A survey of e-prescription readiness in selected Nigeria hospitals

by Adebayo Omotosho (Author) Kazir Olanrewaju Ganiu (Author) Tosin Adewunmi Ogunkoyode (Author)

Bachelor Thesis 2013 56 Pages

Computer Science - Internet, New Technologies






List of tablesv

List of figures


1.1 Background of study
1.2 Statement of problem
1.3 Motivation
1.4 Aim
1.5 Objectives
1.6 Methodology
1.7 Significance of study
1.8 Scope

2.1 Introduction
2.2 E-prescribing
2.2.1 E-prescription and paper prescription system
2.2.2 Issues of paper prescription
2.2.3 Types of an e-prescribing system
2.2.4 Standards for e-prescribing systems
2.3 Benefit of e-prescription
2.4 How e-prescribing works
2.5 Limitations to e-prescribing adoption
2.6 Tele-pharmacy
2.7 Review of related work

3.1 Introduction
3.2 Survey development
3.3 Survey implementation
3.4 Data collection instrument
3.5 Matlab overview
3.6 The matlab language
3.7 Data analysis
Research questionnaire

4.1 Introduction
4.2 Frequency distribution table of demographic
4.3 Respondents
4.4 Economic feasibility
4.5 Technical feasibility
4.6 Organizational feasibility

5.1 Conclusion
5.2 Recommendation



TABLE 2.1 Difference between paper prescription and e-prescription

TABLE 4.1 Frequency distribution table of gender

TABLE 4.2 Frequency distribution table of profession

TABLE 4.3 Frequency distribution table of age

TABLE 4.4 Frequency distribution table of year in practice

TABLE 4.5 Test statistic table for economic feasibility

TABLE 4.6 Frequency distribution table of respondent on internet network improvement

TABLE 4.7 Frequency distribution table of respondent on if e-prescription will improve quality of service

TABLE 4.8 Frequency distribution table of respondent on if e-prescription saves time

TABLE 4.9 Frequency distribution table of respondent on if hospital affordability of computers to physicians

TABLE 4.10 Test statistic table of technical feasibility

TABLE 4.11 Frequency distribution table of respondent on internet network qualities

TABLE 4.12 Frequency distribution table of respondent on ability to operate computer

TABLE 4.13 Frequency distribution table of respondent on response to training

TABLE 4.14 Frequency distribution table of respondent on e-prescription ease of use

TABLE 4.15 Frequency distribution table of respondent on ability to use computer

TABLE 4.16 Test statistic table of organizational feasibility

TABLE 4.17 Frequency distribution table of respondent on government response to hospital needs

TABLE 4.18 Frequency distribution table of respondent on how long hospital can manage e-prescription

TABLE 4.19 Frequency distribution table of respondent on hospital readiness to adopt e-prescription

TABLE 4.20 Frequency distribution table of respondent on patient readiness to adopt e-prescription

TABLE 4.21 Average mean score table

TABLE 4.22 Correlation table


FIG 2.1 Stages for creating and managing a prescription electronically

FIG 4.1 Frequency distribution pie chart of profession

FIG 4.2 Frequency distribution pie chart of respondent on internet network improvement

FIG 4.3 Frequency distribution pie chart of respondent on if e-prescription will improve quality of service

FIG 4.4 Frequency distribution pie chart of respondent on if e-prescription saves time

FIG 4.5 Frequency distribution pie chartof respondent on if hospital affordability of computers to physicians

FIG 4.6 Frequency distribution pie chartof respondent on internet network qualities

FIG 4.7 Frequency distribution pie chart of respondent on e-prescription ease of use

FIG 4.8 Frequency distribution pie chart of respondent on government response to hospital needs

FIG 4.9 Frequency distribution pie chart of respondent on how long hospital can manage e-prescription

FIG 4.10 Frequency distribution pie chart of respondent on hospital readiness to adopt e-prescription

FIG 4.11 Frequency distribution pie chart of resp0ndent on patient readiness to adopt e-prescription


We certify that Kazir Olanrewaju Ganiu, Tosin Adewunmi Ogunkoyode, of the Department of Computer Science and Technology, College of Information and Communication Technology, Bells university of Technology, Ota Ogun State, Nigeria carried out this study and to the best of our knowledge this work has been submitted for the award of a bachelor of technology degree in computer science


We dedicate this project to the entire staff of Bells university of Technology.


