New Brunswick, NJ — Primary care physicians provide essential health services to patients of all ages and while a family physician’s office is a warm, comfortable environment, a physician’s practice also is a business. Ensuring the success of that business, in part, requires keeping up with modern-day technology, a sometimes difficult task for a small practice. Research led by Jesse Crosson, PhD, at UMDNJ-Robert Wood Johnson Medical School has identified key techniques in the implementation and use of electronic prescribing that help to make a physician’s practice efficient in the digital age and more effective at patient care.
Electronic prescribing (e-prescribing) is commonly a first step for physicians in establishing electronic health records and has been a central focus of primary care transformation efforts, as prescription drugs are among the most commonly used treatments in primary care. According to the study, there has been an even greater focus on implementing e-prescribing since the American Recovery and Reinvestment Act of 2009 (ARRA) was passed, establishing incentive payments for physicians who make “meaningful use” of electronic health record systems.
“ARRA gives physicians an incentive to move toward electronic health records. More important, successful e-prescribing can increase medication safety for patients,” said Dr. Crosson, an assistant professor in the department of Family Medicine and Community Health’s research division and principal investigator of the study. “E-prescribing also allows physicians to discuss medication options and the costs of drugs with patients at the point-of-care, having the potential to reduce healthcare costs and increase a patient’s compliance with the recommended treatment.”
Dr. Crosson’s research team looked at five practices of different sizes and organizational structures that were considered successful at overcoming the challenges many physician practices face in adopting e-prescribing. The study determined that the common thread among these “exemplary” practices was that each one had carefully moved through three phrases: planning, implementing and use of the systems.
The planning phase provided a review of workflow within the practice, established standard operating procedures and was inclusive to all team members, including those outside of the office such as local pharmacists. Implementing e-prescribing required ongoing, easily accessible technical support that provided real-time solutions, training of all staff members in both hardware and software systems, and the training of “super users” who could provide support following the implementation, when information technology (IT) personnel may not always be readily available.
“Creation of super users within the physician practices was an essential component for successful e-prescribing,” said Dr. Crosson. “They bridged the role between the staff and IT, preventing frustration and possible interruptions to workflow.”
Use of the systems presented challenges that successful practices needed to continually address. Some challenges were within the systems, such as the need to create shortcuts or templates to establish a more efficient process. But for many practices the biggest obstacle to overcome was the need to redesign procedures when exchange of information with patients’ electronic health records, pharmacies or databases containing drug information wasn’t possible.
The lessons learned from the study resulted in key recommendations that practices wishing to implement – and successfully maintain – e-prescribing should consider: 1 – a practice should have a leader who will advocate the benefits of e-prescribing within the process of delivering clinical care to patients; 2 – develop strategies to communicate with and include patients and pharmacies in the process; 3 – have readily accessible technical support, particularly during implementation, to reduce user frustration; and 4 – be flexible and willing to transform traditional work processes of all staff members to effectively incorporate e-prescribing.
In one of two editorials that accompanied the published study, Carlos Roberto Jaen, MD, PhD, FAAFP, of the University of Texas Health Science Center at San Antonio, wrote “The article by Crosson et al provides us with lessons learned from the successful implementation of electronic prescribing (e-prescribing) in 5 diverse exemplary practices. These lessons share a common pathway for success: (1) extensive efforts to redesign workflow with a deep understanding of the function that they are trying to deliver, (2) willingness and sufficient trust to design protocols to allow non-clinician members of the team to safely deliver prescription-related work, (3) physician champions, (4) ongoing training for team members, (5) readily available technical support, (6) targeted communication to stakeholders outside the practice (patients and pharmacists), and (7) a commitment to continuing improvement. Each of these steps requires substantial transformation of the mental models and processes that are often present in primary care practices.”
Dr. Crosson collaborated on the study with Rebecca Etz, PhD, of Robert Wood Johnson Medical School; Susan Straus, PhD of RAND Corporation, Pittsburgh, Pa.; and Shinyi Wu, PhD, of the University of Southern California, David Eisenman, MD, MSHS and Douglas Bell, MD, PhD of the David Geffen School of Medicine at UCLA, all three of which are also affiliated with RAND Corporation, Los Angeles.
The study “Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices,” appeared in the September 2011 issue of the Annals of Family Medicine and can be found at: http://www.annfammed.org/cgi/content/abstract/9/5/392. It was supported by grants from the US Agency for Healthcare Research and Quality.
About UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL
As one of the nation’s leading comprehensive medical schools, UMDNJ-Robert Wood Johnson Medical School is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school’s principal affiliate, they comprise New Jersey’s premier academic medical center. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.
As one of the eight schools of the University of Medicine and Dentistry of New Jersey with 2,800 full-time and volunteer faculty, Robert Wood Johnson Medical School encompasses 22 basic science and clinical departments, hosts centers and institutes including The Cancer Institute of New Jersey, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels for more than 1,500 students on its campuses in New Brunswick, Piscataway, and Camden, and provides continuing education courses for health care professionals and community education programs. To learn more about UMDNJ-Robert Wood Johnson Medical School, log on to rwjms.umdnj.edu. Find us online at www.Facebook.com/RWJMS and www.twitter.com/UMDNJ_RWJMS.
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