On June 12, the U.S. Agency for Healthcare Research and Quality (AHRQ) put into general release toolsets of knowledge and resources for successfully implementing electronic prescribing (e-prescribing), packages designed for use by doctors’ offices and pharmacies.
A team from the USC Viterbi School of Engineering led by assistant professor Shinyi Wu played a key role in researching, designing, writing, testing, and then guiding the effective use of the toolsets.
Shinyi Wu's E-prescribing toolkits are now available online from the U.S. Agency for Healthcare Research and Quality
Wu, a faculty member of the Epstein Department of Industrial and Systems Engineering, says that the e-prescribing system can greatly simplify and speed up the process of putting the right drugs into the hands of patients, reducing health care costs in general, but the challenge lies on successfully implementing it. Thus, the AHRQ funded RAND and USC to develop the toolset to guide e-prescribing implementation.
The ARHQ eRx download website explains: “The toolsets change the routine nurses and other medical personnel use in getting, verifying and filling prescriptions, mainly replacing consulting and filing paper records with getting and placing the same information electronically.
“This toolset … will allow your pharmacy to receive electronic prescriptions directly into your pharmacy software system and will allow refill requests to be sent electronically from your pharmacy to the prescribers' software. The toolset also includes specific tools to support planning and launching e-prescribing, such as templates for communicating the launch to providers and patients, tools to examine and assess your pharmacy workflow, and a spreadsheet to determine your return-on-investment among others."
Prescription workflow old-style
The toolset also includes patient information posters in English and other languages to explain the system.
In addition to qualification for the incentive payments, Wu says the hoped-for advantages of the eRx system include:
Elements of the toolsets been in limited use for four years, and some 30 percent of possible users do some of their prescription processes electronically, but the users vary greatly in how effectively they are able to use electronic tools.
This is true even though health care providers can also receive federal incentives for implementing Electronic Health Records (E.H.R.). Still E.H.R. use has been retarded by difficulties in changing the institutional culture that exists around numerous medical record practices, including drug dispensing.
Intensive restructuring of the process of prescribing must take place for the new system to work — and a key part of Wu and
her team’s research was identifying how most effectively to make such changes, working directly with a group of five pharmacies identified as model users.
E-prescription flow
These included the pharmacy at the USC Keck.
Key elements for the best practice, Wu’s team found, start with a “champion,” someone who takes overall responsibility for the change and schedules and conducts the intensive training and work changes or process redesign if needed, bringing staff along. Creating “superusers” who can back up and coach others is highly useful, and continued monitoring.
Operational use of the full toolset is still a work in progress, with not enough full e-prescribing in place or use to evaluate results. Wu and her team are continuing their study of use patterns. Adjunct Professor David Belson of the Epstein Department worked with Wu on the project, along with Yihan Xie, who helped with observing and analyzing the workflow of successful sites, and developing the cost-benefit calculator. She has graduated and is working in a health plan company.
Belson did intensive research on existing pharmacy work routines. “I visited independent pharmacies and physician offices in the L.A. area as well as elsewhere, such as one in Redding, CA,” he said, working with USC ISE students.
“We interviewed the staff and observed the workflow. In particular we studied how the system worked in the traditional paper mode and how things changed when it became paperless. We were interested in the impact of the change and how to get a maximum benefit.”
MS student Juan Robles observed the workflow of a pilot site before and after testing the eRx toolset. Doctoral students Magaly Ramirez and Shuli Wang are currently helping with analyzing the new workflow data for a publication.