Firstly, We will want to thank our remarkable parents, Mr. and Mrs. Ganiu, Mr. and Mrs. Ogunkoyode without whom this period would not have been worthwhile.We also appreciate the effort made by our supervisors Prof. D.O Adewunmi and Mr A. Omotosho for taking out time to supervise this project; We also want to thank Mr M.A Adegoke and all staffs of College of Information and Communication Technology, could not have done this work without your help. Thank you.

We appreciate all members of staff of Lagos state university teaching hospital (LASUTH), University of Lagos teaching hospital (LUTH), Federal medical center (FMC Abeokuta) and The Neuropsychiatric hospital, Aro, Abeokuta who took out of their very precious time to answer the project questionnaire.

Lastly, Mr Adelabu Ayinla Ahmmed for taking out his precious time to help me go through this project.


This project is to survey electronic prescription readiness in Nigeria hospitals to know whether they are ready for electronic prescription or not. Electronic prescribing or e-prescribing, is computer-based electronic generation and transmission of a prescription. Prescribing systems helps to increase patient safety and increases prescribing accuracy, the system also helps to reduce costs through improved legibility. The motivation for e-prescribing is greater safety of drug use and the current unacceptable levels of adverse drug events. The aim of this study is to evaluate the readiness of Hospitals in Nigeria to adopt E-Prescription system for patient welfare and improved healthcare service delivery. With this research, problem of writing prescription for patients, which are prone to errors and sometimes result in patient harm, could be rectified if e-prescription is adopted.

A survey was conducted in Nigeria hospitals, which includes Lagos state university teaching hospital (LASUTH), University of Lagos teaching hospital (LUTH), Federal medical center (FMC Abeokuta) and The Neuropsychiatric hospital, Aro, Abeokuta. A well-structured questionnaire was also developed and was given out to doctors, pharmacists, pharmacy technicians and assistants present at the time of survey administration. Analysis of data was surveyed using MATLAB/Spss for analyzing of closed-ended questions; data was analyzed by using descriptive statistics, chi-square test and correlation co-efficient.

From the result of the analysis, it shows that EP system implementation is economically feasible on the side of an individual but on government side adequate funding for the achievement of EP system does not provide for the health sector to acquire the necessary resource and training skill.



1.1 Background of the study

The major challenge of all health systems is to maximize the quality and the quantity of activities related to development or at least stabilization of health status of citizens, this maximization and optimization is often subject to budgetary and other constraints (EU, 2006).

Improvement in information and communication technology, being used in the Healthcare sector, are expected to be the solution for the reduction of rapidly increasing cost and the improvement of poor quality of healthcare services.

Medication prescribing is examined to be one of the most frequently used, powerful, therapeutic tools available to physicians. According to the definition provided by the e Health Initiative (EHI) electronic prescribing refers to “the use of computing devices to enter, modify, review and output or communicate drug prescriptions”. (Perdikouri and Katharaki, 2011). Electronic prescribing has been proposed as an important strategy to reduce medication errors, improve the quality of patient care and create savings in healthcare costs (Tan et al, 2009) Electronic prescribing systems helps to increase patient safety and reduce costs through improved legibility since the misinterpretation of poorly handwritten prescriptions is the most frequently identified causes of medication errors. (Stranges et al, 2008). Despite the advantages of electronic prescribing the survey is to determine whether hospitals, pharmacists and physicians are ready for e-prescription, human factors could play a significant role in the success of the new technology and user satisfaction is one of them, from the view of physicians and pharmacists, changes to workflow, familiarization with the technology, and time commitment may overshadow the potential benefits of electronic prescribing. (Tan et al,2009) Therefore to ensure successful implementation of the system, implementers should frequently monitor areas of satisfaction and dissatisfaction among users, our survey is to determine the rate of how users are ready for e-prescription.

