247889 Factors affecting adoption of e-prescribing in high-need settings: Solo practices and safety net clinics serving urban Medicaid patients

Monday, October 31, 2011: 12:50 PM

Clare Tian, MPPM , West Los Angeles Medical Center, Kaiser Permanente, West Los Angeles, CA
Philip Banks, PharmD , ., ., Porter Ranch, CA
S. Rae Starr, MPhil, MOrgBehav , Healthcare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Qiaowu (Zoe) Li, MS , Department of Research & Evaluation, Kaiser Permanente, Southern California, Pasadena, CA
Faced with growing costs and patient populations, healthcare administrators have looked to technology to save doctors time and improve outcomes. e-Prescribing seeks to improve accuracy, safety, efficiency, and allow more face time with the patient. A key factor in launching new technology, is the removal of technical barriers that cause the physician's initial attempts to fail. This presentation reports lessons learned from implementation of a pilot project to study early adopters of e-prescribing in resource-thin settings.

(1) Focus: We studied providers in clinics serving low-income members of a large urban Medicaid health plan, to learn what would succeed in high-need, low-resource clinics serving low-income patients. The project focused on settings that are traditionally bypassed in the early stages of technological change, to find out what critical mass of resources is necessary for e-prescribing to take root.

(2) Design: This panel study followed 33 physicians who participated in a 1 year pilot project in 2006-2007 to identify factors that produce successful adoption of e-prescribing. Physicians were recruited from 8 small/solo practices and 2 safety net clinics. The study employed detailed pre-test and post-test surveys, and tracked e-prescribing via clickstream data from handheld computers (PDAs) provided to doctors in the study.

(3) Analyses: The presentation reports pre/post change in providers' baseline perceptions regarding e-prescribing's impact on patient safety; workflow efficiency; time savings; and satisfaction with the prescription process. Interviews revealed factors differentiating successful adopters from non-adopters. Participants identified solvable barriers (technical, institutional, systemic) that healthcare systems can address before large-scale roll-out of technical innovations like e prescribing.

Learning Areas:
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1. Describe provider assessments about the impact of e-prescribing on patient safety, provider efficiency, and provider satisfaction with the prescribing process. 2. Describe weaknesses in conventional wisdom on recruiting doctors as early adopters or physician champions. 3. Identify implementation barriers that reduce provider participation in e-prescribing. 4. Identify factors that improve providers' likelihood to continue e-prescribing.

Keywords: Information Technology, New Technology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Experience: Six years as the Senior Biostatistician at L.A. Care Health Plan, managing the CAHPS survey for L.A. Care Health Plan from 2006 to 2011, including all facets of the survey to be discussed in the presentation. Participated as methodologist and biostatistician in design and implementation of a demonstration project on provider adoption of handheld prescribing tools; and a pilot project promoting e-Prescribing among providers in resource-thin clinics serving the urban poor in Los Angeles County, California. Setting: L.A. Care Health Plan is a public entity serving Los Angeles County, California, and the largest public health insurer in the United States. L.A. Care's CAHPS survey represents voice for approximately 850,000 Medicaid and SCHIP members in an ethnically diverse, urban county in the southwest United States. The challenges addressed at L.A. Care likely reflect those of other urban Medicaid insurers, and of state agencies that sponsor the CAHPS survey directly. Education: Master of Philosophy in Policy Analysis from the RAND Graduate School of Policy Analysis (Santa Monica CA); Master of Organizational Behavior from Brigham Young University (Provo, UT); Bachelor of Political Science with Honors from Brigham Young University (Provo UT).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.