Adapted from: Electronic Prescribing: Towards Maximum Value and Rapid Adoption and Kuperman et al. (permission to reproduce applied for) As is evident from the above discussion, the term “ePrescribing” thus encompasses a wide range of systems, these including both CPOE and CDSS and varying degrees of integration with other electronic record systems. In the absence of any agreed definition, ePrescribing is used in this chapter as an inclusive term referring to at minimum the electronic generation of prescriptions, but which may include point-of-care (POC) decision support and, amongst other things, electronic communication of the prescription information to other professionals and agencies involved with medicines management. 10.2.2 Description of use Prescribing is a complex organisational practice, including a range of processes spread across locations and involving diverse actors, so it is unsurprising that that ePrescribing systems are also organisationally complex; the choices available in their implementation and dimensions that can be included in their evaluation are hence also multifarious. Figure 10.2 depicts the complexity of ePrescribing processes. It shows how ePrescribing can involve different healthcare professionals at different points of prescribing procedures and how these may require professionals to have access to patients’ healthcare or medical records to prescribe appropriately. Medication errors can occur at any point in the prescribing processes i.e. prescribing, transmitting the order, dispensing, administration and monitoring, and ePrescribing systems can therefore potentially support any of these functions. Figure 10.2 High-level ePrescribing architecture Source: Bell et al. (permission to reproduce applied for) ePrescribing systems have been developed for use in a range of healthcare settings, these ranging from primary care to hospital-based care. This issue of setting of use is emphasised in the taxonomy developed by Cornford et al. i.e.: Pharmacy-based systems
This refers to the genealogy of the ePrescribing platform–i.e. whether it is a bespoke locally developed (or “home-grown”) system or a standardised commercial package. Locally developed systems may, once mature, demonstrate increased benefits because the systems are developed to fit with idiosyncratic working practices and also because clinicians tend to more tolerant of the shortcomings of a system that they have, even in a small way, contributed to the development of. However, due to the cost of maintaining local IT development resources and the cost of developing bespoke solutions, the trend across the IT sector has move away from bespoke development and become more dependent on standardised packages from major commercial suppliers. This axis is a continuum because systems may initially have been developed for local implementation, but their kernel then forms the basis for a commercial package that is sold onto users elsewhere. This is often witnessed in the major software development processes (see Box 10.1 as an example of this). Furthermore, this is because commercial systems allow differing degrees of configurability, ranging from none or very little to substantial. Rothschild points out the limitation this creates in the current ePrescribing literature as there is possible limited generalisability of findings from studies focusing on locally developed ePrescribing systems, rather than “off-the-shelf” commercial projects that are more commonly found in non-research settings. Most early adopted ePrescribing systems were home-grown while commercial systems tend to be seen as more rigid and lacking the adoptability to meet individual organisational needs.