1.2 Statement of problem

Prescription of medications are among the most commonly used treatment in health care, but the process of managing written prescriptions and related telephone messages consumes substantial time for prescribers and their staff. Furthermore, these processes are prone to error and miscommunication, which sometimes result in patient harm. Electronic prescribing has been proposed as an important strategy to reduce medication errors, improve the quality of patient care and create savings in healthcare costs (Tan et al, 2009)

Many barriers have hindered the adoption of EHRs and e-prescribing systems, including the misalignment of financial incentives, the high cost of purchase, implementation and maintenance of systems; the immaturity of software products and vendors; the lack of integration between EHR systems;(Ash and Bates, 2005)and physician resistance.

A survey conducted by the Massachusetts Medical Society in 2003 revealed a large gap between physicians’ perceived value of e prescribing and their intent to adopt this practice.(Ash and Bates, 2005)Their reluctance to embrace the changeover from paper to computerized systems was based, in large part, on the perception that e-prescribing is time-inefficient.

1.3 Motivation

E-prescribing systems have the potential to greatly reduce adverse pharmaceutical effects deriving from transcription, drug-drug interaction, allergies and dosage errors, to name a few. Indeed, studies show significant improvements associated with e-prescribing implementation, including an 86% decrease in serious medication errors and an increase in Medicare formulary adherence from 14% to 88%. (Speaker and Audet ,2006). Despite this evidence, however, providers have been slow to adopt e-prescribing technology due mainly to cost and regulatory constraints in the health industry.

According to the U.S. Department of Health and Human Services (HHS), while most industries spent $8,000 per worker for IT in the last decade, the health care industry invested only $1,000 per worker. (HR Policy Association, 2006). It should be noted that e-Prescription yields a variety of benefits of to patients, physicians and third parties (Petropoulou et al, 2011):

1.4 Aim

The aim of this study is to evaluate the readiness of Hospitals in Nigeria to adopt e-Prescription System for patient welfare and improved healthcare service delivery

1.5 0bjectives

1. Carry out extensive literature review on related works on e-prescription adoption
2. To ascertain the acceptance level of e-prescription systems
3. To make recommendations based on findings

1.6 Methodology

This study was conducted in Nigeria hospitals; a survey questionnaire was developed after reviewing the literature and interviewing doctors and Pharmacists in the respective institutions.

The survey questions addressed demographic information, experience in healthcare, experience with computers, and experience using an electronic prescription system. In addition to collecting information about the respondents, the survey also covers functionality, user training and support, and overall satisfaction.

Part of our preparation used to conduct the survey was a literature review and research. Academic journals, presentations, information materials, slides were also used to prepare for our study. Using these materials, we built a better understanding of the study. Majority of the materials we studied can be categorized in to some of the following: academic publications on assessment of electronic prescription systems, academic publications on satisfaction and adoption rate of electronic prescriptions systems. A cross-sectional survey was conducted at each hospital and a hardcopy self-administered anonymous questionnaire was given out to doctors, nurses, pharmacists and other medical practitioners. The completed form was collected by hand. Analysis of data was done using a computer programme called MATLAB was used. Data was analysed by using descriptive statistics, frequency distribution was drawn and also chi-square hypothesis test of Non-parametric is employed, to test for the significant of the three variables economic feasibility, technical feasibility and organizational feasibility of E-prescription system.

1.7 Significance of study

Problem of writing prescription for patients, which are prone to errors and sometimes result in patient harm, with this research the problem could be rectified if e-prescription is adopted.

This research would also let us know if the physician, patients and pharmacist are ready for the e-prescription or not.

1.8 Scope

The survey was conducted in Nigeria hospitals, which include Lagos state university teaching hospital (LASUTH), University of Lagos teaching hospital (LUTH), Neuropsychiatric hospital, Aro, Abeokuta and Federal Medical Center Abeokuta.



2.1 Introduction

Paper prescriptions have been in use over the past year, written prescription became the sold means of communication between the physician and pharmacist. However they were drawbacks in this system, written prescription situation becomes even more complicated. The vision for electronic prescription systems was born in order to solve this problem and health informatics experts at the time thought that electronic prescription would be adopted in health industry within a few years, few dispute that e-prescription will improve the safety, quality and efficiency of patient care but low adoption rate persist. In this chapter, the review starts by defining e-prescription and describing its functionalities. Then the issues existing in paper prescription system. Next, review of related work from the perspectives of developed and developing countries.

