The past several years have witnessed an explosion in the automation of healthcare practices and medicine. And while the adoption of electronic prescribing will undoubtedly yield a variety of benefits to physicians, pharmacists, consumers, and payers, several organizational factors must be considered before implementing an e-prescribing system.
For e-prescribing to provide significant value, your staff must use the system and, in turn, the e-prescribing system must deliver the functions desired and required by your organization. This article provides a framework for the knowledgeable consideration and implementation of an e-prescribing system. Below are some important elements to think about when faced with the question, What factors do I need to consider to ensure a successful implementation of an e-prescribing application?
Current Practice Management System
What practice management system is your organization using? Does the system have the ability to export a variety of consumer information to the e-prescribing system, thus eliminating duplicate data entry? If your staff needs to reenter consumer demographic information into an e-prescribing application, this could hinder adoption and efficiency of the system.
Prescriber Adoption and Training
How many prescribers will be using the system? What is their attitude about adopting e-prescribing technology? Will their schedules allow for necessary training? If a large number of prescribers will use the system, training likely will need to be conducted in groups. Doctors must schedule time to attend training without overburdening their schedules, and adequate training facilities will be required to accommodate Web-based training (if applicable) for large groups.
Is there a clear message of support for e-prescribing from the top leadership of the organization? The executive management team must make a strong statement of support for the project from both organizational and technologic perspectives. If your leaders give the impression that e-prescribing is optional, adoption will be spotty at best.
Users’ Computer Fluency
Do designated users of the e-prescribing application have basic computer knowledge? Experience has shown that users familiar with using a computer, whether at home or work, tend to learn the application at a faster rate than those who are not. To accommodate staff members who are not computer-savvy, your e-prescribing application should have an intuitive, user-friendly interface, and should offer as much consumer-specific data as possible.
How many nursing staff members will be using the system? What is their receptivity to adopting e-prescribing? Nurses should be made aware that organizational efficiency may not immediately rise at the point of transition, but over time e-prescribing can greatly assist them in a variety of areas, including reducing the number of calls from pharmacies; this eliminates the need to transcribe medication orders, and improves risk-management efforts.
Does your organization have adequate computer and printing resources for the project to be successful? A computer should be available for each prescriber to use during appointments. Computer monitors should be positioned so that the prescriber doesn't have to turn his/her back on the consumer when issuing a prescription. Also, a printer must be stationed nearby to instantly produce prescriptions (e.g., if the system is down) or collateral information (e.g., patient instructions). Experience tells us that the first thing users will complain about during the introduction of new applications is the hardware (e.g., “The printer doesn't have ink in it so I can't use the new program”).
Do your information technology leaders and staff endorse the project? Are your IT specialists working on other projects concurrently? The effort required to implement new systems should not be underestimated, especially in a setting that will bring technology to the desktops of all clinical staff. Assignment of adequate internal IT resources is mandatory to ensure the project's success.
Consumers on Medications
How many of your active consumers are on medications? A typical estimate is 60 to 70% of active charts. Your organization will need to determine the most efficient way to input consumers’ current paper-based medication information into the new system. Many organizations use manual data entry to do this, but keep in mind that it takes an average of three minutes to enter each consumer's current medication information.
Have you notified all routinely used community pharmacies that your organization will begin e-prescribing? Notifying pharmacies in advance will reduce the number of phone calls about the new prescription formats (e.g., confirming authenticity).
More and more behavioral healthcare providers are adopting e-prescribing as technologic advancements and government regulations drive the healthcare industry toward wholly automated processes. Early experience indicates that the benefits of e-prescribing are real, and by far outweigh the risks and costs of implementation. Transitioning to an e-prescribing system requires a dedicated investment of your organization's time, money, and resources. Good planning and proactive communication with all internal and external stakeholders will help ensure a successful implementation which, in turn, will result in higher-quality care for your consumers.
Charles Klein, PhD, is Director of Clinical Services and InfoScriber Operations at Netsmart Technologies. He has more than 18 years of experience in the behavioral healthcare field. Dr. Klein also is an Adjunct Professor in the College of Organizational Studies at Alliant International University.