing*
  • Formularies as Topic
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Medical History Taking*
  • Medication Errors / prevention & control*
  • Medication Systems, Hospital
  • Organizational Case Studies
  • Primary Health Care
  • Safety Management