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Electronic Prescribing and Post-Implementation Workarounds

Author: Jonathan A. Wolfarth, MA, MS, RN-BC (2013)

Primary Advisor: Juliana Brixey, PhD

Committee Members: Dr. Robert Vogler, DSN

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.


The use of electronic prescribing (e-prescribing) has been heralded as an improvement to the traditional hand-written prescribing process.  According to the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA), (n.d.), the benefits of e-prescribing may improve the efficiency of the prescribing process, has the potential to reduce medication errors and ultimately improve patient safety.  E-prescribing is becoming more established since the Center for Medicare & Medicaid Services (CMS) initiated a financial incentive program in 2009 that pays bonuses to qualifying providers who use electronic health records (EHR) withe-prescribing capabilities or to providers who use stand-alone e-prescribing systems.  CMS also initiated financial penalties that will be imposed on providers who do not use e-prescribing.  Subsequently, healthcare providers and organizations have purchased and/or implemented e-prescribing capabilities to qualify for CMS's financial incentives and to avoid fines for non-compliance (Grossman, J., Cross, D., Boukus, E., & Cohen, G. 2012).

The aim of this literature review was to identify thee-prescribing process, describe post­ implementation errors, unintended consequences (UCs), and workarounds of e-prescribing systems described in the literature; including the challenges, and to make recommendations to improve their study; so they can be anticipated and actively managed.  Complicating a literature search are the names used to refer to thee-prescribing process since no generic name is used and software vendors try to adopt unique names that may make their product stand out.  E­ prescribing may be referred to as: e-prescribing, ePrescribing, EP, eP, eRX, e-RX, eRx, Computer Prescribing (CP), Computer Assisted Prescribing or be included as part of Computerized Physician Order Entry (CPOE) software.