The Impact of Electronic Prescribing System Factors on Prescribing Decision Making: A Systematic Review and Narrative Synthesis
Authors: Alaboud N , Jani Y , Franklin B D 
Published: November 2023

Abstract

Introduction
Medication prescribing is a complex and error-prone process in clinical practice1. Using electronic prescribing systems (EP) allow healthcare providers to prescribe medications electronically. However, many factors can affect the implementation and utilisation of EP systems, including factors related to the end-users, system, and organization2.

Aim
This systematic review aimed to explore and synthesise the literature on the impact of EP system factors on prescribing decision-making. Objectives were to: map the current evidence for EP system factors that inhibit or facilitate prescribing decision-making; identify the positive and negative impact of different design features or data integration of EP systems on prescribing decision-making; identify evidence on the most effective ways to display patient-specific data to aid prescribers in making their prescribing decisions; and make recommendations for future clinical practice and research in designing EP systems.

Methods
We searched PubMed, Medline, Embase and the Cumulative Index to Nursing Allied Health Literature databases for studies published from January 2000 to February 2023 We included all types of primary studies (both evaluative and descriptive study designs) that explored the effect of EP system factors on prescribing decision-making in any healthcare setting. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT)3. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration: CRD42021235988).

Results
Searches identified 6752; after deduplication, 4925 articles underwent title and abstract screening, and 227 underwent full-text review, of which 54 were included from 13 different countries. There were a range of study designs; most (n=30) adopted quantitative methods such as retrospective evaluation by extracting the data from an EP system, nine adopted qualitative approaches such as interviews, and a further 15 used mixed methods. According to MMAT, 32 of 54 studies were deemed to be of high quality. Based on the findings of included studies, three key EP system factors were derived that could affect medication-related decision-making during prescribing processes: (1) design features of CDSS within EP system (how the EP system design interact with the prescriber at the point of prescribing and which design feature has been used), (2) displayed information at the point of prescribing (what and how data displayed to the prescriber at point of prescribing) and (3) Type of EP system based on the system developer (a commercial vs. a homegrown EP system).

Discussion/Conclusion
A total of 18 EP system factors were found that have either positive or negative effects on influencing prescribers’ decision-making and prescribing workflow. The end-users of the EP system played essential roles in system acceptance, and its success in real practices. However, there is a need for more consensus within the literature on designing, implementing, and evaluating EP systems regarding how and when to evaluate any new modifications within the system. Future research should explore the different used design strategies which result in a positive impact on prescribing decision-making and learn from those that have not been successful to develop guidelines/standards for designing EP systems.

References
1. Samadbeik, M., M. Ahmadi, and S.M. Hosseini Asanjan, A theoretical approach to electronic prescription system: lesson learned from literature review. Iran Red Crescent Med J, 2013. 15(10): p. e8436.
2. Sweidan, M., et al., Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Med Inform Decis Mak, 2010. 10: p. 21.
3. Hong, Q.N., et al., The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for information, 2018. 34(4): p. 285-291.