Transcript Evaluating the Adoption of e-prescribing in primary care
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MEASURING E-PRESCRIBING AND EMR ADOPTION IN PRIMARY CARE:
A MIXED METHODS APPROACH eHealth 2013 Gurprit K. Randhawa, BSc, MSc (c)
Agenda
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Background and Study Purpose Methodology Key Study Findings Study Limitations Recommendations Conclusion Q&A
Presenter Disclosure
Presenter:
Gurprit Randhawa
Relationships with commercial interests:
Nothing to disclose
Background and Purpose
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Poor adoption of e-prescribing tools that can boost productivity and safety
Study Purpose:
To examine the e-prescribing and EMR adoption by primary care physicians in Central Vancouver Island who use the same commercial EMR product To make suggestions on improving e-prescribing adoption
Methodology
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Multi-method study design to compare
The Ideal State of E-Prescribing
Literature Review
The Possible State of E-Prescribing
Review of EMR user documentation and provincial conformance specifications for EMRs Interview with an EMR vendor representative
The Current State of E-prescribing
Interview with physicians using e-prescribing assessment tool and an EMR Adoption Survey Discussion group
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Methodology (Cont.)
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Results
10 papers 1 vendor interview 12 physician interviews 6 participants
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Key Study Findings
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Key Finding 1:
E-Rx Features Used by Physicians
Key Finding 1 (Cont.):
E-Rx Features Adopted by Physicians
10 Current Physician Use by E-Prescribing Feature
12 10 8 2 0 6 4
12 12 8 12 12 0 11 11 0 10 9 12 12 12 0 12 12 8 8 11 12 10 12 9 2 0 12 10 10 E-Prescribing Feature
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Key Finding 2:
Barriers and Facilitators to E-Rx Adoption
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5,0 4,0 3,0 2,0 1,0 0,0
Key Finding 3:
EMR Adoption Average EMR Adoption score was 3.1/5
EMR Adoption Score by Functional Area
Overall EMR Adoption: 3.1/5
EMR Functional Area
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Key Finding 3 (Cont.):
EMR Adoption
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Key Finding 4:
Opportunities for Improving Adoption
E-Prescribing Opportunities
Use templates for frequently prescribed medications Review drug monographs Search for drugs by class Do full e prescribing
EMR Opportunities
Priority improvement areas: E-Prescribing and E-Referrals Use EMR for reminders, recalls and chronic disease management Create reports Capture complex care bills Use templates, patient handouts, physician supports, and integrated guidelines Improve technical capabilities Explore use of patient portal
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Key Finding 5:
Gaps between Ideal and Possible States
The Ideal State of E-Prescribing
104 features in total Patient Information, identification, and data access (4 features) Current medications/medication history (12 features) Medication selection (28 features) Prescribing safety (25 features) Patient education (1 feature) Monitoring (4 features) Repeat (renewal) prescribing (7 features) Computer-user interface (5 features) Transparency and accountability (5 features) Security and confidentiality (7 features) Interoperability and communication (6 features).
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Key Finding 5 (Cont.):
Gaps between Ideal and Possible States
The Possible State of E-Prescribing
The EMR product met 27 of the 33 PITO e-prescribing requirements partially or fully Generating prescriptions (1 feature) Processing prescriptions (16 features) Transmitting prescriptions (1 feature) Viewing medications (2 features) Managing renewals (1 feature) Drug formularies (2 features) Interaction checking (1 feature) Medication profiles (2 features) Reference support (1 feature)
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Key Finding 5 (Cont.):
Gaps between Ideal and Possible States 55 of the 75 e-prescribing features from the Ideal state were not fully included in the Possible state
Ideal State of E-Prescribing Features
N = 55 N = 20
Possible State of E-Prescribing Features
N = 9
Recommendations
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Improvements in Current State
Use of features not yet adopted Tailored coaching on the value of using unused features
Improvements in Possible State
Meet 7 additional PITO e-prescribing requirements Consider inclusion and/or improvement of the 55 features from the Ideal State
Improvements in Ideal State
Include 9 features from the Possible State that were not fully included
Study Limitations
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EMR and E-Prescribing adoption examined only at one point in time Study sample Defining Possible State and Ideal State of E-Rx E-Prescribing adoption examined using polar (yes no) questions
Conclusion
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Participating physicians are currently using most of the e-prescribing and EMR features Significant improvements are needed in: Searching for drugs by class Checking for patient coverage Using drug to procedure interaction checking Using drug monographs Several gaps between the ideal, possible, and current state of e-prescribing
Future Directions
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Conduct adoption evaluations at specific times following implementation Examine impact of educational interventions on e prescribing adoption levels Methodology: Review EMR usage logs and conduct on-site observations
Acknowledgements
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Thank you to CIHR-ISPR, Canada Health Infoway, and the eHealth Observatory for supporting this research.
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THANK YOU
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