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Submitted on March 31, 2003
Accepted on September 19, 2003
Affiliation of the authors: 1 Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, School of Medicine, Los Angeles, CA; RAND Health, Santa Monica, CA; 2 RAND Health, Santa Monica, CA; Current Author Affiliation: Regional Director, American Friends Service Committee, Pasadena, CA; 3 RAND Health, Santa Monica, CA; 4 RAND Health, Santa Monica, CA; Current Author Affiliation: Medical Student, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
* To whom correspondence should be addressed.
Objective Electronic prescribing (e-prescribing) may substantially improve healthcare quality and efficiency, but the available systems are complex and their heterogeneity makes comparing and evaluating them a challenge. We aimed to develop a conceptual framework for anticipating the effects of alternative designs for outpatient e-prescribing systems.
Design Based on a literature review and on telephone interviews with e-prescribing vendors, we identified distinct e-prescribing functional capabilities and developed a conceptual framework for evaluating e-prescribing systems' potential effects based on their capabilities. Analyses of two commercial e-prescribing systems are presented as examples of applying the conceptual framework.
Measurements Major e-prescribing functional capabilities identified and the availability of evidence to support their specific effects.
Results The proposed framework for evaluating e-prescribing systems is organized using a process model of medication management. Fourteen e-prescribing functional capabilities are identified within the model. Evidence is identified to support 8 specific effects for 6 of the functional capabilities. The evidence also shows that a functional capability with generally positive effects can be implemented in a way that creates unintended hazards. Applying the framework involves identifying an e-prescribing system's functional capabilities within the process model and then assessing the effects that could be expected from each capability in the proposed clinical environment.
Conclusion The proposed conceptual framework supports the integration of available evidence in considering the full range of effects from e-prescribing design alternatives. More research is needed into the effects of specific e-prescribing functional alternatives. Until more is known, e-prescribing initiatives should include provisions to monitor for unintended hazards.
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