the impact of e-prescribing on prescriber and staff time in.pptVIP

Implementing an e-Prescribing System: A Journey, Not a Solution EB Devine, JL Wilson-Norton, NM Lawless, W Hollingworth, RN Hansen, BA Comstock, AW Fisk, SD Sullivan AHRQ HIT Grant #: 5-UC1 HS015319 (PI: Sullivan) AHRQ Training Grant #: 5-K08-HS014739 (PI: Devine) The Everett Clinic The Everett Clinic’s e-prescribing system CliniTech? Information Resources Internally-developed EHR began in 1995: charts, labs and imaging reports e-prescribing implemented beginning during 2003-05 Features of e-prescribing system Web-based Write new refill prescriptions Output = fax/ print Optimizes choice of medication; generates medication list as prescriptions are written Pediatric antibiotic dosing by weight Utilizes subscription to commercial drug database as back end Builds patient drug database, improving disease management Implementation of e-prescribing Several months in development Accuracy and relevance of drug database Screens easy to use and involve minimal manipulation Basic decision support Adopt an icon = “MedMan” Implement at pilot site; refills first Voluntary use Goal: Implement on platform of wireless laptop Switch to hardwired desktops in exam rooms – 505 exam rooms! 51 months to last clinic go-live Now: 5,000 prescriptions/ day (95% written); faxed to 600+ pharmacies Transition to vendor-purchased EHR in late 2007 – CDS customized; use becomes mandatory AHRQ HIT Grant:Specific Aims Capture lessons learned during implementation Evaluate impact on medication errors and adverse drug events Measure impact on workload / workflow Time-motion study Process metrics (chart pulls, prescriptions written) Evaluate impact on human factors Focus groups Survey assessing readiness to adopt IT Implementation Lessons (1) Culture Visionary leadership; safety-oriented; positive, upbeat work environment Two-way communication constant Iterative implementation Re-engineering / standardization of workflow integral to process Adequate investment in infrastructure