2.2 E-Prescribing

Electronic prescribing has been proposed as an important strategy to reduce medication errors, improve the quality of patient care and create savings in healthcare costs (Woan et al, 2009).Electronic prescription systems allow the prescribing clinician to electronically send an accurate, error-free and understandable prescription directly to the pharmacy. E-Prescribing is the use of healthcare technology to improve prescription accuracy, increase patient safety and reduce costs, as well as enable secure, bi-directional, electronic connectivity between physician practices and pharmacies. This is achieved by providing prescribers a secure means of electronically accessing up-to-date health plan formulary, patient eligibility and medication history at the point of care and securely transmitting the prescription electronically into the pharmacy’s computer system. (Rxhub, 2008).

2.2.1. E-prescription and paper prescription system

With the definition of e-prescription defined earlier, essential differences between e-prescription

system and paper system which is also known as the traditional system, patients visit their health care provider for medical consultation, and after assessment of the medical condition of the patient the doctor writes off a prescription on a paper. The prescription is then signed and given to the patient, then the patient authorized representative presents the prescription to a pharmacy of his/her choice for getting the prescribed medicines while the electronic prescription which is the transmission and processing of medical information contained within medicinal prescriptions through all components of the prescription system, from the initial prescribing of the drugs, through dispensation to the patient, to the eventual close of transaction at some prescription-processing agent.

Table 2.1 Difference between paper prescription and e-prescription

Abbildung in dieser Leseprobe nicht enthalten

2.2.2 Issues of paper prescription

Today most medical prescriptions are typically handwritten or printed on paper and hand-delivered to pharmacists. Paper-based medical prescription has generated and still generating major concerns as the incidences of prescription errors have been increasing and causing problems to patients, including deaths. Though paper prescription system has been in existence for years, it is easily influenced for different types of errors at each step in the process. These errors are the result of difficulties such as

I. Lack of medical information integrity and sharing
II. Drug cross-reactivity and complications
III. Incorrect or inadequate physicians knowledge about the new medications
IV. Slow prescription ordering and dispensing process
V. Security and privacy issues
VI. Lack of standardization of technologies and protocols used
VII. Administrative and organizational issues such as pharmaceutical benefits and billing process.

Fatal health problems can arise due to bad and illegible written prescriptions, errors in dosage and unanticipated drug interactions, communication errors committed during ordering, dispensing and administering of drugs, and dosing mistakes such as incorrect dose of drug and incorrect frequency of drug intake, and lack of reliable health information. Most of these errors of paper prescription system could be reduced by electronic prescription. Though e-prescription is simple and straightforward, it has not yet been widely adopted.

2.2.3 Types of an e-Prescribing system

There are two choices of an e-prescribing system; it is either a stand- alone system, or e-prescribing within an EHR system. There are pros and cons of each option in terms of cost, level of effort and time to select and deploy, impact on practice workflow and productivity initially and over time, and interoperability with other electronic health information systems. A stand-alone system is less costly and less difficult to implement, and thus can be implemented faster than an EHR system. This may be an important consideration for practices that wish to be eligible for Medicare’s e-prescribing bonus that begins on January 1, 2009. E-prescribing systems store and manage patient data specific to the prescribing process (e.g., medication history, medication allergies, etc.). E-prescribing software is offered in two forms: (a) a software package you acquire and download to your office computer system, or more commonly; (b) through the Internet, connecting with an e-prescribing software application service provider (ASP), to whom you pay usage fees.

In terms of e-prescribing hardware, physician practices have many choices including: hand- held devices, tablet personal computers, desktop personal computers, and other hardware made available by technology vendors.

