Transcript Evaluating the Adoption of e-prescribing in primary care

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MEASURING E-PRESCRIBING
AND EMR ADOPTION IN
PRIMARY CARE:
A MIXED METHODS APPROACH
eHealth 2013
Gurprit K. Randhawa, BSc, MSc (c)
Agenda
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Background and Study Purpose
Methodology
Key Study Findings
Study Limitations
Recommendations
Conclusion
Q&A
Presenter Disclosure
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Presenter: Gurprit Randhawa
Relationships with commercial interests:
 Nothing to disclose
Background and Purpose
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Poor adoption of e-prescribing tools that can boost
productivity and safety
Study Purpose:
 To
examine the e-prescribing and EMR adoption by
primary care physicians in Central Vancouver Island
who use the same commercial EMR product
 To make suggestions on improving e-prescribing
adoption
Methodology
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Multi-method study design to compare
 The
Ideal State of E-Prescribing
 Literature
 The
Review
Possible State of E-Prescribing
 Review
of EMR user documentation and
provincial conformance specifications for EMRs
 Interview with an EMR vendor representative
 The
Current State of E-prescribing
 Interview
with physicians using e-prescribing
assessment tool and an EMR Adoption Survey
 Discussion group
Methodology (Cont.)
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Results
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10 papers
1 vendor interview
12 physician interviews
6 participants
Key Study Findings
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Key Finding 1:
E-Rx Features Used by Physicians
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Key Finding 1 (Cont.):
E-Rx Features Adopted by Physicians
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Current Physician Use by E-Prescribing Feature
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# of Physicians
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6
4
12
12
12
12
11
12
11
10
8
12
12
12
9
12
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8
8
12
12
10
12
10
9
2
2
0
0
0
0
E-Prescribing Feature
0
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Key Finding 2:
Barriers and Facilitators to E-Rx Adoption
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Key Finding 3:
EMR Adoption
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Average EMR Adoption score was 3.1/5
EMR Adoption Score by Functional Area
5.0
EMR Adoption Score
4.0
Overall EMR Adoption: 3.1/5
3.0
2.0
1.0
0.0
EMR Functional Area
Key Finding 3 (Cont.):
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EMR Adoption
Key Finding 4:
Opportunities for Improving Adoption
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E-Prescribing
Opportunities
Use templates for
frequently
prescribed
medications
Review drug
monographs
EMR
Opportunities
Priority improvement
areas: E-Prescribing
and E-Referrals
Use EMR for
reminders, recalls and
chronic disease
management
Create reports
Search for drugs
by class
Do full eprescribing
Improve technical
capabilities
Capture complex
care bills
Use templates,
patient handouts,
physician supports,
and integrated
guidelines
Explore use of
patient portal
Key Finding 5:
Gaps between Ideal and Possible States
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The Ideal State of E-Prescribing
 104
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features in total
Patient Information, identification, and data access (4 features)
Current medications/medication history (12 features)
Medication selection (28 features)
Prescribing safety (25 features)
Patient education (1 feature)
Monitoring (4 features)
Repeat (renewal) prescribing (7 features)
Computer-user interface (5 features)
Transparency and accountability (5 features)
Security and confidentiality (7 features)
Interoperability and communication (6 features).
Key Finding 5 (Cont.):
Gaps between Ideal and Possible States
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The Possible State of E-Prescribing
 The
EMR product met 27 of the 33 PITO e-prescribing
requirements partially or fully
 Generating
prescriptions (1 feature)
 Processing prescriptions (16 features)
 Transmitting prescriptions (1 feature)
 Viewing medications (2 features)
 Managing renewals (1 feature)
 Drug formularies (2 features)
 Interaction checking (1 feature)
 Medication profiles (2 features)
 Reference support (1 feature)
Key Finding 5 (Cont.):
Gaps between Ideal and Possible States
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55 of the 75 e-prescribing features from the Ideal
state were not fully included in the Possible state
Ideal State of
E-Prescribing
Features
N = 55
Possible State of
E-Prescribing
Features
N = 20
N=9
Recommendations
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Improvements in Current State
 Use
of features not yet adopted
 Tailored coaching on the value of using unused features
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Improvements in Possible State
 Meet
7 additional PITO e-prescribing requirements
 Consider inclusion and/or improvement of the 55
features from the Ideal State
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Improvements in Ideal State
 Include
9 features from the Possible State that were not
fully included
Study Limitations
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EMR and E-Prescribing adoption examined only at
one point in time
Study sample
Defining Possible State and Ideal State of E-Rx
E-Prescribing adoption examined using polar (yesno) questions
Conclusion
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Participating physicians are currently using most of
the e-prescribing and EMR features
Significant improvements are needed in:
 Searching for drugs by class
 Checking for patient coverage
 Using drug to procedure interaction checking
 Using drug monographs
Several gaps between the ideal, possible, and
current state of e-prescribing
Future Directions
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Conduct adoption evaluations at specific times
following implementation
Examine impact of educational interventions on eprescribing adoption levels
Methodology: Review EMR usage logs and conduct
on-site observations
Acknowledgements
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Thank you to CIHR-ISPR, Canada Health Infoway,
and the eHealth Observatory for supporting this
research.
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THANK YOU
[email protected]
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QUESTIONS?