Towards a Post-Implementation Evaluation Framework of Outpatient Electronic Drug Prescribing

Towards a Post-Implementation Evaluation Framework of Outpatient Electronic Drug Prescribing

Tiago Cravo Oliveira (Imperial College London, UK), Mónica Duarte Oliveira (Technical University of Lisbon, Portugal) and Teresa Peña (Technical University of Lisbon, Portugal)
DOI: 10.4018/978-1-4666-3990-4.ch007
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Abstract

The adoption of electronic drug prescribing (ePrescribing) systems has been largely discussed in scientific literature. Yet post-implementation evaluations of these systems are still in short supply. At a time when large investments are being made throughout the world in health information systems and technologies, under pressure for cost-containment, evidence on which systems provide the largest net benefits is required. In this chapter, the authors start by reviewing the literature on the costs and benefits of outpatient ePrescribing systems and find that the evidence is scattered. There is a general consensus that ePrescribing is beneficial, although few studies quantify the net benefits of specific systems. The review also shows that the evaluation of ePrescribing systems is complex and that most studies share limitations associated with the evaluation of other health information technologies and systems. The authors propose an evidence-based framework to inform post-implementation evaluations of outpatient ePrescribing systems and to improve the quality and comparability of studies in the area.
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Introduction

The challenges facing modern healthcare systems are considerable (Department of Health, 2008; Lerberghe, 2008). On the demand side, increased pressure on healthcare delivery is partly explained by ageing populations, increased life expectancy, increased levels of co-morbidity from chronic conditions, and rising expectations on the level of health services provided. On the supply side, healthcare delivery is increasingly complex, given rapid technological developments that introduce high pressure on cost control as well. Furthermore, although life expectancy improvements have been observed in developed countries, policies in these countries have not been effective in decreasing inequalities both in the access to care and in health outcomes. These inequalities still prevail and have even increased in some countries (Lerberghe, 2008).

Within this context, policy-makers and managers are concerned with the sustainability of healthcare funding and how to best apply scarce resources. In order to make informed decisions, policy-makers and managers need to access information on the costs and benefits related to the adoption and dissemination of healthcare technologies. Although there have been considerable investments in health information systems and technologies in recent years, there is evidence that the use of these systems in general, and of electronic drug prescribing (ePrescribing) systems in particular, is still very limited (Friedman, Schueth, & Bell, 2009). In order to understand why there has been a limited adoption of ePrescribing systems, this study starts by reviewing the literature on the costs and benefits of ePrescribing systems. Based on the results from this review, we propose a framework to evaluate implementations of ePrescribing systems in the outpatient setting.

This chapter is organized as follows: the first section provides background information about the role of prescribing systems in the healthcare system, the basics of ePrescribing, and the diffusion of ePrescribing systems. The second section reviews evidence on the benefits and costs of ePrescribing and the third section introduces the framework. The chapter ends with a reflection on future research directions and with concluding remarks.

Key Terms in this Chapter

Electronic Health Records: Media that facilitate transportability of pertinent information concerning patient illness across varied providers and geographic locations.

Clinical Decision Support Systems: Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.

Medical Order Entry Systems: Information systems, usually computer-assisted, that enable providers to initiate medical procedures and prescribe medications, among other things. These systems support medical decision-making and error-reduction during patient care.

Medical Order Entry Systems: Information systems, usually computer-assisted, that enable providers to initiate medical procedures and prescribe medications, among other things. These systems support medical decision-making and error-reduction during patient care.

Randomised-Controlled Trial: A clinical trial that involves at least one test treatment and one control treatment, concurrent enrolment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process.

Health Information Technologies: The use of information and communication technologies in healthcare.

Randomised-Controlled Trial: A clinical trial that involves at least one test treatment and one control treatment, concurrent enrolment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process.

Clinical Decision Support Systems: Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.

Evaluation Studies: Studies determining the effectiveness or utility of processes, personnel, and equipment.

Electronic Prescribing: The use of computer devices to enter, modify, review, and output or communicate drug prescriptions.

Electronic Health Records: Media that facilitate transportability of pertinent information concerning patient illness across varied providers and geographic locations.

Electronic Prescribing: The use of computer devices to enter, modify, review, and output or communicate drug prescriptions.

Evaluation Studies: Studies determining the effectiveness or utility of processes, personnel, and equipment.

Health Information Technologies: The use of information and communication technologies in healthcare.

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