Table 2
Electronic prescribing (eRx) frames, anticipated outcomes, and issues to consider
| Frame | Expectations of value | Issues to consider | Representative quote |
| eRx as an efficiency and effectiveness enhancing tool | Improved productivity Improved safety |
Research needed to conclusively identify if value exists and how to achieve benefits | “Some docs access from home and check drug allergies…can check stuff in off-hours…” |
| eRx as the harbinger of new practices | Practice transformation | Incremental approach to full digitization but can result in HIT resistance if not successful. | eRx is an important step in “connecting everything together…” |
| eRx as core to the clinical workflow | Re-engineered workflow | There may be initial user resistance to change due to new job roles and definitions. May incur costs of retraining | “I don't even think about it…I'm really not sure how this office would run without it” |
| eRx as an administrative tool | Facilitation of staff work | Doctors and staff must have a shared meaning of the use of eRx or conflict and misunderstanding may result | Doctor commented… “that sort of clerical work should be handled by the nurses…” |
| eRx: the artifact | Clinicians: no near term change Staff: more computer time and possibly more mobility in the future |
Users will resist use due to displeasure with current form-factor but this issue may change with time | Doctor said… “PDA is as much a part of my attire as my stethoscope.” Few nurses commented… they ‘sit at the computer longer now’ |
| eRx as a necessary evil | No consequential impact | Over time these users will either become reluctant advocates or will abandon. This is likely not a sustainable position | “This is the way it is all going…whether we like it or not.” |
| eRx as an unwelcome disruption | Increased workload De-personalization of practice |
Designers of hardware/software must strive to build products that streamline and integrate into work processes. Research needs to identify benefits so the value proposition is more tangible | “The problem with all of this (digitization) is that it is so impersonal. It takes all the joy out of practicing medicine. I want to build a relationship with the patient.” |
