Methods Inf Med 2013; 52(03): 199-219
DOI: 10.3414/ME12-01-0069
Original Articles
Schattauer GmbH

A Comprehensive E-prescribing Model to Allow Representing, Comparing, and Analyzing Available Systems

S. Marceglia*
1   e-Health Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
,
L. Mazzola*
1   e-Health Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
,
S. Bonacina
1   e-Health Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
,
P. Tarquini
2   Ufficio progetti strategici per l’innovazione digitale, Dipartimento per la digitalizzazione della pubblica amministrazione e l’innovazione tecnologica, Presidenza del Consiglio dei Ministri, Rome, Italy
,
P. Donzelli
2   Ufficio progetti strategici per l’innovazione digitale, Dipartimento per la digitalizzazione della pubblica amministrazione e l’innovazione tecnologica, Presidenza del Consiglio dei Ministri, Rome, Italy
,
F. Pinciroli
1   e-Health Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
3   Honorary Visiting Professor, City University, London, UK
› Author Affiliations
Further Information

Publication History

received: 25 July 2012

accepted: 07 April 2012

Publication Date:
20 January 2018 (online)

Summary

Background: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems.

Objective: In this paper, we propose an updated comprehensive model for the ePre-scribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems.

Methods: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis & Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug sur -veillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase.

Results and Conclusions: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.

