Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing

Abstract

Objective This paper explored pharmacy staff perceptions of the strengths and weaknesses of electronic prescribing (e-prescribing) design in retail pharmacies using the sociotechnical systems framework. This study examined how adoption of e-prescribing technology is affecting clinical practice and patient care. Materials and methods Direct observations and think aloud protocols were used to collect data from seven retail pharmacies. Results Pharmacists and pharmacy technicians reported strengths of e-prescribing design that facilitated pharmacy work which included: legibility, ease of archiving, quick access to prescriptions and consistency in the format of electronic prescriptions (e-prescriptions). Design weaknesses and potential hazards to patient care associated with e-prescribing systems were due to differences between pharmacy and prescriber computer systems which resulted in the selection of wrong patient or drug (name, directions, dose, strength, formulation, package sizes). There were unique strengths and weaknesses in the design of e-prescriptions peculiar to the three pharmacy computer systems examined in this study. Discussion Findings from this study can help inform policy on creating e-prescribing design standards for pharmacy. e-Prescribing system developers can use the results of this study to identify and apply the most usable features of the three main pharmacy computer systems to design systems that support dispensing efficiency and safety. Conclusions This is the first study to highlight design flaws with e-prescribing in retail pharmacies. The sociotechnical systems framework was useful in providing an indepth understanding of the pharmacist and pharmacy technician's interface with e-prescribing technology. This information can be used by policy makers to create e-prescribing standards for pharmacies.

Connecting primary care clinics and community pharmacies through a nationwide electronic prescribing network: A qualitative study

“…In this study, factors that were perceived as more crucial in the adoption of the network were related to system quality and were also identified in the literature: issues with interoperability between the systems,6 , 39 , 40 access to useful additional information that are not yet available in the nationwide system, such as laboratory results17 , 21 , 35 , 38 , 39 , 41 and lack of data standardisation. 11 , 17 , 24 , 34 This last issue compromises the security of the patient and may be dangerous if not properly addressed. There were also other crucial issues that were raised by the respondents but not underlined in the literature, notably the lack of legal autonomy for the e-prescription without the paper order signed by a physician and the uneven implementation of the e-prescribing network.…”

“…Even so, the implementation and adoption of e-prescribing is still poor, particularly in the North American context 16 , 17 , 21 , 22. Previous studies have documented the implementation and adoption of e-prescribing in primary care,23 but research on the topic is still limited, particularly among health professionals other than physicians23 , 24 and on the second generation of e-prescribing 11…”

The impacts of second generation e-prescribing usability on community pharmacists outcomes

“…13,14 Other examples of negative outcomes included: workflow and time problems, greater physical and mental workload for physicians and changes in communication patterns, often resulting in negative perceptions of the technology. 9,[15][16][17][18] In a review paper, Khajouei and Jaspers 19 stated that most studies on the impacts of e-prescribing systems had reported negative impacts.…”

“…It has been speculated that if an e-prescribing system is poorly designed, it can negatively impact on the quality of care, while a properly designed system can significantly contribute to improvements. 1,[17][18][19][20][21][22][23] One set of design factors, to improve users' outcomes, is system usability. 17,[23][24][25] However, despite the importance of the issue, the interaction between e-prescribing design features and their outcomes has not been studied adequately.…”

228 Comparison of Primary Compliance in Electronic Versus Paper Prescriptions Prescribed From the Emergency Department

“…For example, with both types of computergenerated prescriptions (e-prescription and printed prescriptions), there are benefits of: eliminated legibility concerns, automated alert system by the computer if a potential allergy or drug interaction is triggered, and increased difficulty to forge. 8,26,29 A number of critiques of e-prescriptions have been noted as well. Perhaps the most alarming critique is an increase in the error rate with e-prescriptions.…”