Collaboration Routines and Workflows in a National Electronic Prescription System: Qualitative Study

Abstract

Background: Electronic prescription (EP) systems are supported by health authorities worldwide, and most European countries have started implementing or have fully implemented such systems. However, few studies have explored how EP systems affect the work of health care professionals (HCPs) across institutions and levels in health and care services.

Objective: This study aims to explore changes in HCPs' roles, tasks, and responsibilities related to medication management by following a national EP system through different contexts and levels in health and care services.

Methods: Through a qualitative study with an ethnographic approach, including participant observations and individual interviews, this study followed an EP technology in an intermediate unit, an emergency unit at a hospital, and a municipal home care service in Norway. Participant observations were conducted for 6 weeks in the intermediate unit, the emergency unit at the hospital, and the home care service. During the observations, 20 individual interviews with HCPs were conducted. For the analysis, we leaned on a stepwise-deductive inductive approach, using the concepts of delegation and enabler as theoretical tools to explore how roles, tasks, and responsibilities were being distributed within the sociotechnical system of which EP formed part.

Results: The results showed that physicians were overall satisfied with the Norwegian EP system and expressed satisfaction that some of their previous tasks were now delegated to the EP system, allowing a more efficient workflow on their side. In contrast, the home care service managing medication on their patients' behalf described several challenges and reported an increased workload related to medication management. Home care nurses often became mediators between the general practitioners and the pharmacies to ensure patient safety. The home care nurses also developed EP-based work-arounds to enable the Norwegian EP system to work.

Conclusions: This study revealed that Norwegian the EP systems altered daily medication management routines, removing tasks from physicians and creating and delegating new roles, tasks, and responsibilities to home care nurses. Drawing on theoretical concepts (delegation and enabler), this study offers insights into the changing distribution of roles, tasks, and responsibilities following in the wake of implementing national EP systems.

Keywords: delegation; e-prescription; enabler; ethnographic study; health professionals; mediator; sociotechnical system; workarounds.

Figure 1

The workflow in the Norwegian electronic prescription (EP) system. EHR: electronic health record.

Figure 2

A flowchart of the medication management in the home care service (HCS) showing how the electronic prescription (EP) system delegates tasks, roles, and responsibilities to the home care nurses and how the home care nurses enable the technology.