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

Design 20-month follow-up study of MOXXI 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 utilization 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 3 months, however only the re-prescribing function was faster using MOXXI than by hand-written prescription. Physicians wrote electronic prescriptions in 36.9/100 visits and reviewed the patient's drug profile in 12.6/100 visits. Physicians rated printed prescriptions, the current drug list, and the re-prescribing 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 ER visits, had more prescribing physicians, and lower continuity of care.

Conclusions 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.