Cited by 132Electronic Health Records SystemsHealth Policy Implementation ScienceInformation Systems Theories and Implementation

Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions

Open access
Gagnon, Marie-Pierre, Nsangou, Édith-Romy, Payne-Gagnon, Julie, Grenier, Sonya, Sicotte, Claude·2014·Journal of the American Medical Informatics Association

Abstract

OBJECTIVE: We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care. METHODS: We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings. RESULTS: We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate for the users, attitude towards e-prescribing, productivity, and available resources. DISCUSSION: This review highlights the importance of technical and organizational support for the successful implementation of e-prescribing systems. It also shows that the same factor can be seen as a barrier or a facilitator depending on the project's own circumstances. Moreover, a factor can change in nature, from a barrier to a facilitator and vice versa, in the process of e-prescribing implementation. CONCLUSIONS: This review summarizes current knowledge on factors related to e-prescribing implementation in primary care that could support decision makers in their design of effective implementation strategies. Finally, future studies should emphasize on the perceptions of other user groups, such as pharmacists, managers, vendors, and patients, who remain neglected in the literature.

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  • In relation to e-prescribing, clinicians did not want to solve implementation problems and believed this should be done by non-clinical staff.

    “in relation to e-prescribing, clinicians did not want to solve implementation problems and believed this should be done by non-clinical staff [14].”

    From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [14]

    The Human perspective Structure section says physicians did not want to solve implementation problems, but believed clinical staff—not non-clinical staff—should do so. That distinction directly contradicts the claim. (LLM, conf=0.94)

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  • Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention, or belief that the intervention was not part of their role were commonly described as a barrier to implementation.

    “Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention or belief that the intervention was not part of their role were commonly described as a barrier to implementation [3, 14, 35, 41, 67–70, 76, 77, 80].”

    From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [14]

    The Human perspective—Structure section describes resistance to e-prescribing when physicians saw no added value, and says some believed clinical staff should solve implementation problems. The Discussion likewise links perceived lack of value to reluctance to use e-prescribing. Our copy does not identify disagreement with evidence as a cause, and its account of professional roles concerns solving implementation problems rather than whether using the intervention was part of a physician’s role. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Existing reviews tend to focus either on a particular type of complex intervention or on a particular health condition.

    “Existing reviews tend to focus either on a particular type of complex intervention (e.g. introduction of new technologies [14] or promoting uptake and use of guidelines [15]) or on a particular health condition (e.g. mental health [16] or diabetes [17]).”
  • When the fit between the intervention and existing workflow and systems was good, work process was improved.

    “When the fit was good [14, 73, 74], for example, when e-prescribing was sufficiently integrated as part of clinician workflow, work process was improved [14].”
  • Contextual factors that are perceived as barriers at the beginning of implementation may become facilitators later on in the implementation process.

    “Contextual factors that are perceived as barriers at the beginning of implementation may become facilitators later on in the implementation process [14].”

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Research works printed but not linked: 1

  1. Anderson JG. Social, ethical and legal barriers to e-health. Int J Med Inform 2007;76:480-3.

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Authors
Gagnon, M.-P., Nsangou, É.-R., Payne-Gagnon, J., Grenier, S., & Sicotte, C.
Affiliations
  • Université Laval (CA)
  • Centre de recherche du CHU de Québec-Université Laval (CA)
  • Centre hospitalier universitaire de Québec (CA)
  • École des Hautes Études en Santé Publique (FR)
Corresponding author
Payne-Gagnon, Julie
Venue
Journal of the American Medical Informatics Association
Published
2014-05
Volume
21
Issue
3
Pages
535-541
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
OpenAlex
W2114801561
Cited by
132
References
68
Citations by year
2026: 8 · 2025: 12 · 2024: 13 · 2023: 10 · 2022: 10 · 2021: 12 · 2020: 8 · 2019: 18 · 2018: 12 · 2017: 3 · 2016: 15 · 2015: 9 · 2014: 2
FWCI
1.46
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Medical Informatics Association (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
Keywords
electronic prescribing, barriers and facilitators, primary care, user perception, interoperability, technical support, organizational support, implementation strategies, Donabedian model
MeSH terms
Workforce, Attitude of Health Personnel, Attitude to Computers, Efficiency, Humans, Nurses, Pharmacists, Primary Health Care, Electronic Prescribing, Physicians, Primary Care

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