Electronic prescribing is an important technology for refining the drug management process’s value, protection, and effectiveness in primary care. In recent years, with the development of health material discussion, electronic prescribing has grown to accept the Electronic Exchange of Medication Data (EEMD) related to suppliers in different places. These networks have been expanded to permit EEMD between doctors and pharmacists in two states. n
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n1): From doctors to pharmacists, the data on a recommended medicine can be transmitted electronically, from one computer to another computer (electronic transmission of prescriptions, or ETP) using a push or a pull model. In the push model, the prescriber must specify the pharmacy to receive the prescription; in the pull model, the prescriber sends the prescription to a data warehouse that can be accessed by all authorized pharmacies.nn2): From pharmacist to physician, dispensed medication histories can be shared based on claims from medication dispensing or networked warehouses of medication records.n
Materials and Methods:
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Context:
nThe Ministry of Health has been deploying a nationwide EEMD network in the province of Quebec since 2011. This network contains two warehouses.n
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- The medication history warehouse.
- The electronic prescription warehouse.
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nThe medication history warehouse comprises proof of every medicine distributed by retail pharmacies linked to the system and contains direct relations to the pharmacies. It is available to official care doctors and pharmacists for the purpose of care across their native application e-prescribing systems. The e-prescription is referred to the main warehouse, and every pharmacy can import the recommendation into its local pharmacy system.n
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Implementation strategy:
nIn every of Quebec’s 18 healthcare regions the Ministry of Health controlled the implementation plan of the EEMD system which was increasingly rolled out. The objective was to attach all primary care health clinics and pharmacies. First of all, clinical sites had to be linked to upload data to the dominant warehouses. Secondly, each particular clinician collected a personal identification device (a USB key) keeping the entrance to the network. All clinicians from a specified area were requested by email to an information meeting prepared cooperatively by the implementation team, the specialized relations (general physicians and pharmacists), and the retailers (EMR) and pharmacy systems).nnAlso Visit:n
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Design and study population:
nA descriptive qualitative study was conducted in two regions. At the time of the study, these regions were the most advanced in their implementation of the EEMD network. These regions accounted for 99.7% of all e-prescriptions transmitted on the entire network by medical clinics, 99.8% of all e-prescriptions imported by community pharmacies, and 90.8% of all consultations of the medication history warehouse. Representative early adopters were targeted for this study: general practitioners, community pharmacists, and their staff. At the time of the study, 68 community pharmacies and 24 primary care clinics were connected to the network in the selected regions. Twenty-four (100%) primary care clinics and 41 (60%) community pharmacies were contacted by phone to solicit their participation in the study.n
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Data collection:
nSemi-structured interview guides were developed using systematic reviews. The interview consisted of open-ended questions about EEMD network utilization covering several topics, such as the quality of the network and the available information, benefits in terms of quality and safety of medication use, and challenges related to network use. Interviews were recorded with the permission of participants and transcribed verbatim.n
Data analysis:
nAll verbatim interviews were analyzed by thematic analysis, using both predefined codes and emerging codes. Predefined codes were developed from the literature on the potential benefits per step in the medication management process, using a framework adapted from Bell. We specifically identified challenges to achieving the expected benefits at each step in the medication management process.n
RESULTS:
nInterviews were conducted with 33 pharmacists, 2 pharmacy technicians, 12 physicians, and 2 managers from 30 community pharmacies and 10 primary care medical clinics. The medical clinics were all group practices of medium size (5–20 general practitioners), privately owned by the physicians and funded by the public health insurance authority on a fee-for-service model. All physicians used a commercial e-prescribing system as part of an EMR. Only full EMRs (no stand-alone e-prescribing systems) accredited by the Ministry of Health can be connected to the network. n
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nThe participating physicians used four different EMR systems. The community pharmacies were all chain pharmacies, from 5 different banners. Two different commercial pharmacy systems, covering 95% of all pharmacies in Quebec, were used in the participating pharmacies. Overall, the medical clinics participating in the study represented 42% of all connected clinics in both regions; they sent 38.4% of all e-prescriptions and performed 54.8% of all medication history consultations in both regions. The pharmacies in the study represented 45% of the connected pharmacies in both regions, imported 74.3% of all imported e-prescriptions, and performed 31.3% of all the consultations by community pharmacies.n
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