A theoretical approach to electronic prescription system: lesson learned from literature review

Secondary uses of electronic prescribing and pharmacy data in UK hospital care: a national survey

Electronic hospital pharmacy (EHP) systems are ubiquitous in today's hospitals, with many also implementing electronic prescribing (EP) systems; both contain a potential wealth of medication-related data to support quality improvement. The reasons for reuse and users of this data are generally unknown. Our objectives were to survey secondary use of data (SUD) from EHP and EP systems in UK hospitals, to identify users of and factors influencing SUD.A national postal survey was sent out to all hospital chief pharmacists with pre-notifications and follow-up reminders. Descriptive statistical analysis was performed.Of 187 hospital organisations, 65 (35%) responded. All had EHP systems (for ≥20 years) and all reused data; 50 (77%) had EP systems (established 1-10 years) but only 40 (80%) reused data. Reported facilitators for SUD included medication safety, providing feedback, benchmarking, saving time and patient experience. The purposes of SUD included audits, quality improvement, risk management and general medication-related reporting. Earlier introduction of SUD could provide an opportunity to heighten local improvement initiatives.Data from EHP systems is reused for multiple purposes. Evaluating SUD and sharing experiences could provide richer insight into potential SUD and barriers/factors to consider when implementing or upgrading EP/EHP systems.

Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals

OBJECTIVES

 Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system.

METHODS

 In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics.

RESULTS

 The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p < 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B =  -7.261, p = 0.004) and effectiveness (B = - 5.784, p = 0.002).

CONCLUSION

 Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.

Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study

BACKGROUND

Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services.

OBJECTIVE

To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China.

METHODS

The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies.

RESULTS

Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice.

CONCLUSIONS

The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.

Explore of the reasons of irrational prescribing in Iran: A qualitative study

Background

Irrational prescribing is highly prevalent in Iran, and it is under the impact of different factors.

Objective

This research aims to recognize the reasons for Irrational prescribing in Iran.

Methods

A qualitative approach and a conventional content analysis were employed to perform this research. The research community includes some experts and key specialists in medication prescribing. Semi-structured interviews were used for data collection. The intentional sampling method was applied, and theoretical saturation was reached by conducting 40 interviews with experts. The data analysis process was done following the steps suggested by Graneheim and Lundman.

Results

Four main categories and 12 subcategories appeared after analyzing the data. The main categories are organizational and management factors, legal factors, cultural factors, and economic factors.

Conclusion

Irrational prescribing can be prevented by reforming the referral system, overseeing pharmacies and physicians, raising public awareness and correcting their misconceptions about the medications, and creating an appropriate mechanism for pricing and selling medicines.

Electronic prescription system requirements: a scoping review

Background

An electronic prescription system is a mechanism that has long been implemented in many countries around the world. In the present study, we reviewed the requirements, standards, and features of an electronic prescription system for its correct and accurate execution.

Methods

This scoping review was conducted according to the PRISMA-SCR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive literature search was performed with the related keywords in Web of Science, PubMed, Scopus, and ProQuest with no time limit. The selection of papers was based on inclusion criteria. After removing duplicates, reviewing titles, abstracts, and full-text, 13 articles were included in the analysis.

Results

Electronic prescription system requirements extracted from the studies: Patient data, Patient selection or identification and data access, Drug Selection, Security, Privacy and administration, Transparency and accountability, Interoperability and communication, Monitoring, report, reminder, and renewals, Feedback at the prescriber level, Infrastructure: Computer equipment, Awareness of physicians and System support, Patient education and information, Usability, Standards, History of Medications / Current Medications, Data transfer and storage, Alerts and other messages to prescribers, and filtering of user-selectable alerts for possible prescription problems and Decision support.

Conclusions

The results of this study showed that the electronic prescription systems have several functional and technical capabilities that can provide significant benefits to all system’s stakeholders, including service providers, drug distributors, patients, and insurance organizations if used correctly.

Developing a Multifaceted Evaluation Tool for Electronic Prescribing System: A Study from a Developing Country

: Evaluation of electronic prescribing systems (EPS) can contribute to their quality assurance, and motivate users and policy-makers to implement these systems, directly influencing the health of society. An appropriate evaluation tool plays a determining role in the identification of proper EPS. The present study aimed to develop a multifaceted evaluation tool for assessing the EPS. This study was conducted in two main steps in 2018. In the first step, we conducted a literature review to find the main features and capabilities of the prosperous EPS. In the second step, a Delphi method was used for determining the final criteria for evaluating EPS. After preparing a primary questionnaire based on the first step results, 27 expert stakeholders from related fields participated in this 3-phase Delphi study. The narrative content analysis and descriptive statistics were used for data analysis. The final evaluation tool consists of 61 questions in 10 main dimensions, including practical capabilities of the process/user and patient safety, data storage and transfer, prescription control and renewal, technical functions, user interfaces, security and privacy, reporting, portability, hardware and infrastructure, and system failure/recovery. The evaluation tool developed in this study can be used for the critical appraisal of features of EPS. It is recommended that this multifaceted evaluation tool be employed to help buyers compare different systems and assist EPS software vendors in prioritizing their activities regarding the system development. By using this tool, healthcare organizations can also choose a system that improves many aspects of health care.

Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry

BACKGROUND

Hospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of "one patient, one chart" to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team.

METHODS

Four focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

RESULTS

A total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness.

CONCLUSION

Overall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians' and the implementation team's perspectives using UTAUT model. The result suggests that clinicians' acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved.

Digital Health in Physicians' and Pharmacists' Office: A Comparative Study of e-Prescription Systems' Architecture and Digital Security in Eight Countries

e-Prescription systems are key components and drivers of digital health. They can enhance the safety of the patients, and are gaining popularity in health care systems around the world. Yet, there is little knowledge on comparative international analysis of e-Prescription systems' architecture and digital security. We report, in this study, original findings from a comparative analysis of the e-Prescription systems in eight different countries, namely, Canada, United States, United Kingdom, Australia, Spain, Japan, Sweden, and Denmark. We surveyed the databases related to pharmacies, eHealth, e-Prescriptions, and related digital health websites for each country, and their system architectures. We also compared the digital security and privacy protocols in place within and across these digital systems. We evaluated the systems' authentication protocols used by pharmacies to verify patients' identities during the medication dispensing process. Furthermore, we examined the supporting systems/services used to manage patients' medication histories and enhance patients' medication safety. Taken together, we report, in this study, original comparative findings on the limitations and challenges of the surveyed systems as well as in adopting e-Prescription systems. While the present study was conducted before the onset of COVID-19, e-Prescription systems have become highly relevant during the current pandemic and hence, a deeper understanding of the country systems' architecture and digital security that can help design effective strategies against the pandemic. e-Prescription systems can help reduce physical contact and the risk of exposure to the virus, as well as the wait times in pharmacies, thus enhancing patient safety and improving planetary health.

Components Affecting Pharmaceutical Strategic Purchasing: A Scoping Review

Pharmaceutical strategic purchasing is considered as a key to improve access to medicines especially for developing countries. The aim of this scoping review is to determine the most important components affecting pharmaceutical strategic purchasing. Here, we employed a comprehensive search strategy across PubMed, ProQuest, EBSCO, ISI Web of Science, Scopus, ScienceDirect, and Google Scholar for the terms related to medicines strategic purchasing. Among 13 included studies, 7 (53.85%) and 6 (46.15%) studies belonged to the developing and developed countries, respectively. Six main variables were emphasized as the effective variables on medicines strategic purchasing, including purchasing interventions, target group and service users, providers and suppliers of interventions, methods and motivations, price, and finally structure and organization. It seems that the insurance organizations of developing countries can achieve strategic purchasing only through the modification of the pharmaceutical pricing system and payment systems. Furthermore, they should pay attention to the real needs of target groups (demand) and modify the structure and organization as well as purchasing the most effective medicines from the best pharmaceutical providers.

The past and current state of the Czech outpatient electronic prescription (eRecept)

INTRODUCTION

Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well.

METHODS

Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léčiv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained.

RESULTS

The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all.

DISCUSSION

A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits.

CONCLUSION

The Czech Republic has joined the EU countries widely using the OEPS.

A Copmarative Review of Electronic Prescription Systems: Lessons Learned from Developed Countries

This review study aimed to compare the electronic prescription systems in five selected countries (Denmark, Finland, Sweden, England, and the United States). Compared developed countries were selected by the identified selection process from the countries that have electronic prescription systems. Required data were collected by searching the valid databases, most widely used search engines, and visiting websites related to the national electronic prescription system of each country and also sending E-mails to the related organizations using specifically designed data collection forms. The findings showed that the electronic prescription system was used at the national, state, local, and area levels in the studied countries and covered the whole prescription process or part of it. There were capabilities of creating electronic prescription, decision support, electronically transmitting prescriptions from prescriber systems to the pharmacies, retrieving the electronic prescription at the pharmacy, electronic refilling prescriptions in all studied countries. The patient, prescriber, and dispenser were main human actors, as well as the prescribing and dispensing providers were main system actors of the Electronic Prescription Service. The selected countries have accurate, regular, and systematic plans to use electronic prescription system, and health ministry of these countries was responsible for coordinating and leading the electronic health. It is suggested to use experiences and programs of the leading countries to design and develop the electronic prescription systems.