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The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care

Affiliations of the authors: Departments of Epidemiology & Biostatistics (RT, YK, MA), Medicine (RT, AH, GB, NW, LP), Family Medicine (RG, MD), Faculty of Management (LT, AP), McGill University, Montreal, Quebec, Canada, College of Physicians of Quebec, Montreal, Quebec, Canada (AJ), Department of Public Health, Régie Régionale de Montréal, Montreal, Quebec, Canada (RP).

Correspondence and reprints: Robyn Tamblyn, PhD, McGill University, Morrice House, 1140 Pine Avenue West, Montreal, Quebec, Canada H3A 1A3; e-mail: <robyn.tamblyn{at}mcgill.ca>.

Received for publication: 06/13/05; accepted for publication: 12/01/05.

Objective: To develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians.

Design: A 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients.

Measurement: MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, and providing electronic prescription, stop order, automated prescribing problem alerts, and compliance monitoring functions. Evaluation of technical performance, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases.

Results: Perceived improvements in continuity of care and professional autonomy were associated with physicians' expected use of MOXXI. Physician speed in using MOXXI improved substantially in the first three months; however, only the represcribing function was faster using MOXXI than by handwritten prescription. Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient's drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the represcribing function as the most beneficial aspects of the system. Physicians were more likely to use the drug profile for patients who used more medication, made more emergency department visits, had more prescribing physicians, and lower continuity of care.

Conclusion: Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care.

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