Many believe that a stand-alone e-prescribing system can serve as a pathway to an EHR system, allowing prescribers to become more technologically proficient and comfortable with using electronic systems to support and improve patient care. When implementing a stand-alone system, it is important to plan how you will eventually transition to an EHR system. An EHR system with an integrated e-prescribing module it gives the advantage of having immediate electronic access to all patient data stored in the EHR system, including diagnoses, problem lists, clinical notes, laboratory and radiology results and orders, adding to a clinician’s ability to make the most informed medication choices for their patients. EHR systems may also often offer an extensive range of clinical decision support, including notification of needed screening tests, immunizations, etc.

Physician practices are increasingly using e-prescribing within an EHR system, due to the EHR system’s more comprehensive functionality, which enables greater gains in quality and safety. Currently, more than 50 EHR systems offer integrated e-prescribing. For practices that are committed to full automation and interoperability with other providers and sources of patient information, an EHR system with e-prescribing would be the better choice.

EHR systems are significantly more costly and difficult to implement than stand-alone e-prescribing applications. (e-health initiative, 2008)

2.2.4 Standards for e-prescribing systems

Physicians, pharmacy dispensers, software vendors, insurers, and patients must work together so that an integrated e-prescribing become a reality. To be able to share critical information across various health care settings, systems must be able to interoperate with one another. The inability for multiple systems to share information with a standard format and vocabulary has been a hurdle to effective implementation of e-prescribing (Perdikouri and Kathraki , 2011). The principal standards proposed for use by e- prescribing systems include:

I. Medication History standard: intended to provide a uniform means for prescribers, dispensers, and payers to communicate about the list of drugs that have been dispensed to a patient
II. Formulary and Benefits standard: intended to provide prescribers with information about a patient’s drug coverage at the point of care. (Information may include whether drugs are considered to be "on formulary," alternative medications for those drugs not on formulary, rules for prior authorization and step therapy, and the cost to the patient for one drug option versus another
III. Prescription Fill Status Notification standard : serving the purpose of notifying the prescriber about whether a patient has picked up a prescribed medication at the pharmacy, so that compliance or not compliance of patient could be estimated
IV. Prior Authorization standard :which refers to the process by which insurers require patients to receive approval before certain drugs will be covered
V. Structured and Codified SIG standard: describes patient instructions for taking medications, called the signature, commonly abbreviated SIG. (The fact that for the present, there is no standardized format or vocabulary for SIGs, leaves room for misinterpretation and error, jeopardizing patient safety
VI. Rx Norm standard: is expected to face the problem of the existence of currently multiple databases of drug names, forms, and dosages.

2.3 Benefit of e-prescription

It should be noted that e-prescribing yields a variety of benefits of to patients, physicians and third parties such as (Petropoulou et al, 2005):

I. Patients: convenience (prescriptions and medications ready for pick-up), fewer difficulties over prescription insurance coverage (therapy starts without delay), satisfaction (simplification of procedure, especially of the one related to renewals of prescriptions), safety (legible prescriptions that have been checked for harmful interactions).
II. Pharmacists: fewer mistakes because of misread, more time spent to critical issues concerning drug therapy matters, competitive advantage over pharmacists who do not adopt e-prescribing, simplification of the claiming procedure.
III. Physicians: on line access to patient’s information, better formulary adherence and alignment with guidelines, on line notification of drug interactions and review of the cost of prescription produced.
IV. Health Authorities: less paperwork, less unproductive time spent on bureaucratic procedures, reduced medication cost by supporting the prescribing of generic, information on the prescribing habits of doctors and health status of citizens.

2.4 How e-Prescribing works

Creating and managing prescriptions electronically involves several steps, as illustrated in the process map below.

Abbildung in dieser Leseprobe nicht enthalten

Figure 2.1 Stages for Creating and Managing a Prescription Electronically(e-health initiative, 2008)

A physician signs in by performing some authentication to prove his or her identity.

The physician identifies the patient record within the e-prescribing system.

Typing demographic information to the e-prescribing system can identify patient records.

The physicians also review the medical history, entering and editing a prescription.

The physicians then authorize and sign the prescribed medications, select the pharmacy; print or send the medications prescribed.

Finally the pharmacy review and process the drugs prescribed.

2.5 Limitations to e-Prescribing adoption

E-prescribing can smooth run work processes and make the system run efficiently if the right tools are available in the right setting. Change can be difficult; e-prescribing may enable your practice to more effectively manage medications for your patients. (e-health initiative 2008)

Challenges that have restricted more global adoption are described below.