* The first two authors equally contributed to the work


 
  • References

  • 1 Electronic Prescribing: Toward Maximum Value and Rapid Adoption: Recommendations for Optimal Design and Implementation to Improve Care, Increase Efficiency and Reduce Costs in Ambulatory Care (eRx Report). A Report of the Electronic Prescribing Initiative. Washington, DC: eHealth Initiative; April 14 2004.
  • 2 Dobrev A, Jones T, Stroetmann K, Vatter Y, Peng K. The socio-economic impact of interoperable electronic health record (EHR) and ePrescribing systems in Europe and beyond. European Commission Information Society and Media. 2009.
  • 3 Figge HL. Electronic prescribing in the ambulatory care setting. Am J Health Syst Pharm 2009; 66 (01) 16-18.
  • 4 Hale P. editor Electronic Prescribing for the Medical Practice: Everything You Wanted to Know but Were Afraid to Ask. Chicago, IL: HIMSS; 2007.
  • 5 Miller RA, Gardner RM, Johnson KB, Hripcsak G. Clinical decision support and electronic prescribing systems: a time for responsible thought and action. J Am Med Inform Assoc 2005; 12 (04) 403-409.
  • 6 Rinner C, Janzek-Hawlat S, Sibinovic S, Duftschmid G. Semantic validation of standard-based electronic health record documents with W3C XML schema. Methods Inf Med 2010; 49 (03) 271-280.
  • 7 Kuilboer MM, van Wijk MA, Mosseveld M, van der Does E, de Jongste JC, Overbeek SE, Ponsioen B, van der Lei J. Computed critiquing integrated into daily clinical practice affects physicians’ behavior - a randomized clinical trial with AsthmaCritic. Methods Inf Med 2006; 45 (04) 447-454.
  • 8 Channick SA. The ongoing debate over Medicare: understanding the philosophical and policy divides. J Health Law 2003; 36 (01) 59-106.
  • 9 Adler KG. E-prescribing: why the fuss?. Fam Pract Manag 2009; 16 (01) 22-27.
  • 10 Aspen P, Wolcott J, Bootman J, Cronenwett L. editors Preventing medication errors: quality chasm series. Washington, DC: National Academy Press; 2006.
  • 11 Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E. et al Adverse drug events in ambulatory care. N Engl J Med 2003; 348 (16) 1556-1564.
  • 12 Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC. et al Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Jama 2003; 289 (09) 1107-1116.
  • 13 Kistner UA, Keith MR, Sergeant KA, Hokanson JA. Accuracy of dispensing in a high-volume, hospital-based outpatient pharmacy. Am J Hosp Pharm 1994; 51 (22) 2793-2797.
  • 14 Kohn L, Corrigan J, MS D. editors To err is human: building a safer health system. Washington, DC: National Academies Press; 2000.
  • 15 Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T. et al Systems analysis of adverse drug events. ADE Prevention Study Group. Jama 1995; 274 (01) 35-43.
  • 16 Khajouei R, Jaspers MW. The impact of CPOE medication systems’ design aspects on usability, workflow and medication orders: a systematic review. Methods Inf Med 2010; 49 (01) 3-19.
  • 17 Kawazoe Y, Ohe K. An ontology-based mediator of clinical information for decision support systems: a prototype of a clinical alert system for prescription. Methods Inf Med 2008; 47 (06) 549-559.
  • 18 Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. Oxford, UK: Oxford University Press; 2005.
  • 19 Ammenwerth E, Gräber S, Herrmann G, Bürkle T, König J. Evaluation of health information systems - problems and challenges. Int J Med Inform 2003; 71 2–3 125-135.
  • 20 Rigby M. Evaluation: 16 powerful reasons why not to do it - and 6 over-riding imperatives. Stud Health Technol Inform 2001; 84 Pt 2 1198-1202.
  • 21 Bell DS, Cretin S, Marken RS, Landman AB. A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc 2004; 11 (01) 60-70.
  • 22 Vatter Y, Jones T, Dobrev A. The socio-economic impact of Receta XXI, the regional ePrescribing system of Andalucia’s public health service, Spain: European Commission Information Society and Media. 2009.
  • 23 Jha AK, Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. Int J Med Inform 2008; 77 (12) 848-854.
  • 24 Anderson JG. Social, ethical and legal barriers to e-health. Int J Med Inform 2007; 76 5–6 480-483.
  • 25 Simon SR, Kaushal R, Cleary PD, Jenter CA, Volk LA, Orav EJ, Burdick E, Poon EG, Bates DW. Physicians and electronic health records: a statewide survey. Arch Intern Med 2007; 167 (05) 507-512.
  • 26 Fleurant M, Kell R, Love J, Jenter C, Volk LA, Zhang F, Bates DW, Simon SR. Massachusetts e-Health Project increased physicians’ ability to use registries, and signals progress toward better care. Health Aff (Millwood) 2011; 30 (07) 1256-1264.
  • 27 Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. J Am Board Fam Med 2010; 23 (05) 655-670.
  • 28 Zhou L, Soran CS, Jenter CA, Volk LA, Orav EJ, Bates DW, Simon SR. The relationship between electronic health record use and quality of care over time. J Am Med Inform Assoc 2009; 16 (04) 457-464.
  • 29 Pizzi LT, Suh DC, Barone J, Nash DB. Factors related to physicians’ adoption of electronic prescribing: results from a national survey. Am J Med Qual 2005; 20 (01) 22-32.
  • 30 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 2011; 8 (01) e1000387
  • 31 Appari A, Carian EK, Johnson ME, Anthony DL. Medication administration quality and health information technology: a national study of US hospitals. J Am Med Inform Assoc 2012; 19 (03) 360-367.
  • 32 Cusack CM. Electronic health records and electronic prescribing: promise and pitfalls. Obstet Gynecol Clin North Am 2008; 35 (01) 63-79. ix
  • 33 Pevnick JM, Asch SM, Adams JL, Mattke S, Patel MH, Ettner SL, Bell DS. Adoption and use of stand-alone electronic prescribing in a health plan-sponsored initiative. Am J Manag Care 2010; 16 (03) 182-189.
  • 34 Hollingworth W, Devine EB, Hansen RN, Lawless NM, Comstock BA, Wilson-Norton JL, Tharp KL, Sullivan SD. The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study. J Am Med Inform Assoc 2007; 14 (06) 722-730.
