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Submitted on December 6, 2004
Accepted on January 15, 2005
Affiliation of the authors: 1 RAND Health, Santa Monica, CA; Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; the Pardee RAND Graduate School, Santa Monica, CA; 2 RAND Health, Santa Monica, CA; 3 RAND Health, Santa Monica, CA; Current Affiliation: Anderson School of Management and School of Public Health, UCLA, Los Angeles, CA; 4 RAND Health, Santa Monica, CA; Current Affiliation: Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; 5 RAND Health, Santa Monica, CA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
* To whom correspondence should be addressed.
Objective To compare the functional capabilities being offered by commercial ambulatory electronic prescribing systems with a set of expert panel recommendations.
Design A descriptive field study of 10 commercially available ambulatory electronic prescribing systems, each of which had established a significant market presence. Data were collected from vendors by telephone interview and at sites where the systems were functioning through direct observation of the systems and through personal interviews with prescribers and technical staff.
Measurements The capabilities of electronic prescribing systems were compared with 60 expert panel recommendations for capabilities that would improve patient safety, health outcomes, or patients' costs. Each recommended capability was judged as having been implemented fully, partially, or not at all by each system that the recommendation applied to. Vendors' claims about capabilities were compared with the capabilities found in the site visits.
Results On average, the systems fully implemented 50% of the recommended capabilities, with individual systems ranging from 26% to 64% implementation. Only 15% of the recommended capabilities were not implemented by any system. Prescribing systems that were part of electronic health records (EHRs) tended to implement more recommendations. Vendors' claims about their systems' capabilities had a 96% sensitivity and a 72% specificity when site visit findings were considered the gold standard.
Conclusions The commercial electronic prescribing marketplace may not be selecting for capabilities that would most benefit patients. Electronic prescribing standards should include minimum functional capabilities, and certification of adherence to standards may need to take place where systems are installed and operating.
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