I. Financial Cost and Return on Investment (ROI): Prescribers, especially those in small practices and in inner city or rural settings, may believe they bear more than their fair share of the cost of e-prescribing, since other stakeholders also benefit from the savings and quality improvements that are achieved, or receive fees from the use of e-prescribing. Physician practices need to invest in hardware and software, and cost estimates vary depending on whether an EHR system is adopted or a stand-alone e-prescribing system is used
II. Change Management: It is important not to undervalue the change management challenges associated with transitioning from paper prescribing to e-prescribing. In a busy practice setting where providers and their staff are accustomed to their current management of patient prescriptions, change management is important. If some of the providers and staff are particularly technology averse, it can be difficult to get everyone onboard with such a dramatic change
III. Workflow: New systems, particularly in the beginning, are likely to add time to tasks like creating new prescriptions or capturing preferred pharmacy information at patient intake, and this can be a barrier. Workflow changes are greater with a full EHR system as compared to stand-alone e-prescribing systems, but either way, practices often experience lost productivity during the transition while they modify the practice workflow and become adept at using the system
IV. Limitations on E-Prescribing System Remote Access: There are often no easy remote access options. In rural areas there may not be many options for consistent remote access services due to cell phone gaps for digital service and limitations of broadband Internet service
V. Patient Acceptance/Usage Issues: Some patients may not feel comfortable with electronic prescriptions and demand their clinician provide a paper prescription. Also, patients who travel frequently, or are otherwise away from home for extended periods may feel more comfortable having a written prescription to take with them
VI. Medication History and Medication Reconciliation: E-prescribing can help provide information to prescribers at the point of care on what medications their patients are taking, and have taken in the past. However, it is difficult to place absolute confidence in the completeness and currency of this information, since medication histories must be reconciled from multiple sources. Prescribers should always consult with their patients about what medications they are taking to validate the medication history information that is available through e-prescribing and update the records accordingly
VII. Hardware and Software Selection: Choosing the right software and hardware and supporting it after installation can be a daunting task for some physician practices, especially small practices that are extremely busy, experiencing declining reimbursements, and lack expert information technology staff. Some struggle with how to get started, vendor selection, negotiation, implementation and long term support.

2.6 Tele-pharmacy

It is the innovative approaches in providing pharmacy services during a time of pharmacist shortage or 24 hours base time. Tele-pharmacy involves integrating telecommunications, information system pharmacy software, and remote controlled dispensing technology to support a pharmacy model in which a central pharmacy is electronically linked to single or multiple physician offices, local and remote clinics, emergency rooms, health and surgical centers, long term care facilities, correctional and rehabilitative facilities or other difficult to serve points of outpatient health care.

Tele-pharmacy means electronic transmission of a prescription order from the remote location to the central pharmacy. There, the order is reviewed and verified by the pharmacist who then authorizes and oversees automated dispensing of the needed medication from the pre-filled drug cabinet at a distance. If necessary, web camera or real time videoconference can enable face-to-face consultation between the pharmacist, the physician and the patient. Tele-pharmacy offers numerous advantages for the patient, including increased convenience, reduced waiting time, and increased access to medications and experts in locations where a full-time pharmacist may not be available. The development of a Tele-pharmacy-enabled model of pharmacy practices is imperative for the pharmacists. (Petropoulou et al, 2005).

2.7 Review of related work

Tan et al, 2009, investigated the satisfaction level of prescription systems implemented in Singapore by surveying about 9 national health care groups. The overall level of satisfaction with electronic prescribing was high. Doctors and pharmacists reported a high degree of agreement that electronic prescribing reduces prescribing errors and interventions, and they did not want to go back to the paper-based system. Only 56.9% of the pharmacy respondents expressed satisfaction with the review function of the electronic prescription system and only 51.8% and 60% were satisfied when processing prescriptions that included items to be purchased from an external pharmacy or prescriptions with amendments. The results also revealed that satisfaction with the system was more associated with users’ perceptions about the electronic prescription system’s impact on productivity than quality of care.