  • 35 Pagán JA, Pratt WR, Sun J. Which physicians have access to electronic prescribing and which ones end up using it?. Health Policy 2009; 89 (03) 288-294.
  • 36 Wang CJ, Marken RS, Meili RC, Straus JB, Landman AB, Bell DS. Functional characteristics of commercial ambulatory electronic prescribing systems: a field study. J Am Med Inform Assoc 2005; 12 (03) 346-356.
  • 37 Hor CP, O’Donnell JM, Murphy AW, O’Brien T, Kropmans TJ. General practitioners’ attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study. BMC Med Inform Decis Mak 2010; 10: 2
  • 38 Crosson JC, Etz RS, Wu S, Straus SG, Eisenman D, Bell DS. Meaningful use of electronic prescribing in 5 exemplar primary care practices. Ann Fam Med 2011; 9 (05) 392-397.
  • 39 Halamka J, Aranow M, Ascenzo C, Bates DW, Berry K, Debor G, Fefferman J, Glaser J, Heinold J, Stanley J, Stone DL, Sullivan TE, Tripathi M, Wilkinson B. E-Prescribing collaboration in Massachusetts: early experiences from regional prescribing projects. J Am Med Inform Assoc 2006; 13 (03) 239-244.
  • 40 Eggertson L. Canada lags US in adoption of e-prescribing. CMAJ 2009; 180 (09) E25-26.
  • 41 Devine EB, Patel R, Dixon DR, Sullivan SD. Assessing attitudes toward electronic prescribing adoption in primary care: a survey of prescribers and staff. Inform Prim Care 2010; 18 (03) 177-187.
  • 42 Au DW, Menachemi N, Panjamapirom A, Brooks RG. The influence of payer mix on electronic prescribing by physicians. Health Care Manage Rev 2011; 36 (01) 95-101.
  • 43 Desroches CM, Agarwal R, Angst CM, Fischer MA. Differences between integrated and stand-alone E-prescribing systems have implications for future use. Health Aff (Millwood) 2010; 29 (12) 2268-2277.
  • 44 Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V, Petrakaki D, Crowe S, Marsden K, Robertson A, Morrison Z, Klecun E, Prescott R, Quinn C, Jani Y, Ficociello M, Voutsina K, Paton J, Fernando B, Jacklin A, Cresswell K. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ 2011; 343: d6054
  • 45 Goldman RE, Dubé C, Lapane KL. Beyond the basics: refills by electronic prescribing. Int J Med Inform 2010; 79 (07) 507-514.
  • 46 Devine EB, Williams EC, Martin DP, Sittig DF, Tarczy-Hornoch P, Payne TH, Sullivan SD. Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment. BMC Med Inform Decis Mak 2010; 10: 72
  • 47 Gaylin DS, Moiduddin A, Mohamoud S, Lundeen K, Kelly JA. Public attitudes about health information technology, and its relationship to health care quality, costs, and privacy. Health Serv Res 2011; 46 (03) 920-938.
  • 48 Castillo VH, Martínez-García AI, Pulido JR. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak. 2010; 10: 60
  • 49 Todd J. E-Prescribing in a Changing Legal Environment. Richmond Journal of Law Technology 2006; 12 (03) 12 Available at http://law.richmond.edu/jolt/v12i3/article12.pdf.
  • 50 Petropoulou SG, Bekakos MP, Gravvanis GA. E-Prescribing - Telepharmacy. Proceedings of The Seventh Hellenic European Research on Computer Mathematics and its Applications (HERCMA) 2005 Conference. Athens, GR. 22–24 September. 2005: 22-24. Available at http://www.aueb.gr/pympe/hercma/proceedings2005/H05-FULL-PAPERS-1/PETROPOULOU-BEKAKOS-TELEPHARMACY.pdf.
  • 51 Hammar T, Nyström S, Petersson G, Åstrand B, Rydberg T. Patients satisfied with e-prescribing in Sweden: a survey of a nationwide implementation. Journal of Pharmaceutical Health Services Research 2011; 2 (02) 97-105.
  • 52 Hyppönen H, Salmivalli L, Tellinger K. Implementing Electronic Prescription Systems - A Comparison between Two Approaches. Proceedings of The Sixth Nordic Conference on eHealth Telemedicine - NCeHT2006. August 31-September 1, 2006, Helsinki, Finland. 2006: 134-136.
  • 53 Fox BI, Felkey BG. Pharmacy Automation and Technology. E-Prescribing Update and Implications for Hospital Pharmacy. Hosp Pharm 2011; 46 (05) 366-367.
  • 54 Warholak T, Hincapie AL. e-Prescribing/Patient Safety Analysis utilizing the Pharmacy and Prescriber e-Prescribing Experience Reporting (PEER) Portal. Final Report. 2011. Available at www.medicationsafety.org/documents/Grant94_FinalReport_September2011.pdf.
  • 55 Robinson GA, Figge H, Stein RL, Russell J. The Life and Times of an e-Prescription. Hosp Pharm 2011; 46 (12) 956-959.
  • 56 Majkowski K. ePrescribing Pilot Findings. In: Results and Impact of Electronic Prescribing (e-Rx) Use. Agency for Healthcare Research and Quality. Nov 2. 2007. Available at http://pbrn.ahrq.gov/portal/server.pt/gateway/PTARGS_0_8762_807449_0_0_18/Nov2_eRxWebConference.pdf.
  • 57 Van Ornum M. E-prescribing safety. In: Electronic Prescribing: A Safety and Implementation Guide. Sudbury, MA: Jones Bartlett Publishers; 2008: 139-164.
  • 58 Barbarito F, Pinciroli F, Mason J, Marceglia S, Mazzola L, Bonacina S. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region. J Biomed Inform 2012; 45 (04) 736-745.
  • 59 EHR IMPACT. The socio-economic impact of the health information platform Sistema SISS in the region of Lombardy, Italy. 2010 Available from http://www.ehr-impact.eu/downloads/documents/EHRI_case_SISS_final.pdf.
  • 60 Rapone M, Pieroni A, Pisani M, Bruno E, Mercatili A, Putzu G. et al Le frodi a danno del servizio sanitario nazionale: dati e riflessioni sul fenomeno ed il suo contesto. In Finanza Gd. editor Quaderni n 19. 2008: 1-198.
  • 61 Ministero della Salute. Sistema di integrazione delle informazioni sanitarie individuali. Available from. http://www.nsis.salute.gov.it/nsis/paginaInternaMenuNsis.jsp?id=26menu=obiettivilingua=italiano.
  • 62 Bonacina S, Marceglia S, Navino S, Pinciroli F. Casi di prodotti e servizi. In Pinciroli F, Bonacina S. (editors) Applicazioni di sanità digitale. ISBN 97888-7398-049-0 Milan, IT: Polipress Editore; 2009: 229-390.
  • 63 Zweifel P. The present state of health economics: a critique and an agenda for the future. Eur J Health Econ. 2012.
  • 64 Marceglia S, Bonacina S, Zaccaria V, Pagliari C, Pinciroli F. How might the iPad change healthcare?. J R Soc Med 2012; 105 (06) 233-241.