Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation

Introduction: use of electronic prescribing (e-prescribing) can improve safety and reduce costs of care by alerting prescribers to drug-drug interactions,patient nonadherence to therapies,and insurance coverage information. deriving these benefits will require clinical decision support based on presentation of accurate and complete formulary and benefit (f&b) and medication history (rxh) data to prescribers,but relatively little is known about how this information is used in primary care. methods: this is a multimethod comparative case study of 8 practices,which were selected to ensure practice size and physician specialty variation,implementing a stand-alone e-prescribing program. field researchers observed prescription workflow and interviewed physicians and office staff. results: before implementation,few prescribers reported using f&b references when making medication choices; all used paper-based methods for tracking medication history. after implementation,some prescribers reported using f&b data to inform medication choices but missing information reduced confidence in these resources. low confidence in rxh data led to paper-based workarounds. conclusions: challenges experienced with formulary checks and rxh documentation led to prescriber distrust and unwillingness to rely on e-prescribing-based information. greater data accuracy and completeness must be assured if e-prescribing is to meet meaningful use objectives to improve the efficiency and safety of prescribing in primary care settings.