In Perdikouri and Katharaki, (2011) the authors reviewed what should be considered when implementing and evaluating an e-prescribing system and they used Greece as case study, and secondly to combine the relevant findings with the current situation in Greece in order to the key factors that will determine the acceptance and the success of such an attempt The analysis reveals that standards, appropriate coding and interoperability are of great interest and can assure the long-term viability of e- prescribing systems, while the participation of all stakeholders (clinicians, patients, healthcare providers and healthcare organizations) is considered to be indispensable for the success of both implementation and function of these systems. However the general principles should be modified in order to fit the special socioeconomic needs that e prescribing is expected to fulfill.

In Went et al (2008) the authors investigated if an electronic prescribing system designed specifically to reduce errors would lead to fewer errors in prescribing medicines in a secondary care setting. The electronic system was compared with paper prescription charts on 16 intensive care patients to assess any change in the number of prescribing errors. The overall level of compliance with nationally accepted standards was significantly higher with the electronic system (91.67%) compared to the paper system (46.73%). Electronically generated prescriptions were found to contain significantly fewer deviations (28 in 329 prescriptions, 8.5%) than the written prescriptions (208 in 408 prescriptions, 51%).

The results conclude that the reduction in prescribing errors with the electronic system is significant. This study confirms the importance of involving clinicians in the design and development of an electronic system to produce a solution that is not only accepted and easily adopted by users but which also reduces the numbers of errors made.

In Ardava et al (2010) the authors performed a research to clarify the attitude of individual pharmacies towards electronic Prescription and necessary amount of investment for introduction and maintenance for this innovation using Latvian pharmacies as case study. The research is based on the attitude of the owners of the pharmacies towards introduction of electronic prescription that is to be sized up through providing a questioning to them. The finds produced research has been displayed that the owners of the pharmacies have been currently showing a vague notion about efficiency of the introduction of the electronic prescription. Problems would be risen if individual pharmacies will have to be financing the introduction of pharmacies information systems by themselves. After study of the problem, there would be several solutions: joint venture of pharmacies, government support, attraction of EU structural funds etc.

In Bell et all (2004) the authors aimed to develop a conceptual work for predict the effects of another designs for outpatient e-prescribing systems. Based on literature review and on telephone interviews with e-prescribing vendors, the authors identified well defined e-prescribing functional capabilities and developed a conceptual framework for evaluating e-prescribing systems’ potential effects based on their potentials. The proposed framework for evaluating e-prescribing systems is organized using a process model of medication management. Evidence was identified to support specific effects for the functional potentials. The evidence also shows that a functional capability with generally positive effects which also could be applied in a way that creates unintended hazards. It was concluded that the proposed conceptual framework supports the integration of available evidence in considering the full range of effects from e-prescribing design alternatives. More research is needed into the effects of specific e-prescribing functional alternatives. Until more is known, e-prescribing initiatives should include provisions to monitor for unintended hazards.

In Tamblyn et al (2006) the authors developed and evaluated the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians. MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases. Physician speed in using MOXXI has done well substantially in the first three months; however, Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient’s drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the re-prescribing function as one of the most beneficial aspects of the system. they ended up concluding that the Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care.

Shams, (2011), also presented a survey result of overall satisfaction which integrated e-prescription was high. Physicians, pharmacy staff and nurses highly agreed that the EPS reduced prescribing errors and they did not want to go back to the paper based prescription system. Pharmacy staff and nurses viewed the EPS more positively and were more satisfied with it than were physicians. It was also found that 74% of patients who responded to the survey were either satisfied or very satisfied with the EPS and preferred it over paper-based prescriptions. In conclusion, the majority of stakeholders were generally satisfied with the current status of the EPS, but they also perceived a few key weaknesses. A total of 12 recommendations were offered to improve the e-prescription in clinical settings in the Sultanate of Oman.

2.8 Concluding remarks

After an extensive review of different development and evaluation of e-prescription , it confirm the importance of e-prescription but however publications studied also refused to thoroughly note some of the challenges the electronic prescription faced before adoption, and also government impact on electronic prescription systems.



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Title: A survey of e-prescription readiness in selected Nigeria hospitals